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

 

 

 

Understanding the role of pharmacists

Pharmacist Amy Schiveley talks with a customer at Lakeview Pharmacy

If your recent flu vaccine was administered at a pharmacy, you have already sampled the expanded role that pharmacists play in our health care today.

A flu shot, though, is just one of many patient-care services pharmacies across the country offer beyond filling prescriptions. From blood pressure tracking to Medication Therapy Management counseling, today’s pharmacists can be a resource for a wide range of information and advice.

In a Medication Therapy Management session, pharmacists can sit down with a customer and go through all of their medications, find out what is working and what’s not, review the purpose of each medication, explain how they work and more, according to Amy Schiveley, managing pharmacist at Lakeview Pharmacy, 516 Monument Square.

Pharmacists already provide some consultation when a customer picks up a prescription, Schiveley said, but MTM sessions take a more in-depth look at the entire medicine profile — including over-the-counter products and supplements — and help the patient better understand what they are taking, why they are taking it and how to take it.

“We go through all of it with a fine-toothed comb,” Shiveley said.

Pharmacists can also help patients understand the risks versus benefits of each medication; explore ways to reduce costs; and work with physicians and insurance companies to figure out what medication options are best for each person, she said.

Click here to read the rest of this article

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Dosage Forms: Introduction to Pharmaceuticals

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This article is a sufficient beginning to know everything about pharmaceuticals. If you are just starting to know about this amazing field, this is a good guide for you.

Drug is the substance used to cure, treat, restore the health state, or optimize a malfunction. Fundamentally, this substance is brought from plants or animals. Rarely, the drug is administered in its primary or crude form. In other words, the drug can be natural, synthetic, or semi-synthetic. The drug’s crude form passes by different processes to give rise to what is called dosage forms.

During manufacturing, the crude drug is called a pharmaceutical preparation. Dosage form is the crude drug in its final form after adding particular characteristics to it. The drug manufacture includes addition of additives; pharmaceutical ingredients.

The additives are mainly non-medicinal substances used for many purposes. They are added to enhance the drug form, quality, and efficacy.

They are used:

As solubilizing agents

For dissolving the drug in a solvent as in the formation of solutions

For dilution

To decrease or optimize concentration

As suspending agents

To suspend solid particles in a solution and form a suspension

As emulsifying agents

To dissolve water in oil or oil in water and produce an emulsion

As thickeners

To harden/thicken creams and ointments

As stabilizers

To maintain the stability of a pharmaceutical preparation

As preservatives

To protect the pharmaceutical preparations from contamination by microorganisms such as bacteria and fungi

As coloring agents

To give the drug a perfect appearance and attractiveness.

As flavoring agents

To hide a bad taste like the bitter taste. Moreover, flavoring agents are used to add a reasonably good taste to the drug and increase its palatability.

Click here to download a PDF with more information

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Congressman and Medical Doctor Phil Roe Presents An Outstanding Obamacare Alternative

Family Research Council discussion of the Republican Study Committee’s alternative to the Affordable Care Act, known as “Obamacare.”

Dr. Phil Roe, the Congressman representing Tennessee’s First Congressional District, will present an overview and answer questions about the RSC’s patient-centered and free market alternative, the American Health Care Reform Act. More information about RSC’s bill can be found here. Because of the federal government’s expansive role in structuring health care’s cost and coverage, this important discussion is relevant to all Americans. Dr. Roe has a valuable perspective as a medical doctor who understands the challenges facing America’s health system today.

Congressman Phil Roe represents the First Congressional District of Tennessee. A native of Tennessee, Phil was born on July 21, 1945 in Clarksville. He earned a degree in Biology with a minor in Chemistry from Austin Peay State University in 1967 and went on and to earn his Medical Degree from the University of Tennessee in 1970. Upon graduation, he served two years in the United States Army Medical Corps. Congressman Roe serves on two Committees, Education and the Workforce, and Veterans’ Affairs, that allow him to address and influence the many issues that are important to the First District students, teachers, veterans and workers.

Click here to watch this presentation on YouTube >>> Congressman Phil Roe: An Obamacare Alternative

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Contrary to Popular Belief Breast Cancer Rates Unaffected by Family History

By Kristina Fiore, Staff Writer, MedPage Today

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

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CHICAGO — Women ages 40 to 49 with no family history of breast cancer have similar rates of invasive disease as those with familial risk, radiologists reported here, firing yet another salvo at government mammography guidelines.

Among a group of more than 1,000 breast cancer patients, 64% of those with no family history of breast cancer had invasive disease, as did 63.2% of those with family history, a non-significant difference, according to Stamatia Destounis, MD, of Elizabeth Wende Breast Care in Rochester, N.Y., and colleagues.

“We were intrigued and surprised by the data,” Destounis said during a press briefing at the Radiological Society of North America meeting, noting that general wisdom suggests women with a family history are at greater risk of developing the disease than other women.

“Since there’s no difference in the rate of invasive breast cancer for women in their 40s whether they have a history of breast cancer or not, the recommendation should be that women in their 40s have screening mammography yearly,” Destounis said.
In 2009, the U.S. Preventive Services Task Force recommended against routine screening for women ages 40 to 49, leaving patients and clinicians to make individual decisions based on their risk. Mammograms should start at age 50, the committee said, and be performed every two years.
Yet the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists, and other groups have called for continued screening in this age group, which Destounis said has led to confusion among patients and their doctors.
Still, the debate has shown few signs of letting up, as studies have continued to flood in — some showing that screening women 40 to 49 offers a robust mortality benefit while others have found only a trivial benefit.
Destounis and colleagues reviewed data on all breast cancer patients seen at their clinic between 2000 and 2010, with a total of 1,071 patients ages 40 to 49 treated for 1,116 cancers.
A total of 373 of those had been diagnosed via screening at their clinic; 61% of those patients had no family history of the disease, while 39% did. There were no significant differences in terms of the percentage of patients in either group who had a personal history of the disease.
The investigators also found that similar percentages of patients with and without familial risk had disease that metastasized to the lymph nodes (29.4% of those without versus 31.3% of those with).
“We agree with the ACS, which recommends screening for every woman in her 40s,” Destounis said.
Gary Whitman, MD, of MD Anderson Cancer Center in Houston, who was not involved in the study, told MedPage Today there are “very few mammographers who feel differently about the need to screen all women at 40 years of age.”
Edith Perez, MD, of the Mayo Clinic in Jacksonville, Fla., who also was not involved in the study, noted that it may show that family history isn’t necessarily useful for deciding whether a younger woman may be at greater risk of breast cancer, though this hypothesis would need further testing.