The Health Shopper

U.S. News and World Report mentions Vimo in this article on how to keep medical costs low. And judging by recent media coverage of health care pricing, consumers need all the help they can get.   

This Wall Street Journal story focuses on a man who, through a series of unfortunate events, wound up hospitalized for a staph infection that spread throughout his body. He wound up with more than $1 million in debt, in part, because his hospital demanded a $791 payment for a $12 pair of stockings that could improve circulation. This was hard information to come by, since the hospital charged the patient and his wife $1,030 to get an itemized copy of his bill.

The New York Times has a devastating story about the difficulties of keeping Medicare costs low. The story focuses on delivering oxygen to patients, a necessary service, but one for which, "The total cost to taxpayers and patients is… more than double what somebody might spend at a drugstore." Although Medicare administrators are well aware of the problem, any time they attempt to lower payments for oxygen tanks, oxygen companies rally senior citizens to flood congressional offices with calls.

Wall Street Journal columnist Dr. Benjamin Brewer offers a fascinating glimpse into patient efforts to squeeze in extra doctor visits before deductibles reset or insurance changes. A woman in her early twenties, for example, tries and fails to schedule a necessary surgery for December while a Medicare patient puts off a prescription she can't afford and winds up in the emergency room-at taxpayer expense.

Brewer's point is that a lot of bureaucratic regulations have nothing to do with providing good care and instead drive people to "play shell games" and "play beat the clock" to manage their care.

Hospitals in Minnesota and Massachusetts have voluntarily agreed to stop charging patients for the costs of major medical mistakes like leaving a surgical instrument inside a patient or performing the wrong procedure. The decision follows a Medicare rule that will be implemented in 2008 that will eliminate payments to hospitals for a broader number of mistakes like letting patients get infected through prolonged catheter use.

Although these sorts of mistakes are exceptionally rare, it's hard to imagine how a hospital could justify charging a patient after "mist[aking] her kidney for her gall bladder."  

Suddenly, direct to consumer DNA testing has become all the rage. As we have noted a number of new companies are rolling out technologies to let consumers learn about their own genetic constitutions and disease risks.

In Saturday's New York Times, Amy Harmon describes her own experience getting tested. Not only did Harmon learn about her risks for common diseases-an increased risk of heart disease moved her to go to the gym-but she also found out that she was genetically predisposed to dislike Brussels sprouts because of a genetic variation that lets her taste a bitter property in the vegetable. In other words, testing has become pretty sophisticated.

But there are a lot of reasons people might hesitate before testing. At a practical level, there are no legal protections to keep testing companies from selling genetic information to insurers or employers, which would prevent them from being able to purchase insurance.

Harmon also observes that while she wanted to learn about her own DNA, she didn't want to find out anything about her three year old daughter's background because she "didn't want to regard anything about her as predestined." Also, as she says, "Once I looked at my results, I could never turn back."

California has fined Health Net $1 million for misleading investigators regarding the company's policy of tying bonuses to decisions to deny claims or cancel policies. The fine is independent of an ongoing investigation into Health Net, which, according to the state, illegally set annual cancellation targets that formed the basis of employee evaluations. The investigation stems from a lawsuit brought by a Southern California woman who had her policy retroactively cancelled after she was diagnosed with breast cancer.

Linking performance to policy cancellations is illegal for good reason: That sort of policy encourages insurers to deny rightful claims when medical bills get costly. Patsy Bates, who is now suing Health Net, was in the hospital getting ready for lump removal surgery when a hospital official told her that the surgery would not proceed due to insurance problems. Although she managed to get the surgery, she wound up $200,000 in debt, because, as she put it, "I've got cancer" and Health Net "walked away from the agreement."

California is investigating the cancellation policies of several other insurers. Health Net has since said it will discontinue linking policy cancellations to performance reviews.

A number of Hospitals, including the Mayo Clinic, have begun opening convenient care clinics near hospital locations, a response to the rapid growth of convenient care clinics in the past five years. According to the Minneapolis Star Tribune, hospitals are opening convenient care clinics to meet consumer demand. "The explosion in retail care has shocked traditional providers out of complacency, forcing many hospitals, clinics and pediatric practices to start offering same-day appointments, extended urgent care hours and even patient care on weekends."

Mayo has been operating a single clinic for approximately a year, and will be opening a second one early next year, in what hospital executives expect will be part of a larger expansion. In addition to offering traditional retail clinic treatment, Mayo clinics also have access to patient records from the hospital system, which hospital officials hope will make convenient care an integrated part of health delivery.

High-deductible health plans with HSAs offer the best values to individuals and families, according to a recent report by the Consumers' Checkbook that focused on health options for federal employees. Walton Francis, an analyst for the organization, told the Washington Post that HDHPs "are among the biggest bargains," noting that while "they are a bit complicated to understand" they offer much better values for the average consumer.

Although the Consumers' Checkbook study focused on federal employee health options, this commentary argues that an HDHP is a smart option for anyone. Writing about efforts to shift Milwaukee area residents to HDHPs, state representative Bob Ziegelbauer notes that HDHPs provide better coverage at lower costs and encourage preventive care. "The power of the plan is in empowering the insured. It is the power of individuals making decisions affecting their own lives with their own money."

New Hampshire Senator Judd Gregg has sent a letter to Health and Human Services arguing that the agency should release Medicare claims data to the public. Writing in response to a recent Health and Human Services decision to refuse to release Medicare claims data to the public, Gregg argues that "In order for America's health care system to improve, we need to understand the quality of the care we are purchasing."   

Worried that unabated health spending growth could severely damage the economy, Dr. Peter Orszag of the Congressional Budget Office suggests that reforms to American health care need to center around delivering treatment that is not simply effective but cost effective. For example, Orszag argues that instead of providing greater reimbursements for more expensive treatments, insurers should instead reimburse the most cost effective treatments at the greatest rates, leaving consumers who seek more expensive, less effective treatment to foot a larger percentage of the costs.

Orszag's commentary is one of several recent pieces in leading medical journals advocating a greater focus on cost effective treatments. Cost concerns are not just gaining traction among the ranks of health experts but among average people. As Niko Karvounis notes, "Back in 1999, Americans thought AIDS and cancer were bigger concerns, but today it's the cost of health care that keeps Americans up at night. The average American is just as worried about cost as is the policy wonk, making now the perfect time to institutionalize a role for the public in cost management."

The National Committee for Quality Assurance, with support from a number of large insurers and professional physician associations, is proposing to increase reimbursements to primary care doctors in order to allow them to spend more time talking to and treating individual patients. The NCQA suggests paying physicians or nursing coordinators for making phone calls or sending follow up emails to patients. Payments for routine physicals would also increase, encouraging family doctors to spend more time with patients.

Whether or not the NCQA's reforms gain any traction, the organization is attempting to replicate primary care innovations driven by enterprising doctors who have responded to patient concerns for better, more personalized primary care. This clinic in San Francisco, California, for example, charges an annual fee that helps cover the costs of out-of-office communications, and allows the clinic to provide same day appointments, longer primary care visits, and other forms of enhanced care.  Other doctors have succeeded with using monthly fees for unlimited primary care.