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Costs, Schmosts!

modernmedicinenetworkTalk to your doctor about your out-of-pocket expenses. Ask about the cost of your meds. And await for the sound of silence! Sadly, that is too often what happens in medical clinics today. Here is a nice essay, exploring the topic, from a healthcare reporter.

With access to information about the costs of care, patients can make better choices about treatment paths that are aligned with their financial goals. Absent that information—or conversations with their physicians about costs—it’s virtually impossible for patients to incorporate this information into their decision-making.

Herein lies the problem: When physicians don’t talk to their patients about the cost of the care they receive, patients who are blindsided by medical bills may stop showing up for appointments, stop taking medications, and/or decide against pursuing their recommended treatment plans, which reduces the cost of care in the short term but can result in higher costs—for payers, providers, and patients—in the long term.

“We as physicians are trained to try to help patients weigh pros and cons [associated with treatment paths], but we don’t do that well when it comes to costs,” says Peter Ubel, MD, professor of business administration and medicine at Duke University. “Take an ultrasound, for example. A lot of [physicians] think, ‘What’s the downside? It’s a non-invasive test. I’ll just [order an ultrasound] and check the results.’”

What physicians often forget is that the cost of that ultrasound—which could be as much as $500—can “invade our patients’ wallets,” he says.

To read the rest of this article, please visit the Modern Medicine Network.


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Medicare Is Reducing the Cost of Knee Replacements (Here’s How That Could Backfire)

Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the United States doubled, to more than one million. Experts think the figure might rise sixfold more in the next couple decades, because of our aging population. Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. In response to this huge rise in expenditures, Medicare is experimenting with ways to reduce the cost of procedures. But that raises a disturbing possibility. If orthopedic surgeons make less money on each knee replacement they perform, they might start performing unnecessary procedures.

Consider Medicare’s recent experiments with reimbursing knee replacements according to “bundled payments.” Under such reimbursement, Medicare gives healthcare organizations a lump sum to cover the cost of a knee replacement–not just the cost of the operation but also the cost of post-operative x-rays, physical therapy, even time in nursing homes or rehab hospitals. Before bundled payment, providers would receive separate payments for each of these services, meaning inefficient providers might take more x-rays than necessary, or keep patients in rehab hospitals longer than they needed such comprehensive care, and be rewarded for this inefficiency by receiving additional payments. Under bundled payment, Medicare tracks all the knee-replacement costs for a given patient, over a 90-day period. If a patient incurs fewer expenses than expected, Medicare gives the providers part of these savings back as a reward. (Warning–this is a very oversimplified description of bundling.)

Early evidence suggests that bundled payments reduce the cost of knee replacements by an average of almost $1,200 per procedure. With a million such procedures performed in a year, that reduction could save over $1 billion. Moreover, these savings don’t seem to come at the expense of quality, at least as far as we can tell. (Quality measurement in healthcare is notoriously difficult.) For example, when knee replacements were paid for through bundled payments, there was no subsequent increase in readmission to the hospital or emergency room visits among patients whose procedures were reimbursed according to bundled payments. Same quality at a lower price–who could be against that?!

To read the rest of this article, please visit Forbes.

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Video Discussion of Healthy Eatin’

It is gratifying to occasionally see some of my blog posts picked up and developed by other folks, to spread the word about the topics I care about. Here is a blog post, and a video, that expands on one of my recent Forbes essays.

Increase sales, add excitement to the store, and you’re set. Easy. But a column by Peter Ubel on discusses how one’s willpower effects how a person responds to the taste of food. Grasping this concept in full just may change the ways in which stores offer food samples to influence customers –– and make them more effective in the end.

Ubel writes that there’s a trade-off consumers are faced with when deciding what to eat. Some foods are bad for our health but satisfy us with their taste. All of us have limited willpower, and when we’re exhausted, unhealthier foods become more difficult to resist.

Think about it: How many shoppers are exercising their best willpower when they’re rushing up and down the aisles of their local grocery store?

To read the rest of this article please visit, Progressive Grocer.

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The Right to Healthcare—Both Liberals and Conservatives Should Be Able to Make This Happen!

Here is an article in the Duke University student newspaper, summarizing a public forum I led last night. Really nice summary—almost makes me sound coherent!

In the midst of an ongoing debate about the future of the nation’s health care system, Duke professor Peter Ubel discussed the limitations of the current system and encouraged bipartisan solutions at a talk Monday.

Ubel, the Madge and Dennis T. McLawhorn University professor of business administration, medicine and public policy, suggested that policymakers should seek to achieve a minimum health care standard for the country. Solutions from both conservative and liberal politicians could be successful, he noted.

“I really think we have a right to a decent minimum of health care in this country. We ought to promote that right,” Ubel said. “There are liberal and conservative ways to meet that goal. I don’t really care that much [about] how we meet the goal, but let’s meet it.”

After Republicans maintained their majorities in both the House of Representatives and Senate during the 2016 elections, several prominent government officials—including President Donald Trump—have promised to repeal the current framework of Obamacare, but their plans for replacing the act remain unclear.

Ubel said that although the law’s future is unclear, Republicans may favor a consumer-oriented replacement, which would provide Americans more choice in their coverage and make the sector more privatized. He added that this approach, if chosen, could potentially have a successful outcome. He pointed to countries like Germany, which has a model with both the private and public sectors playing a role.

“If we’re going to move toward a more consumeristic health care system, I’m okay with that as long as it’s compassionate consumerism,” he said.

Keeping consumers informed of treatment options and quality control measures would be an important aspect of such policies, Ubel said. He added that most patients are often too uninformed to judge the health care options available to them.

To read the rest of this article, please visit The Chronicle.

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What Americans Are Eating – Now vs 2000

A JAMA study shows how our diets have changed since 2000. The big winners?


Whole grains

Whole fruits

The big losers?

Sugar sweetened beverages

Fruit juice

White potatoes

Photo Credit: JAMA

Photo Credit: JAMA

Maybe there’s hope for us after all?

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My Dad Makes the News. Kind of…

Data Visualization — Simplifying the Complex

When I graduated from college, I was chosen as one of the commencement speakers. In my speech, I pretended to be reading a letter I wrote to my father. My dad came to the graduation, completely unaware of my speech. When he heard me start reading the letter, he put his head in his hands and waited for the worst – he figured I would just try to roast him. I didn’t. Though I did joke that he referred to my school as a “liberal” arts college.

In any case, I’ve written about my dad a few other times, and one brief mention of my father, in my book Critical Decisions, just made it into a blog post written by a scholar at George Mason University. Here’s the beginning of that interesting post:

Healthcare innovation is more than new drugs, devices and procedures. As Digital Age patients play larger roles in determining their own health, an increasingly important area of innovation is data visualization — making complex, specialized information readily intuitive to laypeople.

Patient-oriented data visualization departs sharply from Western medicine’s 2,500-year legacy of paternalism. Since Hippocrates, medicine’s overarching assumption has been that physicians are vastly better informed than patients and that patients ought to obediently take orders from physicians. The Hippocratic Oath and later tracts codified the notion that physicians should even withhold information from patients — in part to keep them ignorant of decisions over which they were deemed incompetent to participate.

In December 1963, economist and 1972 Nobel laureate Kenneth Arrow penned the founding document of modern health economics (“Uncertainty and the Welfare Economics of Medical Care”). This article popularized the notion that healthcare differs from other industries because its producers (physicians) possess information that is vastly superior to that held by its consumers (patients).

A few weeks after Arrow’s article, however, another future Nobelist, Bob Dylan, noted that the times, they are a-changin’. Soon after Arrow’s article appeared, economic changes began to undermine its presumptions.

Physician Peter Ubel wrote, “When my father first practiced medicine in the 1950s, his pharmaceutical armamentarium included a handful of antibiotics and 2 or 3 antihypertensives. The most expensive diagnostic tests were plain film radiographs.” From then until today, medical knowledge grew far more complex. No physician could possess more than a small fraction of total medical knowledge. In the latter half of this post-Arrow world, the information technology revolution vastly increased laypeople’s access to medical information and to data on their individual health metrics.

To read the rest of this post, please visit Inside Sources.

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Why Rich People Hate Taxes — Hint: It’s Not for the Reasons You Think

Photo Credit: Fanpop

Photo Credit: Fanpop

I was raised in a family that hates taxes. Not hates taxes as in “Gosh, it’s too bad such a high percentage of my paycheck goes to the government.” More like: “How dare the government steal my hard-earned money and give it to undeserving moochers!” (Is there such a thing as a deserving moocher? Sorry, I digress.)

The origins of this anti-tax sentiment are deeply ideological, steeped in a frothy mix of conservative and libertarian principles. My family loves freedom, property rights, and the Protestant work ethic (even though they are Catholic). Their attitudes towards taxes spring forth from their deepest moral values. It’s not just the taxes that bother my parents and siblings, but the thought that income is being redistributed to unworthy people.

Or so it seems. Evidence is now accumulating that people’s attitudes towards topics like taxes and income redistribution are more fragile than many of us think, and that sometimes our desires – for social status, and for income we may or may not have earned – take hold on us, forcing us, unconsciously, to later embrace political ideologies that coincide with our preceding desires. When it comes to our attitudes towards taxes, we feel first and think later.

(To read the rest of this article, please visit Forbes.)


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Obamacare Hasn’t Killed Employer-Sponsored Health Insurance

Some people worried that the ACA would kill employer-sponsored health insurance, by giving employers an “out” – by letting them shift insurance to the exchanges. The ACA set up financial incentives, to reduce such shifting. And so far, it looks like it’s working:

Obamacare Hasn’t Killed Employer-Sponsored Health InsuranceStill quite early, of course. I’ll keep my eyes open for further developments.

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Hurrah for Community Health Centers

The U.S. healthcare system has an unsung hero – community health centers, which provide basic medical care for under-served communities. Even dental care! Right now 1 in 6 Medicaid enrollees receives care at one of these centers, a proportion that has been growing for decades:

hurrah for community health 1In some states, 1 in 3 enrollees use community health centers:

hurrah for community health 2Hopefully Medicaid programs will continue to work closely with such centers, to provide affordable, high quality care to needy Americans.

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A Surprising Way to Stop Eating so Many Brownies

I know why I sometimes eat too many brownies. They taste great! The same goes, of course, for a whole slew of desserts–I love me my strawberry rhubarb pie, and I never say no to a ginger snap. And while a touch of dessert is often a fine way to top off dinner, many of us get in trouble when we gorge on desserts.

So how can we get a taste of dessert without overindulging? This might sound weird, but try eating in front of a mirror–it will make junk food taste less delicious.

Bear with me while I explain the science behind this weird mirror research, and then show how that the finding is relevant whether or not you plan to actually eat in front of a mirror.

Normally, we think of how food tastes as being an objective phenomenon. Our taste buds tell us whether food is salty or sweet, tart or bland. But behavioral science has shown that our taste perceptions are influenced by a slew of unconscious factors. Give kids apples from a brown paper bag–meh. From a McDonald’s brown paper bag–yummy! Put green (tasteless) food coloring in a glass of orange juice–yuk! Tell someone a cracker is healthy–yawn. Describe the same cracker as unhealthy–delish!

(To read the rest of this article, please visit Forbes.)


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