Most people can’t successfully comparison shop for healthcare

by Ateev Mehrotra MD

Comparison Shopping for Healthcare

As a doctor,  I’m the perfect person to price shop for an operation. But the process went terribly.

 

After three months of using hot compresses to shrink the stye on my daughter’s eyelid, it wasn’t getting any smaller. My daughter is prone to this sort of growth, called a chalazion. This one would have to be removed surgically, like the one she had removed from the same eyelid two years earlier.

But there was one key difference this time around: Like tens of millions of people who get health insurance through their employer, my family was now in a high-deductible health plan. That meant we would have to pay for the entire cost of the surgery out of pocket. Suddenly, the cost of the surgery became very important to our family.

Encouraging patients to price shop for their health care is one reason employers are switching to high-deductible plans. The theory is that patients will compare prices across different doctors or hospitals and choose the lower-priced one, thereby saving themselves (and their employer) money. But in order to shop, you need to be able to see what something costs beforehand. Transparency in health care prices is a goal of President Trump’s health agenda, and is a priority for other politicians as well.

My family had every advantage that newly minted price shoppers could possibly have: We live in Massachusetts, one of the states that have passed price transparency laws to help patients shop for care; I am a physician; my research focuses on consumerism and price transparency, giving me plenty of insider information; and the surgery was minor and not urgent, giving us lots of time to shop around.

How did it go? Terribly. Here’s why:

On the website for our health plan, we muddled our way to its hard-to-find price transparency page. When we finally got there, we didn’t get the information we needed: removing a chalazion is not a common procedure, so it wasn’t listed.

An ophthalmologist would remove the growth. The billing department for the ophthalmologist who evaluated my daughter could tell us only what the doctor’s fee for the surgery would be ($1,007) and didn’t know the fees for the anesthesiologist or the operating room, both of which could be as much as, or more than, the doctor’s fee.

To get a better price estimate, we called our health plan. It asked us to submit a written cost request for the surgeon and the hospital we were considering. Twenty-four days later, we received an estimate of $452, which was both incomplete (it only showed the ophthalmologist’s fee) and incorrect (the health plan mistakenly assumed we were in a different insurance plan).

Other ophthalmologists we called said they would give us a price quote for the surgery only if we brought our daughter in to be evaluated. Each evaluation visit would cost more than $200.

One month into our price-shopping effort, all we knew was that the ophthalmologist’s fee would be in the $452 to $1,007 range, and the total surgery would cost much more. All the while, the red, swollen eyelid on our increasingly miserable middle-schooler was waiting to be treated. So, we decided to go ahead and have the original ophthalmologist do the surgery, even though we had no idea what it would really cost.

In the end, it cost us $1,443, including $556 for the ophthalmologist and $887 for the anesthesiologist and hospital. Despite the challenges, we recognize that we were fortunate — our daughter’s surgery went well and we could afford this unbudgeted expense. Others aren’t so fortunate.

Sadly, my family’s price-shopping experience is the norm in the U.S. My colleagues and I have found that most people can’t successfully shop for care, and that offering people a price transparency website doesn’t help them switch to lower-cost providers and doesn’t decrease health care spending.

Why isn’t price transparency currently working? It’s not that Americans don’t agree with the idea of shopping for health care. Most believe it makes sense and could save money for families and the health care system. Many recognize that there’s a great deal of price variation and believe that health care prices have little relation to quality, a suspicion our research backs up.

What can be done? First, we need to bundle payments to hospitals and surgery centers: a single payment that covers everything related to a procedure or doctor visit. Patients shouldn’t have to navigate the craziness of different bills for the hospital, surgeon, operating room, pathologist, anesthesiologist, and the like.

Click here to read the rest of this article originally published in STAT

 

 

 

JD Power Identifies Decline in Pharmacy Customer Satisfaction Driven by Escalating Prescription Drug Costs

by Michael Johnsen

 

The U.S. pharmacy industry, perennially one of the highest-scoring industries measured by J.D. Power, experienced notable declines in overall customer satisfaction this year, the research firm reported Tuesday.

According to the J.D. Power 2017 U.S. Pharmacy Study, decreases in satisfaction with both brick-and-mortar and mail order pharmacies were driven primarily by declines in satisfaction with cost.

“Pharmacies have historically earned very high marks for customer satisfaction, so any significant year-over-year decline is cause for closer investigation,” stated Rick Johnson, director of the Healthcare Practice at J.D. Power. “Consumer concerns about rising drug prices have likely affected perceptions of the cost for their retail prescriptions. The decrease in satisfaction with cost is the primary drag on overall customer satisfaction, creating a serious challenge for retailers.”

“Pharmacies have historically earned very high marks for customer satisfaction, so any significant year-over-year decline is cause for closer investigation.”

Decreases in satisfaction with brick-and-mortar pharmacies were driven by year-over-year declines in satisfaction with cost, which fell 27 index points to 789 (on a 1,000-point scale), and the in-store experience, a 14-point drop to 851.  Decreases in satisfaction with mail order pharmacies were driven by declines in satisfaction with cost (minus 49 to 787) and the prescription ordering process (minus 15 to 877).

This year’s study measured drug adherence levels across the different pharmacy channels for the first time, and found that 79% of customers who filled prescriptions through a brick-and-mortar pharmacy reported they always were adherent to their medications. This compares with 84% among mail order customers and 74% among specialty pharmacy customers. Customers who discussed a prescription with a pharmacist in a brick-and-mortar pharmacy at the time of pick-up had the highest overall levels of adherence.

Among all channels studied, supermarkets had the highest levels of overall customer satisfaction (859), followed by mail order (853); hospital or clinic (851); chain drug stores (849); specialty pharmacy (842); and mass merchandisers (839).

AmerisourceBergen’s Good Neighbor Pharmacy ranked highest overall among brick-and-mortar chain drug stores with a score of 889.  McKesson’s Health Mart (886) ranked second and Cardinal Health’s The Medicine Shoppe Pharmacy ranked third (879).

Sam’s Club ranked highestoverall among brick-and-mortar mass merchandisers with a score of 874. Fred’s (873) ranked second and Costco (875) ranked third. While CVS Pharmacy at Target placed fifth this year, it had the largest increase in satisfaction of any pharmacy from 2016 (+20).

Brookshire Grocery ranked highest overall among brick-and-mortar supermarkets with a score of 894. H-E-B (893) ranked second and BI-LO (891) ranked third.

Walgreens Specialty Pharmacy ranked highest among specialty pharmacies with a score of 853. BriovaRx (851) ranked second and CVS Specialty/CVS Caremark (840) ranked third.

 

Link to original article posted in Drug Store News

Food & Drug Administration Warns of Gastric Balloon Deaths

by Kristina Fiore

7 reports of death tied to gastric balloon obesity treatment since 2016

The FDA sent a letter to healthcare providers warning of reports of seven deaths with liquid-filled intragastric balloon systems used to treat obesity.

In five cases, the cause of death was unclear, but all occurred within a month or less of balloon placement, the agency said. In three of those cases, the patient died within one to three days of having the balloon inserted.

Four of these reports involved the Orbera Intragastric Balloon System from Apollo Endo Surgery, and one involved the ReShape Integrated Dual Balloon System by ReShape Medical.

The FDA noted that for these five cases it doesn’t know “the root cause” of the problem. It also can’t determine the incidence rate of patient death, nor could it “definitively attribute the deaths to the devices or the insertion procedures for these devices” — meaning they couldn’t tell if death was due to gastric or esophageal perforation, or to intestinal obstruction, or to some other cause.

Two additional reports of deaths in the same time period — since 2016 — were also noted in the FDA letter. One was related to gastric perforation with the Orbera Intragastric Balloon System and one to esophageal perforation with the ReShape device.

The FDA said it’s working with both companies to better understand what’s causing these issues, and to monitor potential complications of acute pancreatitis and spontaneous overinflation. It also emphasized that it had mandated ongoing post-approval studies for the devices.

Article originally appeared in MedPage Today

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Do you Really Need These Vitamin Supplements?

By  Dr. Manny

According to 2016 consumer survey data, 71% of U.S. adults take some type of dietary supplement. And the appeal of supplements is obvious. We know vitamins are necessary for health, so why not make sure we’re covering our bases?

The darker side of dietary supplements is that many of the alleged health benefits are coming straight from people who stand to make big money from vitamin sales, and the research doesn’t always agree with the claims of vitamin manufacturers and retailers.

Here’s a look at four vitamins you may want to think twice about taking.

1. Vitamin E

According to the National Institutes of Health, the recommended daily allowance (RDA) of vitamin E for adults is 15 mg (or 22.4 IU). RDAs are based on what will meet the nutritional needs of 97-98% of healthy people, but supplements are widely available from 200 to 1000 IU per pill. When it comes to vitamin E, the research is clear that you can have too much of a good thing. A large review of the research by John Hopkins University found that people who took more than 400 IU daily faced a 4-6% increased risk of death. Another large study found that, despite health claims to the contrary, vitamin E did not decrease prostate cancer risk in study participants. In fact, men who supplemented with vitamin E were slightly more likely to develop prostate cancer than men who didn’t use the supplement.

2. Vitamin C

Pricey vitamin C supplements marketed for the prevention and treatment of the common cold and the flu have popped up in every grocery store and drug store. They come as pills, lozenges, and powdered drinks and typically contain 500-1000mg of vitamin C, at least 5-10 times the RDA of vitamin C for adults. Some people use supplements daily to prevent colds, and others use high doses at the beginning of a cold to shorten its duration. But a review of the evidence shows that vitamin C only impacts the common cold in one way – if you’re already taking daily vitamin C, your colds may be a little bit shorter. Despite the claims of manufacturers, people who supplement daily don’t get fewer colds, and starting supplementation at the beginning of a cold doesn’t affect cold symptoms. If you choose to take a daily vitamin C supplement to shorten your colds, keep in mind that mega doses can contribute to kidney stones.

3. Vitamin A

Vitamin A can be toxic in large doses, causing symptoms like nausea, vomiting, and abdominal pain. Most cases of vitamin A toxicity occur in adults using mega doses of vitamins to treat illness or in children who accidentally ingest supplements, but researchers are now wondering if smaller supplemental doses of vitamin A can cause health problems too. The RDA for vitamin A for adults is 700-900 mcg, and an article published in The American Journal for Clinical Nutrition notes that just twice this amount has been connected to osteoporosis and hip fracture in people without other symptoms of toxicity.

4. Multivitamins

Seventy-five percent of Americans who take supplements take a multivitamin, making it the most popular dietary supplement in the US. Multivitamins are all different, but most contain a long list of vitamins and minerals, sometimes in amounts well over their recommended daily intakes. Over the last few years, study after study has challenged the alleged health benefits of multivitamins, but there have also been a few that show some health benefit. In a large study of older women, multivitamin use was associated with increased mortality. An eight-year study showed no protective effect against cardiovascular disease or mental decline but a slight protective effect against cataracts and cancer. And most recently, a 2016 study has contradicted previous research by showing a slight benefit for heart health. The research surrounding multivitamin supplements isn’t clear-cut, and it’s possible that not all adults benefit from them.

It’s important to consult with your doctor before taking a new supplement and to know that adding more fruits and vegetables to your diet is the most evidence-supported intervention you can make for your own health. Fruits and veggies can lower your risk of cardiovascular disease, cancer, diabetes, and high blood pressure without any dangerous side effects. And a cart full of produce is much more affordable than a cabinet full of supplements.

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Study Boosts Case for Over-the-Counter Hearing Aids

OTC hearing aids performed nearly as well as prescription devices, but not yet legal for sale

In a highly controlled comparison study, several over-the-counter hearing assistance devices performed almost as well as a conventional hearing aid that cost thousands of dollars more.

Three of five selected personal sound amplification products (PSAP) were found to improve speech understanding among participants with mild-to-moderate hearing loss to a degree that was comparable to results obtained with a hearing aid, Nicholas Reed, AuD, of Johns Hopkins School of Medicine, and colleagues wrote in the July 4 issue of JAMA

Hearing aids for both ears typically cost around $4,500, while PSAPs cost several hundred dollars or less.

The Over-the-Counter Hearing Aid Act of 2017 is being sponsored in the Senate by Elizabeth Warren (D-Mass.) and Charles Grassley (R-Iowa) and in the House by Joseph Kennedy (D-Mass.) and Marsha Blackburn (R-Tenn.).

Reed told MedPage Today that the study findings lend support to the creation of the new regulatory classification for hearing aids.

“Some of these devices did about as well as the hearing aid in our controlled environment, suggesting that some PSAPs are pretty good,” he said. “Perhaps we should support the movement to get these in the hands of more people and to regulate them to improve the quality of the products.”

Click here to read entire article published in MedPage Today