The Health Shopper

A number of health insurers have begun offering credit cards to be used specifically for health related costs. According to the Fort Worth Star-Telegram, insurers including Humana, UnitedHealthCare and Aetna are offering the cards to consumers with high-deductible plans as a way to speed doctor's office payments and streamline administrative paper work and costs. The good news for consumers? Many of these cards have interest free grace periods of several months, allowing consumers to pay off medical bills over several months. However, after a few months, interest rates on the cards can climb to above twenty percent.

Insurers are seeking to expand these sorts of offerings as the number of people in consumer driven plans grows. A new study by the International Foundation of Employee Benefits Plans found that more than 40 percent of private employers are offering consumer driven plans to employees, including 22 percent who offer HSA-qualified high deductible plans.

HHS Secretary Michael Leavitt is the latest health expert to look to Holland for the solution to breaking the employer-based health insurance system while eliminating the ranks of uninsured. Leavitt will be visiting both the Netherlands and Switzerland, which require citizens to buy insurance or face financial penalties, and use subsidies to make costs manageable for lower income individuals.

Leavitt said that the Bush administration is not looking at proposing sweeping changes to the health care system at the moment. However, Senators Ron Wyden and Robert Barnett, a Democrat and a Republican, have introduceda bill to create individual mandates in the Senate. Similarly, Democratic Presidential candidates John Edwards and Hilary Clinton have both suggested reforms that largely mirror the Dutch model.

U.S. News and World Report has partnered with the non-profit National Committee on Quality Insurance to release national rankings of health insurance plans. The two organizations collected information from a variety of sources and ranked plans on consumer assessment, preventive care, and treatment and rated commercial plans as well as Medicare and Medicaid plans.

The rankings do not include any cost information or ratings. The U.S. News article that accompanies the rankings also focuses on workplace wellness and employer-based insurance and sets aside the individual market entirely. Despite those limits, these rankings offer fairly thorough information on care access and quality.

Doctors Tom Delbanco and Sigall K. Bell, who have produced a documentary film on medical errors, write this week in the New England Journal of Medicine that patients and family members often feel as much guilt over medical errors as their doctors. Patients and their families also feel shut out by physicians and nurses who limit communication as much as possible after medical errors and fear that doctors might provide poor treatment in response to too much questioning. These communication problems further weaken treatment and create additional mistrust.

Delbanco and Bell suggest that "Honest and direct communication may be the best antidote" to dealing with medical errors, a piece of advice Washington Hospitals would do well to heed. Although the Washington State Hospital Association has reluctantly agreed to let the state release information about which hospitals commit the most errors, it spent much of the week fighting against releasing the data that the public should have the right to and that patients need. As one victim of medical error told Delbanco and Bell, "If the doctors aren't telling me the truth about this… what else aren't they telling me the truth about?"

The Department of Health and Human Services filed an appeal last week against a summer court decision that would require the department to release reams of physician data generated from Medicare payments. Although current HHS officials have expressed support for increased transparency, an HHS spokesperson said that the department is appealing the decision because two courts have offered two different rulings on the matter. He suggests that HHS needs to appeal to clarify what can and cannot be released.

The suit was initially brought by Consumers' Checkbook, who plans to post the Medicare data on their site for public use. The Organization's President, Robert Krughoff, has vowed that the organization will continue "fighting [for] the release of information that would be of such clear value to consumers."

Overtreated author Shannon Brownlee writes in the Washington Post that "a small but growing number of doctors" are gravitating toward shared decision-making for medical decisions. Simply put, shared decision-making means that doctors take the time to discuss treatment options with patients and give patients clear information about how likely a treatment is to work and how often it causes complications. The patient then works with the doctor to decide the best course of action.

Brownlee offers the following example:

Today, debate over the PSA test rages on, and neither doctors nor patients know what the right course of action is. For some men, the fear of cancer might outweigh any concerns about side effects from the treatment that might follow a troubling test result. But for others, a cancer that often grows very slowly might seem less of a worry than being incapacitated by a prostatectomy.
That's why Fairfax physician Krist tries to help his patients reach their decisions. In the decade that William Forrester has been a patient of his, they have discussed the PSA test annually. Most years, Forrester, a retired journalist, declined the test. No matter which way he chose, he says, Krist helped him feel comfortable with his choice.

What's mind-boggling is that Brownlee describes information sharing as a new trend and one that many doctors and hospitals are reluctant to accept. Shouldn't the patient, and not the doctor, get to decide if he is more willing to face the risks of cancer or the risks of prostate surgery?

A West Virginia primary care facility is experimenting with charging monthly retainers in exchange for unlimited primary and urgent care, according to the Wall Street Journal. The clinic's director, Dr. Vic Wood, initially tried to offer services for a monthly retainer in 2003 but was nearly shut down by the State Insurance Commission. After spending $300,000 of his own money and catching the attention of the Governor, Wood's clinic is one of eight clinics in a pilot program to see if a flat-fee model can reduce costs and improve primary care.

Critics of this pricing model argue that at $83 a month for an individual or $125 for a family, Wood is charging too much for just primary care services. He argues, however, that coupled with an HSA and high deductible plan, his patients can get more personalized service at cheaper prices, and still be protected against hospital costs.

If you are paying for your own health care, either through an HSA or out of your own pocket, you'd be wise to check out the November issue of Consumer Reports, which identifies the Top 10 most overused medical tests and treatments.

Most doctors and hospitals are paid on a "piecework basis," which means the more tests and surgeries they perform, the more revenue they generate. This might be fine with you — if all your bills are being paid by your insurance company. But more and more Americans are becoming responsible for their own medical bills.

The Top 10 Most Overused Medical Tests and Treatments, according to Consumer Reports, are:

1. Back surgeries. "Don't rush to surgery for a simple slipped disc. In 90 percent of cases, the pain goes away on its own within six weeks."

2. Heartburn surgeries. A nearly $15,000 surgery offers as much relief as a proton-pump-inhibitor which only costs $1 a day.

3. Prostate Treatments. "Prostate cancer is often overtreated by surgery that costs $17,000, or by radiation therapy for $20,700 or more, plus physician's fees, without adequate discussion of the alternatives …"

4. Implanted Defibrillators. "[O]ne-third of people who get them might not really need them, according to research reported in 2007."

5. Coronary Stents. For patients with stable coronary artery disease, this procedure along with heart drugs works no better at preventing future heart attacks than drugs alone.

6. Cesarean Sections. Used for a record high of 30.2% of births in 2005.

7. Whole-Body Screens. "There are no proven benefits for healthy people, the Food and Drug Administration has concluded."

8. High-Tech Angiography. It can be a waste because "standard angiography is sometimes still needed to confirm blockages that might require aggressive treatment."

9. High-Tech Mammography. "[A] 2007 study found that this technique failed to improve the cancer-detection rate significantly, yet resulted in more needless biopsies."

10. Virtual Colonoscopy. The procedure isn't cost-effective because suspicious findings require the real thing.

A recent Booz Allen Hamilton report finds that approximately 26 million privately insured Americans are enrolled high deductible health plans, a near seven-fold increase since 2000. Because of the continuing rise in health costs along with increased efforts to cover the uninsured, the firm predicts that as many as sixty percent of privately insured Americans might have high deductible insurance by 2020.

Although many individuals in high-deductible plans augment their coverage through health savings accounts, more than half of people insured in high deductible plans are not eligible for HSAs but are still responsible for an increasing share of costs. Gary Ahlquist, a Booz Allen senior vice president, commented that "Giving consumers more cost responsibility in a broken wholesale healthcare market will not work… The supply side of healthcare needs to be restructured such that patients can shop by comparing value. Consumers will also need real options for healthcare delivery and incentives to adopt healthy behaviors, along with new insurance and financial services products to help finance their care."

Consumers looking for convenient access to care are finding they can get an increasing array of treatments at local pharmacies. A National Public Radio story reports that a rapidly growing number of pharmacists are administering flu shots and vaccines. This is good news for consumers, who are finding that many doctors no longer provide vaccines due to storage costs and low reimbursements, and helps pharmacies increase foot traffic.

The shift is part of a larger trend in which pharmacists are taking a more active role in patient care by monitoring patient medications to prevent negative drug interactions and, in some instances, making house calls. For example, one pharmacist cited by USA Today manages diabetes patients. He went to a sick patient's house to find that the reason the patient's diabetes was not under control was that he did not have a working refrigerator to store his insulin. This prompted the pharmacist to adjust how often his patient would come in for insulin.