Surgery Prices Online?

oklahoma-surgery-pricingThe Surgery Center of Oklahoma’s decision to publicly post prices for common procedures could prompt other hospitals and medical facilities to follow suit.

Want to know how much it will cost to repair your torn Achilles tendon? At the Surgery Center of Oklahoma, you won’t run into a wall of bureaucracy trying to find out: The price for that procedure ($5,730) and other common surgeries is posted online.
The surgery center is at the forefront of what many observers say is the beginning of a sea change in the health care industry: telling patients up-front how much their operation or treatment will cost.
Consumers will insist on knowing the costs of medical procedures as they pay more out of pocket for their health care and as the Affordable Care Act, or Obamacare, requires all individuals to carry some minimum health insurance or pay a tax, experts say.
“There will be incredible demand and outcry from consumers if they don’t receive this transparency in pricing,” Dr. Keith Smith, co-founder of the Surgery Center of Oklahoma, told MSN News.
“I think you’re going to see websites pop up like Priceline where you enter your ZIP code and enter your desired procedure.”
“There are an increasing number of patients with high-deductible plans and those patients are going to ask questions before they will go to some of these places,” said Dr. Peter Ubel, a professor of public policy at Duke University…. (Read more here)

When Governments Nudge Physicians to Use EMRs

Physicians have been, at best, slow to adopt electronic medical records. But who can blame them? These computerized systems often cost lots of money, and force physicians to spend gobs of valuable time learning a new way to track how they care for patients. On the other hand, we would all be better off if more physicians used EMRs. So to get things moving along, the U.S. Congress started giving physicians financial incentives to adopt these computerized records into their practices, starting in 2008. And evidence is that this had a big effect:
EMRs
Sometimes people need a little push to do the right thing.

Denying Jobs To Smokers Is Bad Policy

smoking docMy former employer, the University of Pennsylvania Health System, no longer hires tobacco users.  It has joined a growing group of employers, including many health systems, that discriminate against smokers on the grounds that such employees cost the employer money (through loss in productivity) or, in the case of medical institutions, act against the health promoting values of the employer.
Such policies might be well-intentioned, but they are misguided and ethically muddled.  As much as I like the idea of incentivizing people to kick the habit, denying jobs to qualified people because they smoke is not an appropriate intervention…(Read more and view comments at Forbes)

Banning Smoking in Parks and Beaches

A July article from Health Affairs published just how many parks and beaches in United States have banned smoking, since 1993. The picture for US parks is below:

These bans have grown in popularity even though the risk of secondhand smoke is dramatically reduced outdoors. In fact, many US parks are quite large, from what I’ve seen, and it is verging on the draconian for public health officials to be adopting these bans with such increasing frequency.
I would prefer, instead, significantly stiffer penalties for littering, while clearly warning people that abandoned cigarette butts are a form of litter.
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The Hazards of Blogging: Being Misquoted and Misrepresented

In a recent post, I wrote about the fact that many physicians in the US do not accept new appointments with Medicaid enrollees. I was surprised to see it quickly garnered over 25,000 views. I guess it’s good to write posts that people read. But I fear that many people read it because it was linked in other articles that used it as evidence against Obamacare.
I want to be clear on this. Obamacare has nothing to do with physician willingness to see Medicaid patients. The data I reported on, in fact, were collected long before Obamacare had any impact on Medicaid coverage. Indeed, as of this posting, the Obamacare Medicaid expansion hasn’t even come into effect.
Like I have written about many times before: it’s fine to criticize Obamacare, but at least base your criticisms upon facts!
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Death With Dignity Should Not Be Equated With Physician Assisted Suicide

In 2008, the state legislature of Washington passed what was called the Death with Dignity Act, a law that legalized physician assisted suicide.  Under the law, terminally ill patients (predicted to have less than six months to live) can request prescriptions for lethal medications from their physicians, under a series of safeguards:  multiple requests for example, determination of competency, and the like.  Then, if the patients so choose, they can ingest the pills at the time of their choosing, thus controlling the manner and location of their demise, a last act of control in the face of an otherwise debilitating illness.
I have no beef with the letter or spirit of Washington’s law.  I have long contended that in rare circumstances, physician assisted suicide is a compassionate and morally appropriate policy.  Nor am I worried about the way the Washington law has worked in practice.  Indeed, a New England Journal of Medicine study from April demonstrates that patients have chosen assisted suicide sparingly, and without undue coercion from clinicians urging them to “off themselves”.
My beef is not with the letter of the Washington law, it’s with the name.  I think it is wrong-headed to equate assisted suicide with the concept of a dignified death.  Such a link unduly narrows the concept of dignity, and potentially undermines our ability as clinicians to help patients find other ways of achieving a dignified death… (Read more and view comments at Forbes)
 

How "Vague" Writing Can Be Powerful: A Lesson from Abe Lincoln

In his wonderful 1992 book – Lincoln at Gettysburg – Gary Wills explains that one of the reasons the Gettysburg address was so powerful is that Lincoln did not use any proper names – that’s right any – in the entire address. Consider this portion of the speech:

Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battlefield of that war. We have come to dedicate a portion of that field…

Not the Civil War but a civil war. Not the United States, but “that nation.” What’s the name of that battlefield? You won’t find that out by reading Lincoln’s speech. By being so nonspecific, so general, Lincoln made the message of his speech that much more universal. This is a writing lesson to keep in mind. Normally being more specific and more concrete makes writing more powerful. In this case, Lincoln found a better way to get his ideas across.
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Do Cigarette Taxes Work?

Here is a nice picture, from the Wonkblog, summarizing the best evidence to date on whether cigarette taxes reduce smoking.

The bottom line here is that cigarette taxes slightly reduce smoking among smokers. That slight reduction reflects, in part, those people who quit smoking because it has simply become too expensive. It also includes people who simply smoke fewer cigarettes. But given how addictive tobacco is, it shouldn’t be surprising that the price elasticity of cigarettes is not that great. When you go into withdrawal every time you stop using your product, the price the product becomes a little bit less important.
By contrast, cigarette taxes have an especially large effect on young people. Most importantly, high prices discourage many young people from becoming smokers. In addition, many young people aren’t dealing with the same long-standing addiction that adults have to contend with.
If you like the idea of discouraging kids from smoking, you should be a fan of cigarette taxes.
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Before Anesthesia

In an article from the Atlantic last January, Joshua Lang wrote a wonderful article about the challenge of deciding whether surgical anesthesia actually makes people unconscious, or whether people remember parts of their surgery and are traumatized by them later. In the article, he quotes George Wilson, a Scottish chemist who had his foot amputated in 1843, long before the existence of anesthesia. Wilson’s description of his surgical experience is visceral:

Of the agony it occasioned I will say nothing. Suffering so great as I underwent cannot be expressed in words, and fortunately cannot be recalled. The particular pangs are now forgotten, but the blank whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelms my heart, I can never forget, however gladly I would do so.

Anyone reading that amazing paragraph should have a glimpse of why post-traumatic stress disorder is such a serious problem. Memories can torture.
 

New Yorker Article on Medical Decision-Making

Here is a link to a New Yorker website article, exploring the challenges of helping patients understand their medical decisions. The author, a physician, makes mention of some of my research.
But that’s not the only reason I’m pointing towards the article.  🙂

 

PeterUbel