It is Possible to Shop for Healthcare Bargains if You Can Access Them

Are you one of the many Americans facing potentially high healthcare costs? If you have a high deductible health plan, or even a medium deductible one; if you are expected to fork over substantial copays for medical care—I’ve got good news for you. There are potentially a lot of healthcare bargains out there, if you’re willing to dig around for them.

Consider the state of Massachusetts, a relatively high cost place to get healthcare. A recent study in Health Affairs showed that there was substantial variation in healthcare prices across the state for privately insured patients.

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

Oncologists Were Paid to Prescribe Generic Chemotherapy (Here’s Why It Didn’t Change a Thing)

Brand-name chemotherapy is often incredibly expensive, in excess of $100,000 per patient. Sometimes there are excellent generic alternatives, but many oncologists are hesitant to prescribe generics because such prescriptions cost them money. For many medicines, you see, oncologists receive a 6% markup, meaning when they infuse a patient with a $10,000 monthly course of chemotherapy, their practice yields an extra $600. By contrast, if the practice treated that patient with a generic chemotherapy, they’d be out most of that extra money.

A private insurer, UnitedHealthcare, tried to incentivize oncologists to prescribe generic chemotherapies by giving them financial bonuses for doing so. For example, a generic medication that would have previously been accompanied by a $12 markup now received a $500 one. That’s a lot of money; but, from the insurer’s perspective, it would have been more than made up by the savings accompanying the use of the generic drug. (In this case, the brand name drug costs $7,000 more than the generic equivalent.)

Fantastic idea, yes? Unfortunately, it didn’t increase generic prescribing one iota.

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

A Patient Complained about the Cost of Her Medical Care. Here's How Her Doctor Responded.

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The oncologist had prescribed Xgeva hoping it would strengthen her bones while also delaying the progression of Angela Kahn’s breast cancer. But Kahn (a pseudonym) couldn’t get over the price of the drug. Before the oncologist had a chance to ask how she was feeling, she blurted out that the medication cost “$15,000 a shot.” “That’s crazy,” the oncologist replied, continuing by saying the price “fits right in with the rest of the insanity” of U.S. healthcare pricing. At that price, Kahn concluded, “I don’t think I should get it.”

The oncologist assured her “You’re getting it,” and they both laughed.
Not that either thought Xgeva’s price was a laughing matter. In fact, like many medications, Xgeva costs much more in the U.S. than in any other developed countries, with a single injection costing more than $2,000.
There’s too many reasons for these high prices to delve into them in the space of a short essay. Instead, I want to show how the insanity of American healthcare prices played out in this one, real oncology appointment. (Note: The appointment was recorded by a marketing company, Verilogue Inc., with the permission of the doctor and patient. I gained access to an anonymized transcript of the appointment for a research project approved by the Duke University IRB.)
After assuring Kahn that she’d remain on the Xgeva, her oncologist explained how he believes healthcare pricing plays out in the U.S. “It’s totally outrageous. What usually happens is the hospital or the clinic will charge 300 times what they think they can get, and the insurance company pays 1/20th of the original.”
“Oh, okay,” Kahn replied, with a touch of confusion.
“So it’s just a game, it’s a total horrible game,” the oncologist continued. “That’s crazy,” Kahn reiterated.
(To read the rest of this article, please visit Forbes.)

How Doctors Turn Patients into Lobbyists

Some cancer patients and family members weighed in unknowingly during a public comment period last year on the Trump administration’s plan to cut a drug discount program for hospitals. (Matt Rourke/AP)

I recently spoke with a Washington Post reporter about a troubling practice. Physicians convince their patients to sign letters to influence public policies the patients often don’t understand. Here is the beginning of that piece. Check it out:

A proposal to sharply cut a drug discount program that many hospitals rely on drew some 1,400 comments when the Trump administration announced its plan last year. Hundreds appeared to come from patients across the country — pleas from average Americans whose treatments for diseases such as cancer depend on costly medicines.

But a review of the responses found that some individuals were not aware they apparently had become part of an organized campaign to oppose what’s known as the “340B” program. Some had no memory of signing anything, much less sending their opinions about it.

Of the 1,406 comments that specifically mentioned 340B — part of several thousand comments submitted on a broad proposal to revise medical payment systems — about half included the same or similar wording and were submitted anonymously, an analysis by Kaiser Health News found. Those comments lamented “abuse” of the drug discounts, faulted hospitals for being “greedy” and used phrasing such as “quality, affordable, and accessible.”

Two that were duplicated hundreds of times made the very same grammatical mistake.

They “are clearly related,” said Robert Leonard, a forensic linguistic expert at Hofstra University whose team analyzed the submissions for KHN.

In fact, the wording in the duplicate comments tracks language in a formal letter submitted to regulators by a nonprofit trade group, the Community Oncology Alliance, which receives funding from pharmaceutical companies. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said public comments played into the final decision on the 340B drug program. (Julio Cortez/AP)

Cancer survivor Janice Choiniere’s name is on a public comment saying reform of the 340B program will help “those suffering from this insidious disease.” But when reached by phone, the 69-year-old Florida resident said she had “no idea” what the program is and didn’t recall signing a petition.

“My first thought is, I don’t fill out and send in responses casually,” Choiniere said. “I’m hoping nobody lifted my information.”

To read the rest of this story, please visit The Washington Post.

Making Money by Getting an MRI?

MRI technologists move a patient from a MRI scanner at Wake Medical Center. Under a new program introduced by Blue Cross and Blue Shield, patients could receive cash rebates for choosing cheaper MRI facilities. N&O File photo.

Usually it costs money to get an MRI. But sometimes, in order to save money, insurance companies pay patients to seek less expensive medical care providers. Here is an excellent news report on the topic from The News & Observer:

North Carolina’s largest health insurer is proposing a solution to control runaway health care costs: paying people to use cheaper doctors and procedures.
Blue Cross and Blue Shield will offer customers between $25 and $500 per medical procedure for more than 100 procedures. The amount of the rebate depends on the procedure’s complexity and the cost savings of the cheaper option.
A Blue Cross spokesman pointed out that picking a cheaper option is more valuable than just the cash rebate.
“There is also the big cost-saving potential where you can shop, find a high-quality provider, and really reduce your out-of-pocket costs,” said Blue Cross spokesman Austin Vevurka.
Insurers have for years sought to influence patient decisions through co-payments and high deductibles as a shared financial responsibility for medical costs. Blue Cross is taking the concept further by offering to share savings with the customer as a thank-you for reducing costs. In the past, this approach has been tried by financially rewarding doctors and hospitals for achieving cost savings.
Some health care experts are excited at the prospect of pulling back the veil on health care costs, saying that pricing transparency is long overdue. But others warn that using money to influence private medical decisions can be harmful, noting that not all doctors are equal.
“I would caution patients to be careful,” said Raleigh orthopedist Dr. Bradley Vaughn who operates at UNC Rex Hospital. “If someone saves $500 from a hip or knee replacement and suffers a serious complication, that $500 will be a drop in the bucket compared to all the misery they’ll experience.”
Blue Cross is offering the SmartShopper only to companies that pay for their employees health insurance and health care. In these instances, Blue Cross only administers the plan. There are nearly 400 such employers in North Carolina administered by Blue Cross and their plans cover nearly 1 million employees.
So far, 10 of those companies have opted to offer SmartShopper to their employees. Blue Cross, which covers 3.8 million people in the state, is not offering SmartShopper to patients on individual plans and other employer-sponsored policies at this time.
The State Health Plan, the largest Blue Cross customer in the state, has opted not to buy the SmartShopper service for the 727,000 state employees, teachers, retirees and dependents it insures. State Health Plan spokesman Frank Lester said the service “did not add any value.”
Nationwide, SmartShopper has generated more than $56 million in savings for employers and has paid out $6.7 million in cash incentives to employees in the United States in the past four years, according to Vitals, the New Jersey company that launched the technology in 2015. It’s used by 230 employers and more the 20 health plans with 2.5 million members around the country, company spokeswoman Rosie Mattio said.

Is it ethical?

Several medical ethicists praised SmartShopper as a technology that empowers the public on health care costs that have for far too long remained hidden in a black box.
“I like the idea of paying people to pay attention to what they’re doing because of the principle of responsibility — pay attention to the cost of your choices,” said Lance Stell, a retired philosophy professor at Davidson College who taught medical ethics to residents at Carolinas Medical Center. “We want patients to be empowered.”
And Dr. Peter Ubel, a physician and health sector management professor at Duke University’s Fuqua School of Business, made a different ethical point. “When a gastro-enterologist charges way more than another one down the street, nobody was raising ethical concerns about that, and yet you may be responsible for 20 percent of the cost.”

To read the rest of this article, please visit The News & Observer.

Emergency Room Prices: They Are Outrageous, But I Am Not Blaming ER Clinicians

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Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs – either with no insurance or insurance that is out-of-network – they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services.

After the post, I was inundated with angry tweets and emails, mainly from emergency medicine physicians outraged that I would blame them for these prices.
Below, I lay out some of these criticisms. I don’t expect I’ll satisfy all my critics, but I certainly want them to know that I’ve heard them, and that much of their concerns were ones I already shared.
Blaming Doctors:
Physicians told me that I was blaming them for high ER fees. I even received an irate email from an emergency medicine physician working in Europe, saying I had offended her, a strange response given that I was writing about the United States. But I think I know why she was upset. I presented data on physician fees. But when health policy wonks, like me, talk about “physician fees,” we aren’t referring just to what doctors charge for their services. Instead, we are talking about all healthcare charges that aren’t part of a hospital bill. Terrible terminology, I know. But it goes back a long ways, to the separate evolution of Blue Cross insurance plans (set up by hospitals to cover their fees) and Blue Shield plans (set up by doctors to cover other medical bills—hence “physician fees”). This terminology even got carried forward into Medicare when it was formed, with Part A paying hospital bills and Part B paying physician services—including things like outpatient xrays, lab tests, EKGs, and the like.
Here’s the misunderstanding: To Medicare, ER bills are considered physician services, not hospital bills. So when I rightly criticized the high cost of ER care, it sounded like I was blaming physicians.
(To read the rest of this article, please visit Forbes.)

Bait and Switch: The Sneaky Way Your Employer Just Passed Healthcare Costs onto You

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If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their healthcare expenses.

Not long ago, having insurance coverage meant your costs were largely covered. Americans could count on their employers to offer health insurance plans that covered the vast majority of their healthcare expenses. What’s more, employers even chipped in generously to cover a good chunk of people’s monthly premiums. As a result, Americans with good jobs could live their lives unafraid that they would be financially devastated by an unexpected acute illness.

But this generosity came at an increasingly unaffordable cost for American companies, with the price of health insurance threatening their bottom line. In response, companies have looked for ways to get their workers to pick up more of the tab.

Enter high out-of-pocket health plans.
On the surface, these plans look like bargains, because they cost less each month than other plans. When signing up for insurance, many people are attracted to these plans, knowing they will have less of their take home pay diverted to an insurance company. But then they discover that even a minor illness can turn that bargain to a burden.
(To read the rest of this article, please visit Forbes.)

Is Federal Policy Really to Blame for the High Cost of Cancer Care?

(Photo By BSIP/UIG Via Getty Images)

U.S. healthcare costs have been high for decades, outpacing other developed countries since at least the 1980s. But costs continue to rise, and that is causing many experts to ask why. Some people blame federal policies. As an example, they point to reimbursement policies that create incentives for healthcare providers to consolidate. When hospitals merge with each other, or when hospitals buy out physician practices, healthcare providers gain negotiating leverage over insurers, which enables them to negotiate higher prices.

But what evidence do we have that federal policies are to blame for such consolidation?
(To read the rest of this article, please visit Forbes.)

How Physicians Respond to the Price of Lab Tests before Ordering Them

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Healthcare prices in the U.S. are often hidden. Some people think this price opacity contributes to our nation’s high healthcare spending. If people don’t know how expensive healthcare is, they won’t have much reason to restrain healthcare utilization.
recent study tested what would happen if physicians were immediately informed of the price of lab tests that they were planning to order for their patients. The study took place in three Philadelphia hospitals. The researchers randomized whether or not the electronic health record gave physicians price data on specific lab tests. For some lab tests, the computer never gave doctors price information; for other tests, they always got price information (after a baseline, so the researchers could establish how often doctors normally ordered the tests).
(To read the rest of this article, please visit Forbes.)

How a Leading Medical Journal Helped a Pharmaceutical Company Exaggerate Medication Benefits

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How excited would you be about a medication that lowered your risk of cardiovascular death, heart attack, or stroke by 1.5%? Excited enough to spend a few thousand dollars a year on the drug? I expect not.
What if, instead, the drug reduced those same terrible outcomes by 20%? That’s probably enough benefit to interest some in the drug.
Well, those statistics come from the same clinical trial, evaluating the same drug. In fact, they present the exact same results, but they simply do it in different ways. The 1.5% number refers to the absolute reduction in the risk of those outcomes—the drug reduced the two-year risk of cardiovascular death, heart attack, and stroke from 7.4% to 5.9%. That’s an important reduction by any account. That’s on par with many medications that have become critical in combating cardiovascular diseases. But that 1.5% reduction sounds much less impressive than the “20% reduction” that the authors describe in the discussion section of their New England Journal article, and was repeated, practically verbatim, by the physician who wrote an accompanying editorial in the same journal.
How can these experts claim a 20% reduction in risk when the study showed only a 1.5% reduction? Because 1.5% is approximately 20% of 7.4%. When summarizing the impact of this drug, the researchers and the editorialist chose to emphasize the relative risk reduction of the treatment rather than the absolute risk reduction.
(To read the rest of this article, please visit Forbes.)

PeterUbel