Musings on Medicine and the Health Care System

Goodbye 2016, Hello 2017

Looking Back on the Year in Health Care: There Were Some Bright SpotsLooking Back on the Year in Health Care: There Were Some Bright Spots

I don’t know about you, but I personally hate end-of-year columns. I had to write far too many when I was a newspaper reporter (back in the day when you got ink on your hands while reading a newspaper).

So why am I writing one, you ask?

Sigh. Blame it on the young lady who handles my social media. She’s making me.

So here goes.

2016 Highlights in Health Care

There’s a lot of moaning on social media about 2016 and what a terrible year it was. And yes, it did suck for many reasons, none of which I’m going to go into here. Instead, I’m going to talk about a few positives on the health care side for which I’m thankful.

Fewer Uninsured Americans Twenty million previously uninsured Americans now have health insurance. Put another way, the uninsured rate in this country has never been lower. Gains Under the Affordable Care Act Many aspects of the Affordable Care … Continue Reading

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ACA Affordable Care Act cancer health insurance

Memo to Health Insurers: Pay Attention to Us

Memo to Health Insurers: Pay Attention to UThe text came from our 20 year old. His girlfriend had gone to her doctor to get the implantable birth control, Nexplanon, which (as every parent of a teenager might be happy to know) is nearly foolproof for 3 years. Needless to say, we were thrilled.

The problem?

It cost $1,500 and insurance wasn’t paying.

The Explanation of Benefits that Was Anything But

Impossible, I said (after all, there’s not much I know about but health insurance and the Affordable Care Act [ACA] are two). The ACA requires that most health insurers/employers provide all FDA-approved contraception with no out-of-pocket cost.

It took several back and forths between the girlfriend, her father, and me, including copies of the statement from the insurance company, before I figured it out. She was only seeing the insurance company statement, called an explanation of benefits (EOB), showing what was billed and what was paid. She didn’t owe a thing.

And therein likes one of the many problems with health insurance today. It’s unnecessarily complicated and confusing. After all, how many mere mortals … Continue Reading

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ACA Affordable Care Act FDA healthcare costs patient-centered care reprodutive rights

From CrossFit to StorySLAM: The Value of Taking Risks

From CrossFit to StorySLAM: The Value of Taking RisksIn honor of Thanksgiving and the start of the holiday season, I’m taking a break from my rants about the election and health care. Instead, I want to talk about taking risks.

I’ve never been a risk taker. I don’t gamble. I’m extremely financially conservative. I would never go on vacation without a hotel reservation. The biggest risk I’ve taken in the past 20 years was starting my own business.

But as I move through my 50s (I turn 54 November 30) I’m also moving out of my comfort zone and starting to take more risks. It began two years ago when I started CrossFit, the uber exercise program that combines strength training with cardio with gymnastics. To understand how unlike me this was, you should know that I hated exercising and did the bare minimum required so I could drink as much wine as I wanted and still fit into my clothes.

Then came an hour of daily torture that often left me close to tears and literally on the floor staring at the ceiling certain … Continue Reading

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stress work/life balance

Dear Donald: Here’s How Health Insurance Works

Dear Donald: Here's How Health Insurance WorksDear Donald (I can call you Donald, right?):

I really appreciate that you think there are certain parts of “Obamacare” worth keeping. Like continuing to be able to cover adult children up to age 26 on your health insurance (I’ve got one of those on our health insurance right now) and ensuring that health insurers can’t discriminate or charge higher premiums based on preexisting conditions.

There’s just one teeny, tiny problem. There is no way to keep the preexisting condition part without also keeping the mandate that everyone has some kind of health insurance.

It might be a little complicated for you, so I’ve done my best to bring it down to a first-grade reading level.

An Analogy for How Health Insurance Works

1) Insurance, any insurance, is based on a risk model. The more people in the risk pool, the less impact the truly risky have on the pool.

Think of it this way. If you put five drops of red food coloring in a swimming pool, there’s no change in color. If you put five drops of red … Continue Reading

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ACA Affordable Care Act health insurance healthcare reform Obamacare politics

The Election and the ACA: Why I’m Sad, and Will Be for a Long Time

The Election and the ACA: Why I'm Sad, and Will Be for a Long TimeI’ve been writing this blog on and off for about eight years. And in all that time, I’ve tried to keep it as apolitical as possible. But, at my core, I am a writer. It’s all I’ve ever done for 30 years. And when writers can’t make sense of the world, or don’t know what to do with their feelings, well, they write.

So, spoiler alert, I am devastated by Tuesday night’s results for so many reasons. For an end to women’s reproductive rights. For an end to what I thought was a decent, inclusive country. For an end to a free press. For an end to LGBT rights. For an end to the respect we once had from the rest of the world.

And for the horrific overt racism and homophobia that has been unleashed in this country in just the past few days.

But, since I earn my living as a healthcare writer, the one I’m going to focus on here has to do with the almost-certain death of the … Continue Reading

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ACA Affordable Care Act health insurance health insurance exchanges healthcare reform healthcare system; Medicare politics

Is The ACA As Big A Mess As Everyone Says?

Is The ACA As Big A Mess As Everyone Says?Maybe. But many of the problems the Affordable Care Act (ACA) is now encountering – insurance companies on the exchanges pulling out, large premium increases in some states – are not unexpected given the design of the program.

Major problem? The Patient Protection and Affordable Care Act bill set the penalties for not having insurance too low. Far lower than the cost of the insurance to begin with. So there is little incentive for healthy people to enroll. Without healthy people enrolling, it was only a matter of time before the death spiral began.

It’s a simple equation: Sick people + no preexisting condition restriction – healthy people = high spending that outstrips existing premiums.

To add insult to injury the government was too lenient in allowing people to sign up outside of open enrollment, ie, when they got sick and needed the insurance. Plus, as The New York Times explained in a recent editorial, insurers set premiums too low in the beginning in order to attract enrollees.

Is the ACA dead? Should we scrap … Continue Reading

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ACA Affordable Care Act health insurance

Value-Based Reimbursement: There’s a New Player in Town

Value Based Reimbursement Webinar

 

There’s a new player in town. In case you haven’t heard, his name is VBR – value-based reimbursement. He’s smart. He’s tough. He’s out to break you down and build you up. And if you’re a healthcare provider, there is nowhere to hide.

For several years now I’ve been writing about the “coming” revolution in healthcare reimbursement as the system moves from a fee-for-service approach (ie, the more you do, the more you earn) to one based on cost and outcomes, aka, value. Well, the revolution has begun. Just consider:

➢ On April 1, nearly 70 hospital systems will switch from billing separately for each component of a knee or hip replacement to receiving a bundled payment for all care provided from the time the patient enters the hospital until 90 days after discharge. Just consider the possibilities!

➢ Two weeks ago, the Centers for Medicare & Medicaid Services (CMS), which is driving the value-based revolution, announced a proposal to change the way physicians are paid for drugs administered in their offices (mainly oncology medications).

Today, doctors get the … Continue Reading

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Affordable Care Act healthcare costs healthcare reform healthcare system; Value-based reimbursement

Ladies: Stop Cutting Off Healthy Breasts

Ladies: Stop Cutting Off Healthy BreastsReally scary story in The Wall Street Journal this week about a dramatic increase in double mastectomies in this country — and not for women who need them.

Most women diagnosed with breast cancer only need a lumpectomy in the affected breast or, more rarely, a mastectomy. There is no evidence that removing the healthy breast reduces the risk of recurrence or increases survival.

Yet rates of double mastectomy among women diagnosed with breast cancer have skyrocketed in the past 13 years, from 2 percent in 1998 to 12 percent in 2011. And no, it’s not because women have been diagnosed with more severe breast cancer or some major study showed that slicing off healthy breasts keeps cancer at bay.

As one plastic surgeon quoted in the Journal article tells his patients: “Why don’t we simply remove your foot? It will have the same effect on survival.”

Don’t take my word for it; check out this study of 190,000 women with breast cancer that compared survival rates in those who had a double mastectomy vs those who underwent lumpectomy … Continue Reading

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cost health insurance waste

How Much Is That CT Scan In the Window?

transparencyDo you know how much that 50-inch, flat-screen TV cost? How about your car? The cashmere cardigan you just had to have?

So how much did that visit with your gyn because of your painful period cost (men: substitute whatever you want here)? The ultrasound to see if you had a fibroid? The myomectomy to remove the fibroid?

A few years ago it didn’t matter so much; most of us only had to handle relatively small copayments and many of us didn’t even have deductibles. Fast forward to today, when the cost job-based health insurance has grown faster than our incomes, essentially eating up any salary increases over the past 10 years. In fact, the average deductible has more than doubled for most employees regardless of the size of their companies.

Note I said the past 10 years. Which means you can’t blame the five-year-old Affordable Care Act entirely. In fact, out-of-pocket payments would likely be higher without the ACA; a recent report from the Commonwealth Fund found a “marked slowdown in premium growth in 31 states and the District of Columbia.” However, that same report also found that premiums increased about … Continue Reading

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cost health insurance healthcare costs healthcare reform payment