You Know Who Else Fails 'The Jimmy Kimmel Test?' Hospital Emergency Rooms

(Randy Holmes/ABC via Getty Images)

When Jimmy Kimmel’s child was diagnosed with a serious heart condition, Kimmel realized that people without his wealth (or his generous insurance coverage) would not be able to pay for the life-saving care that his child received, if their children were to be similarly ill. So he gave a moving monologue one evening, explaining why he now believes that healthcare policies should be judged by whether they keep finances from being a barrier to receiving lifesaving care, a view that some now call “The Jimmy Kimmel Test.”
Kimmel’s monologues on this topic have gone viral, but it doesn’t look like hospital ERs have gotten the message. Too often, they charge patients outrageous prices for their services, especially when people don’t have insurance.
Do you think these hospital ER prices are irrelevant for you, because you have insurance? Think again.
Suppose you are on vacation when your diabetes spins out of control. Or you are shopping at a local mall when you have a fainting spell. You are rushed to the nearest hospital by an ambulance crew to an emergency room, where you get an IV, an EKG, and other state-of-the-art care. All is good, until you receive the bill.
According to a recent study, if you happen to receive care in a for-profit hospital emergency department that’s out of your insurance network, you can expect a bill that’s almost six times higher than what Medicare would have paid for those same services. Did you get an EKG? Medicare would have paid $16 for that test. Your bill could be more than $300, a bill that you will have to pay, not your insurance company.
(To read the rest of this article, please visit Forbes.)

Burdened by High Medication Costs? Your Boss May Be Able to Help


Pharmaceutical companies have been charging way too much for way too many of their products. Both Donald Trump and Hillary Clinton complained about drug prices during the election campaign, but neither political party has taken action since November to tackle the problem. Insurance companies aren’t doing much about this problem either, despite having a huge incentive to tackle high prices.
But there is someone who appears to be up to the challenge – employers. According to a recent study in the New England Journal, a consortium of 55 Catholic organizations decided to redesign their employee healthcare benefits in 2013. Before that time, these organizations provided their employees with tiered co-pays for their medications. Under formulary tiers, a patient might pay $10 a month for generic drugs, $25 a month for brand-name drugs, and $100 or more per month for expensive specialty drugs and biologics. Tiered formularies are designed to motivate patients to use less expensive medications, because they carry lower co-pays. But such formularies are usually blunt motivational instruments. They might convince a patient to choose a generic medication rather than a brand-name cholesterol pill, but the patient will have no further incentive to choose the least expensive generic medication. Similarly, a patient with rheumatoid arthritis will face a significant co-pay for a biological therapy, but that co-pay won’t change from one biologic drug to another, even if those drugs have very different price tags.
That’s where reference pricing comes in, a topic I have written about before. The Catholic organizations got together and looked at different categories of medication, and decided how much they would pay for drugs within each category, with the understanding that patients would pick up the rest of the tab. For example, medications for stomach reflux range in price from $26 a month to almost $300 a month. The employers promised to cover $26 of the cost of whichever reflux medications patients chose to take. Similarly, patients who wanted to take $400 nasal inhalers for their allergies could go ahead and do that, but the insurer would only cover $34 of that price, given that an equally effective inhaler was available at that price.
(To read the rest of this article, please visit Forbes.)

Are Your Healthcare Prices Outrageous? Here's What Happens When Prices Come Out Of The Dark

They both had shoulder pain, persistent despite weeks of physical therapy. Both received MRI examinations at reputable radiology facilities, looking for things like rotator cuff tears, labral disruptions and other anatomical abnormalities. What was different was the price they paid for the MRI, with one patient paying $1000 more than the other. Welcome to the crazy American medical marketplace!
Health care prices in the US vary substantially across providers, in part because those prices are so often opaque. When primary care physicians order MRIs for their patients, for example, few patients shop around for affordable radiology centers. There is no reason to shop, because most probably wouldn’t find out what the price was anyway.
That may soon change, if promising results from a recent experiment hold true. The experiment was launched by AIM Specialty Health, an insurance-like company that tries to manage the cost of expensive tests and procedures. The company decided to call patients up on the phone whenever the patients had scheduled MRIs that were either substantially more expensive than competing providers, or were going to be performed by a radiology group rated as significantly lower in quality than its competitors.
After receiving these phone calls, some patients shrugged their aching shoulders and went to whichever facility they felt like going to, realizing they weren’t going to pay out-of-pocket for their MRIs anyway. For example, if a patient had reached her out-of-pocket maximum for the year, then going to a high priced MRI facility would not affect her pocketbook. So she might stick with her originally scheduled test. But other patients, once they learned about the price and quality of alternative providers, canceled their originally scheduled scans and rescheduled with a competitor.
(To read the rest of this article, please visit Forbes.)

Guess Who Is Struggling to Pay Their Medical Bills!

Here is a picture from the Kaiser Family Foundation showing which Americans were most likely to report problems paying medical bills last year. The sad news is that just about any way you divide it, a hell of a lot of Americans are having a heckuva time paying these bills:

Photo Credit: Kaiser Family Foundation
Photo Credit: Kaiser Family Foundation


Here's How a Great Doctor Helps Her Patient Make a Cost-Conscious Treatment Decision

Photo Credit: Consumer Reports
Photo Credit: Consumer Reports

Sometimes in my research on physician/patient communication, I come across a doctor who is so good with her patients, I have to share their bedside manner with you. The most recent example is a (to remain unnamed) oncologist in the Northeastern United States who practically gave a primer on shared decision making when caring for a patient with metastatic cancer.
The patient (I’ll call her Jennifer Decker) had stage 4 breast cancer, which had metastasized to liver and bone, the latter leaving her with substantial pain. Worse yet, a PET scan she received a week before her clinical appointment showed that the cancer had progressed significantly since her last test. “So we need to think about what to do next,” her oncologist explained.
A great statement, the idea of “we” – both doctor and patient – making a medical decision together. That’s a paradigm known as shared decision making, and is one that in my research I find is rarely achieved. Many doctors say they want to partner with patients in making healthcare choices, but most do not know how to accomplish this goal. Instead, they often earnestly overwhelm patients with well-intentioned information, at which point patients ask “what should I do?,” and the doctors point them towards treatments, even though they have done little to discuss what patients think about the pros and cons of their alternatives.
This oncologist, on the other hand, partnered like a pro. He explained that the first big choice Decker had to make was whether or not to have chemotherapy, to try to slow the spread of the cancer: “The biggest decision we’ve got to make right now is chemotherapy or not. Now chemo, thankfully, comes in a huge variety. There are probably a dozen drugs that work for breast cancer like yours. And you can use them one at a time. You don’t have to use two, three, or four.”
He explained some of the main differences between available treatments, the main one being that some treatments were given intravenously, meaning she would have to come into the clinic for treatment. But one treatment, Xeloda, could be taken as a pill, “and it’s not less chemo than any other product,” he assured her. He added, “if it doesn’t work, we have tons of other options you can switch to, but they are intravenous, so you have to come here and get an infusion.”
Decker asked a few questions and then told him she wanted to try one of the treatments: “I got to do what I need to do.”
The visit was already a p rimer on shared decision making, with the oncologist clearly and patiently explaining the patient’s treatment choices, simplifying the decision to its first branch point – chemo or not chemo – rather than overwhelming her with in-depth information on all her treatment options. Then, when he moved to the next branch of the decision tree, things got even more spectacular.
(To read the rest of the article, please visit Forbes.)

The Bills People Struggle to Pay

I post pretty regularly on out-of-pocket medical expenses, a topic I’ve been conducting research on, and one that will fit centrally into the new book I’m writing. Most often when people think about paying for medical care, they think about medications. But as this figure from the Kaiser Family Foundation shows, don’t forget about the cost of doctor visits, x-rays, blood tests and, of course, trips to the emergency room:

Photo Credit: Kaiser Family Foundation
Photo Credit: Kaiser Family Foundation


Inflation Crawls While Deductibles Sprint Ahead

With increasing frequency, Americans are purchasing health insurance plans that require high out-of-pocket costs. Chief among those costs are deductibles, the amount of money a person or family must spend out-of-pocket on medical care in a year before their health insurance “kicks in.” As this figure illustrates, from the Kaiser Family Foundation, deductibles have been rising much more quickly than overall inflation, than incomes, and than the cost of their health insurance premiums.
Inflation Crawls While Deductibles Sprint AheadBecause of these high deductibles, January and February have become months where many people, when faced with illness, are also faced with burdensome healthcare bills.

Talking To Your Doctor About Out-Of-Pocket Costs Can Save You Money

Healthcare is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year.

What’s a poor patient to do?

For starters–they can talk to their doctors about these costs. According to a study my colleagues and I just published, when healthcare costs come up for discussion during clinical appointments, doctors and patients increasingly discuss strategies for how to lower out-of-pocket expenditures.

In the study, we analyzed transcripts of almost 2,000 outpatient clinical appointments, appointments audio recorded and transcribed by Verilogue Inc., a marketing research firm whose CEO, Jamison Barnett, was generous enough to collaborate with us on this research. (Full disclosure: All the doctors and patients gave permission to be audio recorded by the company. Verilogue removed all identifying information from the transcripts. And my colleagues and I did not enter into any financial relationship with the company, nor cede any control over our right to publish our findings.)

We analyzed three groups of patients, all of whom potentially face high out-of-pocket costs: breast cancer patients seeing their oncologists; rheumatoid arthritis patients seeing their rheumatologists; and patients with depression seeing their psychiatrists. We looked for any conversation that touched on the topic of healthcare costs–from discussions of whether insurance would “cover” a specific service (or whether the patient would instead be responsible for its cost) to patient complaints about out-of-pocket costs they’d already incurred from services ordered by their doctors during previous appointments.

In the first article published from these analyses (recently released on the website of Medical Decision Making), we focused on the strategies doctors and patients discuss to reduce patient out-of-pocket costs. And what did we find? That discussion of cost-reducing strategies was both common and rare. Common, in that once healthcare costs came up in the conversation, discussion of cost-reducing strategies occurred almost 40% of the time. Rare, in that healthcare costs came up as a topic of conversation in only 22-38% of the out-patient visits, meaning that in the majority of encounters, there was no discussion of healthcare costs, and thus no discussion of how to reduce patients’ out-of-pocket expenditures. Here is a picture showing those findings:

Talking to Your Doctor About Out-of-Pocket Costs Can Save You Money Figure 1

Sometimes doctors and patients found ways to reduce out-of-pocket costs without changing the plan of care. For example, doctors would refer patients to copay assistance programs, or give them free medication samples. Sometimes they would play around with the logistics of care, moving an expensive test up to December rather than January, so that the patient would not have to start spending through her deductible again.

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

Sticking It to the… Employee!

Old news – healthcare costs are rising again. Older news – healthcare costs have been rising, faster than inflation, for most of the last half-century. Newer news – those costs are increasingly being born by employees rather than employers. Here’s a picture I came across at Vox, an excellent website for healthcare news.
Sticking It To The Employee

Stingy Insurance + Low Income = Bad Combination

The Commonwealth Fund recently circulated information on the widespread difficulty many Americans have paying for their medical care, even when they have insurance. Burdened by high co-pays and high coinsurance rates, these out-of-pocket expenses are putting people on the financial edge. Here is a picture of the results, which show that a third of people living at less than 200% of the federal poverty limit struggled paying for such services in the past 12 months:
Stingy Insurance + Low Income = Bad CombinationWe have an affordability problem in the US healthcare system!