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My Best Friend Siri

October 21, 2014

SiriOccasionally we come across articles that contain useful information, or are news stories related to our industry or the more general world of health care and insurance and its ever-changing complexities. And there are those articles we want to share with our readers for the simple reason that we are human. We came across one of these recently, “To Siri With Love,” in The New York Times. We hope that people read this because it is beautiful and moving, and always worthwhile to remember that life is experienced by people in a myriad of ways.

The mother of a 13-year-old autistic boy discusses her son’s interaction with Siri. As she notes:

This is a love letter to a machine. It’s not quite the love Joaquin Phoenix felt in Her, last year’s Spike Jonze film about a lonely man’s romantic relationship with his intelligent operating system (played by the voice of Scarlett Johansson). But it’s close. In a world where the commonly held wisdom is that technology isolates us, it’s worth considering another side of the story.

Read more…

With a Choice, Parents Opt for Cheaper Surgery

October 9, 2014

child in hospitalA study offers a compelling case for price transparency in helping reel in the nation’s health costs. As this New York Times article notes, a recent study looked at parental choices when faced with selecting between two different methods of routine, uncomplicated appendectomies for their children.

In the study two groups of parents were shown informational videos on the two different appendectomy procedures - open surgery or using a laparoscope. Laparoscopic surgery is the less invasive of the two, and was priced at $2,000 more. The videos were identical except that one included the price of the two procedures; the other did not.

Interestingly, by nearly a 2/3 margin the parents chose the less expensive though more invasive option. 90% of parents commented that they appreciated having the choice, suggesting that people given price information are more likely to choose the cheaper option.

The surgeon who conducted the study said the information from the hospital could be surprisingly hard for even surgeons to obtain because hospitals consider their price lists proprietary. Where else is the consumer not allowed to know the price, either with or without such choices to make?

He added, “Medicine is often regarded as this magical part of our economy where patients can’t make any choices.” But they can, and that can help hold down costs, he said, noting, “With a bit of information, I can choose my cellphone even though I don’t understand how it works.”


When Is Spoken Conversation not a Matter of Free Speech?

September 30, 2014

When it is “medical treatment,” apparently. According to a 2-1 decision this past summer by the United States Court of Appeals for the 11th Circuit. Specifically, everything a doctor says to a patient is “treatment,” not speech, and the government has broad authority to prohibit doctors from asking questions on particular topics.

As background, in 2011 the Florida Firearm Owners Privacy Act was passed, which threatens doctors with professional discipline if they ask patients whether they own guns or record the resulting information in a patient’s files when doing so is not “relevant” to a patient’s medical care. “Relevant” is not defined, and no provisions for establishing relevancy are outlined. The constitutionality of this Act was questioned and ultimately upheld by this summer’s Wollschlaeger v. Governor of Florida ruling.

Is the 2011 law necessary in any way? Opponents of Florida’s law, including the Brady Campaign to Prevent Gun Violence, believe the opposite, that asking patients about gun ownership is a legitimate means of promoting public health by giving doctors the opportunity to share firearms-safety tips. As this Times editorial notes, “the First Amendment generally doesn’t let the government outlaw the asking of annoying questions. Instead, people can refuse to answer or decline to associate with those who insist on asking such questions” and asks us to:

Imagine if tobacco companies successfully lobbied for a law that prohibited doctors from asking patients whether they smoke. Some doctors may want to know so they can conduct lung examinations, while others may just want to urge their patients to stop. But everyone should recognize that a law outlawing a simple question infringes on speech.


A Surprise $117,000 Medical Bill

September 22, 2014

hidden feesI dropped my jaw as I read this article in the Sunday New York Times, front page. On the one hand, it is above outrageous. On the other hand, this is not news. It is normal life in American health care. I did wonder if the $116,862 that Anthem Blue Cross Blue Shield paid to Dr. Mu had an extra digit added by accident. But I know that the New York Times would have corrected such an error. Even at $11,000 the amount would have been excessive.

There is so much to relish in terms of excesses in this article. Excesses in fees, excesses in treatment (note Dr. Deyo’s comments on the high rate of spinal surgery in the US compared to elsewhere), and excesses in bizarre and improper behavior by an insurance company (who paid this sort of bill and uses its “high costs” as a justification for future rate increases).

If this article does not suggest that the current system is more than broken, what is?

Medicare Spending Decreases

September 18, 2014

medicareMCNTalk regularly addresses inequities and the strange world of medical pricing. To our surprise, this article would suggest that health care inflation with regards to Medicare is waning. And the numbers are considerable, with a reduction of about 11% per beneficiary since 2010. Those of us who pay into the private system have seen anything but a decrease in 4 years. This is a 95 BILLION dollar difference!

It would appear that a good portion of the decrease is behaviorally based, where consumption of costly items have declined in favor of less costly, lower utilization and other measures.

As always, the comments by readers are illuminating. Among the most amusing are those who decry Medicare and claim that surgeons under Medicare are paid “poverty wages.” Clearly the writer has never experienced poverty.

MCNTalk remains baffled by the inability for US citizens to focus on the facts that drive our system and the associated costs. As Daniel Patrick Moynihan said, “You are entitled to your opinion. But you are not entitled to your own facts.” A confusion between opinions and facts seems to drive the healthcare and cost debate.

There is nothing magic about the age of 65 or so as a trigger for Medicare. Fee schedules exist for all services and in fact many younger people with disabilities are covered by Medicare. Perhaps one day employers will be able to focus on their business and not selecting insurance for their staff, and relinquish health care to the public, like they do education and other universal goods.

The other side of the coin includes the challenge of containing costs when the consumer has no skin in the game, which insurance, whether private or public, does nothing to address.

We will continue to post on this topic.

Deaf to Moore’s Law: The $6800 Hearing Aid Set, or the $475 One?

September 12, 2014

hearing aidThis Forbes article describes the applicability of Moore’s Law to health innovation and pricing. The author needed a hearing aid. He cited a teacher who had paid $6,800.00 for a pair of hearing aids. The writer had his own hearing loss and with some shopping, found an innovative source that sold him a hearing aid online for 7% the cost — $474.50 — delivered in 2 days via FedEx.

To be fair, the author notes that he does not know how his condition compared to that of the teacher.

We have seen similar disruptive changes in eyewear with Warby Parker and others selling prescription glasses for $100.00 or so, less than the cost of lenses alone in most outlets.

Must a set of hearing aids really cost thousands of dollars? Setting aside our lack of full information, we do know that they are a solid state electronic device, sold by the thousands and mass produced at some level. They would appear to filter and amplify sound, and be quite small.

Should a set of glasses cost hundreds of dollars? One has a piece of colored plastic in the form of a frame, and a piece of plastic bent to refract light. Both made by machines in bulk. There is a fashion aspect of the frames that to many buyers matters a great deal. Eyeglasses, unlike hearing aids, are worn by many billions of users world-wide, a number of whom own multiple pairs.

Compare a hearing aid to a smart phone. A top of the line Iphone without a carrier subsidy can be bought for $750.00. This device, like similar Android phones, is remarkable. Unlike the $5,000+ hearing aid, it is a full-fledged computer that computes, locates, calls, transmits, schedules, messages, photographs, shops, informs, and performs hundreds of other functions depending upon apps installed. One might reasonably assume that these devices are far more complex than a top of the line hearing aid. The price difference likely has more to do with scale, competition, buyer motivation, and other market factors.

Those who shop for eyeglasses and hearing aids are often paying out-of-pocket, and have a motivation to shop. Those selling such devices have a motivation to attract buyers with innovative delivery and pricing models. Can and should similar innovation be applied to high priced pharmaceuticals, medical devices, and medical procedures?

A Doctor’s Malaise, and a Profession’s

September 9, 2014

Brian L. Grant MD

doctoredReading the NY Times Review of this book leaves one with their own sense of malaise, whether they are a doctor or a patient. The anecdotes shared reflect the reality for many physicians and health care workers. This writer recalls a number of years ago, refusing to sign off on routine admit orders for a patient who had no need for $5.00 multivitamin tablets that could be purchased at a drug store for a hundredth the cost (not that they were needed at all from a clinical or nutritional standpoint), I was called in to “meet” with the hospital administrator, a non-clinician, who was clearly irritated with my decision, and the general comment that I was going to do what was clinically appropriate and was not concerned with his cost and profit issues. Thankfully I was not an employee of the hospital, or that may have been my last day.

It is hard to feel sorry for colleagues on an economic basis, as physicians are hardly on the bottom rungs of the US economic ladder. But one is more likely to enjoy a waterfront home as an MBA or entrepreneur than an employed physician. The lack of autonomy driven by a seizing of power by payers, drug companies, and non-medical managers is perhaps what drives physician malaise. Medicine is not your father’s profession any longer. Not only is your doctor more likely than ever to be a mother now, but the economic realities of health care have substantially changed. The smartest people in the health care room are as likely to be the investors and non-medical managers who ably control distribution and access. And as has been discussed before in these pages, the lack of market dynamics in a system where the ultimate consumer – the patient — is generally buying without paying, abets a system where abuses like unneeded treatments, consultations, and tests can take place.

Today the new IPhone comes out to great fanfare. It will be expensive relative to most phones. Some will decide they must have it, but many will stick with what they currently have in their pockets – whether a current IPhone or another brand. If phones were paid for by “phone insurance,” many would decide that this latest version is the only acceptable option and that it is unjust and unfair for their carrier to deny them this phone. And of course Apple would determine that their phone will be priced at a much higher rate reflecting the perceived necessity of it and lack of market constraint and competitive drivers like we see in many a medical device, drug, procedure or study.

The saddest part is that while nobody has ever died or been hurt from too nice a piece of consumer electronics (unless they were mugged to get at it), many a patient has been harmed from unneeded care and medical intervention. And society is harmed from way too much money being spent in the health care sector, driven as much by overconsumption as by high prices.

Thoughtful physicians and health practitioners are saddened and disheartened when they conclude that much of what they do lacks value relative to the cost and actual impact. They realize that they are part of a system driven by excesses and motivated by behaviors on the part of colleagues, hospitals and companies that are less than admirable in many cases; and driven on self-interest rather than the physical and economic well-being of patients and society. The ideals that still drive many to enter health care are challenged regularly, leading to a disconnect between one’s self-identity and reality. This can give way to depression, cynicism, or concession. On the other hand there still remain many in medicine who have found ways to do what they love, while serving others with integrity and pride.


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