Current Feed Content from 28 Sep 08 08:24
Cost Plus Medical Billing Preys on the Uninsured
Mon, 08 Sep 2008 14:32:06 -0800I'm in the health insurance business, but I was recently blown away by the absurdity of the medical billing system. I have lower back pain from a condition called spondylolisthesis. That's basically a slippage of one of the vertebra in my lower back that pinches the nerves and causes sciatic pain. When the pain gets bad, I get an epidural injection that takes away my pain for a couple of months at a time. The outpatient surgical center billed $4, 136 for the epidural procedure. My insurance company allowed only $1, 039 of which I paid $208 for my coinsurance – just 5% of the amount originally billed. Why are medical bills so outrageously overpriced? Who pays the full “retail” bill? Not the insured. It's the uninsured who are stuck with these inflated medical bills. As individuals, they have very little negotiating power to reduce the initial bill to a reasonable fee and are left with no choice but to pay the inflated fee which can wipe them out financially. Medical administrators call this system "cost plus" billing. The cost plus bill includes the cost of the service plus a share of the provider's overhead expenses, including the unpaid bills of the uninsured. And so it goes in an ever escalating spiral of unrealistic medical costs.Declining Mental Skills as Markers of Death in Old Age
Fri, 29 Aug 2008 12:02:36 -0800My mother is 89 years old and suffers from advanced dementia so I'm perhaps more interested than most of you in new information about the aging brain. Having said that, I find fascinating the results of a recently published study published in the August 27, 2008, online issue of Neurology® - the medical journal of the American Academy of Neurology. The study documents 30 years of testing of people's mental skills from age 70 to death. The study involved 288 people with no dementia who were followed from age 70 to death, with an average age at death of 84. The participants' mental skills were measured up to 12 times over a period of 30 years, and they were evaluated to make sure they had not developed dementia. "These changes are different and separate from the changes in thinking skills that occur as people get older, " said study author Valgeir Thorvaldsson, MSc, of Goteberg University in Sweden. "We found accelerated changes in people's mental skills that indicated a terminal decline phase years before death." For instance, perceptual speed - measured by how quickly one can compare figures - begins declining 15 years before death. Spatial ability - everyday tasks such as finding one's way in the environment and learning the layout of a new environment - starts declining eight years before death. And verbal ability starts declining about six-and-a-half years before death. Thorvaldsson noted that verbal abilities declined sharply in the terminal phase and did not decline significantly due to age only. "This indicates that people remain stable in their verbal abilities unless they are experiencing disease processes that also increase their mortality risk, " he said. "A change in verbal ability might therefore be considered a critical marker for degeneration in health in older people." How much longer will I live? While not frequently verbalized, this question is in all of our minds and one would assume that it's much more prevalent in those of advanced age. As I see it, this study's uniqueness lies in identifying specific declines in mental skills as markers of life expectancy.The Uninsured Pay More and Get Less Medical Care than the Insured
Tue, 26 Aug 2008 16:00:14 -0800Americans without health insurance for any part of 2008 will spend $30 billion of their own money for medical care. Many cannot pay their own expenses and they rack up another $56 billion in medical expenses. Most of that amount - $43 billion - is paid by various state and federal government programs: $18 billion by Medicare and Medicaid, $15 billion by state and local government indigent programs, and $10 billion by the Veterans Administration. The uninsured that pay out of their pocket for medical care pay more overall and get a lot less care for their money. Someone who is uninsured all year pays 35 percent ($583) out of pocket toward their average annual medical costs of $1, 686 per person. In contrast, annual medical costs of the privately insured average $3, 915, with $681, or 17 percent, paid out of pocket.Prostate Screening No Longer Recommended for Men Over 75
Fri, 08 Aug 2008 11:01:13 -0800For years, the medical community has assumed that the early detection of prostate cancer by PSA testing improved health outcomes of all men tested. Now, the U.S. Preventive Services Task Force (USPSTF) recommends against routine cancer screening for men over 75. PSA tests do dectect the disease, but more harm than good can be done with treatment, starting with prostate biopsy and perhaps surgery and or radiation and chemotherapy. The recommendation is based on the fact that the average 75 year old American male will live less than 10 additional years and probably die of causes other than prostate cancer, So why risk the emotional and physical trauma of current treatment methods. Of course the decision to test or not is an individual one. For example, a 75 year old male in excellent health should live considerably longer than the average and will probably want to continue with PSA testing.Your Prescription History May Keep You From Getting Health Insurance
Tue, 05 Aug 2008 15:04:53 -0800Databases with the prescription drug histories of 200 million Americans are now being used by many health insurance companies to evaluate applications for individual health insurance. The data work like a credit report for health. The data originate with pharmacy benefit managers and contain details like the prescribing doctor, dates, drugs, dosages, etc.. The benefit companies then give their client insurance companies access for a fee. Insurance companies can better evaluate the expected risk for a particular applicant so this is a great value for them. It works a lot faster that their alternative which is to request medical records from the applicant's physicians. Privacy and consumer advocates complain that there are more and more companies holding vast amounts of patients' health information, mostly unknown to the average consumer. The database companies say they provide information to insurers only after having been released by consumers.Necessary Medical Care Increasingly Ignored
Mon, 30 Jun 2008 14:54:16 -0800One in every 5 Americans put off or avoided necessary medical care in 2007. That’s a 43% increase in this behavior over the past four years. Obviously, the higher cost of medical care was a big factor. So was the increased cost of health insurance, leading to more uninsured residents – 38% of uninsured residents ignored necessary medical care. The report is available online.Retail Medical Clinic Operators Hit a Rough Patch
Wed, 14 May 2008 10:32:27 -0800Retail walk-in medical clinics in pharmacies are proving more difficult to establish than initially thought. The clinics are more complicated and expensive to operate. It seems, operators and investors were overly optimistic in their return on investment estimates. The clinics are experiencing an 18 to 24 month break-even rather than the initial projections of a six month break-even. Much of the added cost is in marketing to make the public aware the service exists in each market and to gain acceptance. While the pubilc likes the convenience of the walk-ins, it takes a lot of users to make it pay.Florida Health Reform Legislation Passed
Thu, 08 May 2008 13:45:29 -0800The state of Florida has passed health insurance legislation that will allow insurance carriers to offer bare-bones coverage for as little as $150 per month. Aimed at Florida’s 3.8 million uninsured residents, the plans would be exempt from existing state-mandated coverage requirements. For instance the plans would not be required to offer coverage for long-term hospitalizations or treatment from specialists, but would cover preventive care and office visits.Paternity Kits Available Over The Counter
Thu, 03 Apr 2008 16:08:57 -0800Consumers with a pressing need to validate the paternity of a child can now buy a DNA Collection Kit offered by a Utah-based genetics company called Identigene. Available over the counter at Rite-Aid stores in 30 states. You pay $22.99 for the kit and another $119 processing fee for the results. The kit has swabs to collect cell samples from the inner cheek of the child and the "alleged" father and consent forms. You get the results in the mail in 3 to 5 business days. Ethical concerns are plenty. Will samples be collected without consent while the alleged father sleeps? What if the samples are used to determine genetic conditions or diseases? What if mistakes are made? According to Identigene the test is 99.9% accurate, but is not legally binding because there is no verification that the samples are from the people listed on the forms sent to the lab. Identigene offers a legally valid test that costs $350 where consumers go to a collection site that oversees sample collection and identity verification. Where's the market? 60% of kit purchases were made by women. Most people purchasing the kits were in their 20s. No surprises there.Shortage of Geriatric Physicians Grows
Thu, 13 Mar 2008 14:08:38 -0800The US doesn’t have enough Geratricians. Currently, there about 7, 000 Geriatricians practicing in the US. And the shortage is getting worse, because our medical schools and teaching hospitals are training one or two geriatricians for every nine specialists in higher paying specialties like cardiology or orthopedic surgery, Geriatricians make less money because their patients are on Medicare and their services are reimbursed a lower rate than private insurance patients. Additionally, the treatment of the elderly is less attractive to young doctors selecting a specialty. Public relations programs to convince the public of the value of Geriatricians has not had much of an impact on the shortage. So medical schools are adding more courses on the treatment of the elderly for all doctors and some foundations are providing grants to fund those courses. Because there are too few Geriatricians, primary care doctors also need to receive extra training in the treatment of elderly patients and perhaps even be required to be certified in elderly treatment.Proposed California Health Plan Dies
Thu, 31 Jan 2008 11:31:00 -0800Sadly, the California Senate Health Committee defeated a ground-breaking proposal to reform the state's health insurance system and extend coverage to millions of uninsured residents. In the end, it was the economic downturn that killed the well-intentioned plan. The state already has a $14.5 billion deficit, so the pprobability that the ambitious proposal would not be self-sustaining was just too risky to bear at this time. The nation was watching California on this one and the proposal's failure doesn't bode well for health insurance reform at the national level, regardless who gets elected.Saline Nasal Wash Beats Commercial Cold and Sinus Products
Thu, 24 Jan 2008 11:38:33 -0800If you have a child, you know all too well how often they have upper-respiratory tract and sinus infections. According to recently published studies, commercially available sinus and cold medications are ineffective at best and in some cases even dangerous for use by children. For treatment of cold symptoms, try using a nasal wash solution made from processed seawater. It can also prevent respiratory infection from coming back. During the study, 390 children were tested over a period of 6 weeks. The noses of the children in the nasal saline solution group were less stuffy and runny. During the prevention phase, the children in the saline solution group had substantially fewer sore throats, nasal obstructions/secretions, and coughs compared to the children in the standard treatment group who did not receive the saline solution. The researchers also found that during the prevention phase fewer of the saline group children were using fever-reducing drugs (9% vs. 33%), nasal decongestants (5% vs. 47%), mucus-dissolving medications (10% vs. 37%) or antibiotics (6% vs. 21%). Those in the saline group also experienced fewer days of illness and complications during the same period. Available nasal wash products include Ocean Premium Saline Nasal Spray and SinuCleanse.People Are Sicker Without Health Insurance
Fri, 04 Jan 2008 13:07:38 -0800A Harvard Medical School study (published recently in JAMA) found that older individuals got sicker than insured people in a comparable age group. Additionally, the differences in health were quickly reduced when the uninsured individuals became eligible for Medicare at age 65. The study also found that previously insured participants experienced no significant change in their health as they transitioned to Medicare, while participants who previously had little or no prior coverage experienced a significant slowing of the decline of their health once on Medicare.Small Business Supports Individual Health Insurance Mandate
Fri, 04 Jan 2008 12:16:17 -0800Group health insurance is too expensive for many small businesses and it’s not surprising that almost 70% of the working uninsured are employed by businesses with fewer than 100 employees. A majority of small business owners (57%) say they will support an individual health insurance mandate - where individuals are required to insure themselves. It stands to reason that small businesses would jump at the chance to get their employees covered by individual plans especially if they wouldn’t be required to contribute very much to offset the lack of group coverage. Presidential candidates Clinton and Edwards, both Democrats, have proposed universal health insurance with individual mandates. Interestingly, small business owners, typically Republican, find at least one of their business interests aligned with the opposition.Give The California Health Plan a Chance
Wed, 19 Dec 2007 13:43:25 -0800The status quo of American health care is unacceptable. What makes it a political nightmare to fix is that what one side really wants is a single payor government system like Medicare and what the other side really wants is to minimize government involvement and let a free market bring about changes naturally. How's that working for us so far? Pragmatists, including most presidential candidates, occupy the middle ground seeking workable solutions at the risk of loosing their political constituancies. Such is the case in California, where Repubilcan Governor Arnold Schwartzenegger made a deal with Democratic Assembly Speaker Fabian Nuñez to compromise on a health care bill similar to the recently enacted Massachusettes plan. The California bill has passed the House and will face a Senate vote in January 2008. Both men are risking a lot of their political capital to make this happen. We could use more politicians like them. On the plus side, insurers would no longer be able to reject applicants for pre-existing health conditions. Health insurance in California would be mandatory in 2010 and low income residents would be subsidized. Coverage will be extended to 4 million previously uninsured California residents. California would get up to $4 billion in federal funds that the state has not previously been able to get its hands on, but there are some significant funding hurdles to overcome. In an effort to end-run a two thirds vote for the establishment of any new taxes, the bill's backers plan to introduce an initiative on the November 2008 ballot asking voters to authorize funding. The nation is watching to see if California can pull this off. I sure hope we do.
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