Musings on Medicine and the Health Care System

Is Your Mammogram Worth the Price?

When two people mention the same thing to me within a week, I know it’s time to take notice. This time it was 3-D mammograms (aka digital breast tomosynthesis). Hospital radiology departments and mammogram centers are marketing them as if they were the new female Viagra and yet. . . we don’t yet know if the risks are worth the benefits.

A traditional mammogram consists of vertical and horizontal images. The 3-D mammogram, as its name implies, provides a more holistic view as it swings in an arc around the breast, then combines those pictures into a three-dimensional image just like a CT scan. Studies find that combining the two may reduce call backs for additional tests and improve cancer detection rates.  Overall, the National Cancer Institute reports, about 20 percent of breast cancers are missed during mammography and about 10 percent of women get called back for further screening.

I first heard about 3-D mammography during a dinner party, when a friend announced that she’d been diagnosed with early-stage breast cancer (actually, she’d been diagnosed with ductal carcinoma in situ [DCIS], which is not technically cancer). If it weren’t for this amazing … Continue Reading

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cost mammograms

On Death and Dying

dyingOk, so it’s not the most uplifting title of a post, but it’s one that’s been on my mind the past few weeks as I researched and interviewed people for a story on end-of-life issues. I’ll post a link to the story when it appears in Consumer Reports later this summer, but I’d just like to riff a bit about the way we view dying in this country.

The first thing we don’t seem to realize is that we are all going to die. I’ll say it again. We. Are. All. Going. To. Die. No matter how much medical technology we throw at it, something is going to kill us. So the question becomes, as one of my experts said, how do you want to die?

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end-of-life care

The CT Scan Cost HOW Much??

So a couple of months ago I saw my doctor about this chronic pain in my lower right abdomen. I’d had it for about a year, sometimes barely noticeable, sometimes more noticeable, and, being a medical writer, I was certain it was ovarian cancer (don’t ask my why, but I’m convinced that this is the cancer lying in wait for me, even though I have no risk factors. Medical writers are only second to med students in terms of hypochondria).

Anyway, my doctor thought it was probably gynecologic and told me to see my gyn. But he also suggested a CT scan to rule out a kidney infection or stone. Sure, I said, and off I went to radiology.

Long story short, we still don’t know why I have this sometimes pain, but it’s not that bad and I’ll just live with it (until it turns out to be something serious and it kills me [see, I told you medical writers were hypochondriacs]).

But the pain got much worse last week when I received a bill from the radiology center for $778.62. Turns out that’s what I owe after my insurance company paid it’s part of the charge. Here’s how … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform healthcare system; Obamacare payment

Would You Walk Away from $2 Billion? Then Why Is Virginia (and 26 Other States)?

Hey, I just won the lottery! Two billion dollars! But you know what? I think I’ll just refuse it.

That, dear readers, is what my much beloved state of Virginia is prepared to do. On March 24, the General Assembly meets in a special session to consider the new budget — which is tied to expanding Medicaid. The Republican-led body has already voted against the budget because of the Medicaid requirement.

The expansion is part of the Affordable Care Act. If states expand Medicaid eligibility to those making up to 138 percent of the federal poverty level, including childless adults, the feds will pay for 100 percent of the expansion for the next five years, after which it picks up 90 percent. That’s a big bonus given that the state and the feds split the cost of traditional Medicaid.

Currently, Virginia covers children up to age 19 and pregnant women with  family incomes  up to 133 percent of the poverty level, and parents with family incomes up to 31 percent of the federal poverty level. No matter how poor you are, if you don’t have kids and you’re not pregnant, you’re out of luck.

So let’s take a look at … Continue Reading

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Affordable Care Act

Reigning in the Cost of Health Insurance, or, Why We Can’t Have Granite Countertops on a Laminate Budget

This blog comes to you courtesy of a nasty exchange on Facebook. It started with a posting about the fact that an insurance plan offered through the state exchange did not include the regional children’s hospital in its network.

This is happening around the country as insurers limit provider networks in order to keep premiums within  prescribed limits, whether those limits are mandated by the Affordable Care Act or by the employer paying for the health insurance. And it’s no secret that specialty hospitals like children’s hospitals and teaching hospitals have far higher costs than community hospitals. Reasons include the cost of training medical residents and fellows, the high percentage of Medicaid patients they see as well as the high percentage of uncompensated care they provide, and their mission to do research as well as provide patient care. They do receive additional federal and state funding to compensate — at least partly — for those expenditures, but in this day of shrinking budgets it doesn’t cover it all.

On the other hand, insurers offering policies on the exchanges must keep premiums within a certain limit based on actuarial data in their region. In addition, employers are looking for ways to … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform high-deductible health plan Obamacare

Time to Get Our Patientzilla On!

I just finished talking to a woman about her experience traversing our paternalistic medical system. She’d been having very strange symptoms for months — dizziness, numbness and tingling in her head and hands, blurred vision. After a particularly scary episode, she went to the emergency room where the ER doctor, in her words, basically dismissed her by telling her she had none of the risk factors for a stroke — she was only 40, in good health, a nonsmoker. “It’s probably anxiety,” he told her. “Of course I’m anxious!” she said. “I have two little girls in the waiting room scared to death because they’ve never seen their mother like this and I’m scared because I don’t know what’s going on!”

Nonetheless, she left without any idea of what was going on, convinced it was all in her head. Another visit a week later to another emergency room, where this time the doctors performed a battery of tests, including a CT scan, MRI, blood work, etc. Again, nothing.

A few weeks later, with the symptoms now so bad she had to hold a coffee cup in two hands, she saw a neurologist. Again, a battery of tests. Again nothing. By … Continue Reading

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double standard gender bias patient-centered care patient-centered healthcare

How Much for That Shoulder Replacement?

Forgive the blog silence, I’ve been online trying to sign up for health insurance on www.healthcare.gov (just a little healthcare reform humor there).

So today we’re going to do a bit of math. Don’t worry — I’m not a math person so this will be simple and painless.

We’re going back to my aunt, who was prominently featured in my last post.

She’s doing quite well ( thanks to all who sent good wishes). And she just received the first of what will be many bills.

This one was for the surgery and hospitalization. The hospital billed Medicare $11,851. Keep in mind that’s for the hospital only. Not the radiologist who read her xrays, or the anesthesiologist who made sure she felt no pain, or the surgeon who replaced her shoulder, or the visiting nurse, or the physical therapist, or the outpatient prescription medications. Just the facility charges for the surgery and three days in the hospital.

Medicare and her supplemental insurance paid the hospital $2,016 — about 17 percent of the total charges (don’t worry, I used an online calculator to figure this out). She had no copay thanks to that supplemental insurance.

If she didn’t have insurance, however, … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform healthcare system;

What I Learned About the Healthcare System From My Aunt’s Shoulder Surgery

I’m here in the cold northeast helping my 80something aunt out for a couple of days as she recovers from shoulder replacement surgery. It’s been a great real-life example of the good and the bad in our  healthcare system.

The good part is that the surgery went well and the hospital arranged for post-discharge physical and occupational therapy, as well as a home health nurse to check on my aunt, all of whom are great.

But the main problems come with the coordination of care for my aunt, as well as the communication. Our changing healthcare system relies on greater patient empowerment and patient-centered care. That, in turn, relies on educating patients about their condition. That so did not happen here. Here’s where I think the failures occurred:

— My aunt’s doctors did not set realistic expectations. She talked to several people who’d had the surgery before who told her what a breeze it would be. So when she experienced swelling, bruising, nausea, pain, etc., she thought something was terribly wrong and she panicked. Her doctors — and the nurses — should have prepared her for what such a major surgery would involve, particularly for someone her age.

— Her … Continue Reading

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healthcare reform healthcare system; patient-centered care patient-centered healthcare

Would You Buy a Car the Way You Buy Medical Care?

I was at book club the other night, pouring another glass of Chardonnay, when my friend told me that in August she was diagnosed with three blocked arteries, one of which is 100 percent blocked. I could rant about the fact that she’s been walking around like this for three months with only a beta blocker and statin as treatment, but that’s fodder for another blog.

When I talked to her she had an appointment with a cardiologist in our area. “Oh, he’s wonderful,” she said. because that’s what she’d heard from other people. What she didn’t realize, however, is that “wonderful” doesn’t mean good. She didn’t know how often he performed the procedure she might need; how well his patients did with or without surgery; what ties he might have to the pharmaceutical or medical device industry that could bias his recommendations; if he’d had any malpractice suits against him and how they’d turned out.

Choosing a doctor based only on what your friends tell you is like buying a car based on its color, something few of us would do. Instead, we research cars to find out which gets the best gas mileage, its safety record, its cost. … Continue Reading

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CABG doctor offices healthcare system; patient-centered care patient-centered healthcare quality