The Health Care Blog – Page 258 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

How Much Does it Cost to Have a Baby?

Sep 1, 2018

By Kenny Lin, MD

When my wife delivered our second child in 2008, the hospital sent our health insurance company a bill for $8569. The insurance company then wrote off $4117 of that bill, paid $4352, asked us for a copayment of $100. When we found out last year that we were expecting again, we noted that my wife’s new insurance plan requires us to pay 20% coinsurance for all non-preventive care. That would have amounted to several hundred dollars of our 2008 bill, and knowing the rapid rate of health care inflation, we thought it would be good to find out how much it would cost this time around. So we went back to the same hospital, where we expect our third child to be born in a few weeks, and asked if they could give us an estimate of the charges. It seemed like a reasonable enough request, especially since the pre-admission consent form we signed specifically said that patients had a right to know what the hospital charged for its services.

We’re just looking for a ballpark number for our flexible savings account, we said. The charge for an uneventful labor, vaginal delivery and single overnight stay. We understand that unexpected things can happen in childbirth, and we won’t hold you to it.

Cost Awareness in Health Care: An Idea Whose Time Has Come

Sep 1, 2018

By Christopher Moriates, MD

It didn’t take that long during intern year to realize that something was wrong. As I signed so many orders that my signature, once proudly readable, began its gradual but clear progression towards more abstraction, I eventually started to wonder just how much all of these tests were actually costing my patients. After all, once you start checking boxes on an order sheet, the “calcium/phos/mag” just seems to roll off of the tongue. However, not just how much was this “costing” patients financially, but also in potential risks, harms and adverse effects.

I particularly remember being bothered when told by an Emergency Room attending physician that I had to get the Head CT on my 28-year-old male patient presenting with a benign-sounding headache and a normal physical examination, “unless you could go in there and tell him that you personally can guarantee him with 100% certainty that he does not have something bad like a brain tumor.” This did not seem like a fair bar to hop, particularly having put the M.D. after my name a mere few months prior. So I scribbled my name on another form and with the whisk of my pen subjected this patient to a normal CT head examination, saddling this young man with a significant amount of radiation and a hospital bill that now included an approximately $2,500 imaging charge. Nobody seemed to flinch, but it got me thinking.

The Czar of Ebola

Sep 1, 2018

By JOHN IRVINE

As every American now knows, Ebola is a horrible African hemorrhagic fever with a high mortality rate and relatively low risk of transmission, except in cases where the disease is transmitted, where the risk of transmission is very high.

The disease has infected 8,000 people in West Africa. WHO officials predict that up to 1.5 million people could be infected by the end of January 2015.

In the United States Two people are known to have been infected with the disease. Both are nurses. Their names are Nina Pham an Amber Joy Vinson.

We now have an Ebola Czar to educate us about these facts and others as they become available.

Facing criticism from Congress this week over the handling of the crisis, President Obama named Ron Klain, a former chief of staff for vice president Joe Biden and Washington loyalist. Critics wanted either somebody with a medical backround or experience handling infectious diseases. Until yesterday, Klain worked for Steve Case.

Technically, of course Klain is not a czar, although almost everybody will call him by that title. His technical title is Federal Ebola Response Coordinator.

“He is smart, aggressive, and levelheaded; exactly the qualities we need in a czar to steer our response to Ebola,” said Sen. Charles Schumer (D., N.Y.).

“By appointing a Democrat political operative as the Ebola czar, it is clear that the president sees Ebola as a political crisis and not a health crisis,” said one critic, Rep. Bill Cassidy (R., La.).

Healthcare : The Case of the Patient Portal

Sep 1, 2018

Let’s stop calling them patient portals, for crying out loud.

It’s a relic of the early internet days; when you could go to this cool technology called the world wide web that let you peer into far away places which were new and candidly, otherworldly. Yahoo was a portal – waaaay back in the day. To me, it’s reminiscent of the old TV shows Land of the Lost dimensional portal and Star Trek machinations about the future. It conjures up quantum physics and a tear in the time-space continuum.

For some reason, the healthcare cognoscenti are as creative as a lizard when it comes to using language that is both welcoming and fresh.

Patient Portals sound sterile and distant. Furthermore, a portal is a gateway; both an entrance and an exit. Patients, or better, people want access. They want information like everyone else…and why are they called patients (separate post – coming soon).

We don’t log into an Apple Portal, a Facebook Portal or a Google Portal.

If the healthcare industry is attempting to create a lexicon that provides a friendly environment, we should look no further than our current world wide web, not the one from 1996. I have not seen any reference to portals on any website in 2014.

Why do have to label this type of access to our medical records or our doctor. Every other web-service has a log-in button and when you log-in, you have immediate access to the products and services. Simple.

Healthcare has a bad habit of using words that suck (hence my screeds). Hopefully we can change that by thinking outside of our stogy, large, healthcare box.

When healthcare treats patients more like people, we have a chance to re-frame the experience and the sad impression of our impenetrable Fortress Medicine

I welcome any ideas for better descriptions…if we need them.

Addiction Nature versus Nurture –Which? Both?

Sep 1, 2018

By TERRY M BENNETT, MD

For those of you who missed the first essay in this series, on the genetics of addiction, in all of us there is a genetic code, a code, which along with billions of other variations , contains a fairly common single gene genetic variation , the Folic Acid ( Vitamin B9) transport gene, which we can test for, using a cheek swab.

This deficient/diminished Folic Acid transport gene variation, present in many of us, slows or halts the transport of folic acid into our brains, predisposing us to lifetime depression and , in many cases, into early drug or alcohol experimentation, in an attempt to “feel better”. Why?

Folic acid is required by the brain in order to construct the neurotransmitter substances; Dopamine, Norepinephrine, and Seratonin. So, too little or no Folic acid present ,and too little or no brain neurotransmitters get constructed, and the patient’s darkened mood reflects that lack. Experimentation often follows early and often in such patients’ lives.
As most of you know, I run a Suboxone Clinic as well as a standard general practice, and I have yet to discover a Suboxone Clinic patient who transports Folic Acid normally from blood stream into their brain.

Spring Training for Health Care Teams

Sep 1, 2018

By Thomas H. Lee, MD

Two years ago, I wrote a piece in HBR called “Turning Doctors into Leaders,” which began with the sentence “The problem with health care is people like me” — that is, physicians who had been trained in an era when excellence in medicine was defined by what you did as an individual. In the short period since, the concept that medicine is actually a team sport has become increasingly accepted. Because of medical progress, there is too much to know, too much to do, and too many people involved to give patients excellent care, unless we get better at working in teams. A lot better.

Sounds good — but it’s a lot easier to write or talk about than to do. In fact, organization and collaboration are unnatural acts in much of medicine, where payment is still fee-for-service and the culture of individualism still dominates. Progress is being made — more in some regions and at some delivery systems than others. In this post, I will assess that progress by giving grades in various key functional areas akin to those that sportswriters are currently giving baseball teams as they get ready to break spring training. Like those sportswriters, I will try to blend optimism and realism.

Ability to put a team on the field — C. The payment system actually is changing, and ambitious pilots like Medicare’s Accountable Care Organization contracts are underway. In these new contracts, providers share heavily in savings and losses. And, as a provider, I can tell you that we really hate to lose (i.e., bear financial losses for care we have given).

E-Prescribing: Experiences from Physician Practices and Pharmacies

Sep 1, 2018

By Teresa Zayas-Cabán

The May 2012 edition of the Journal of the American Medical Informatics Association (JAMIA) offers the opportunity for a second look at an important recent study on e-prescribing. The study, “Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies,” examines practitioners’ experiences with this potentially game-changing technology.

The study, first available on the AMIA web site in November 2011, is now one of 12 articles included in the JAMIA issue on the “Focus on health information technology, electronic health records and their financial impact.” (It is available at no cost at http://jamia.bmj.com/content/current.) In the article, Joy M. Grossman, PhD, and colleagues from the Center for Studying Health System Change (HSC) conducted a qualitative analysis of 114 telephone interviews with representatives from 97 organizations including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions. This study is part of a larger qualitative project on e-prescribing. An earlier publication, released in May 2011, explored physician practice use of e-prescribing to access external information on patient medication histories, formularies and generic alternatives. It can be found at http://www.hschange.org/CONTENT/1202/.

The (Affordable!) Health Coach in Your Pocket

Sep 1, 2018

By Kim Krueger

Vida, a new health coaching app that connects users to coaches and educators for $15/week, launched commercially this week with $5 million in funding from Khosla Ventures and several others, as well as an on stage demo at Code Mobile.

Vida is the latest in a crop of health apps focused on tech-enabled services. The idea is a familiar one at this point, but something that health care has struggled with: how can we keep individuals with chronic illnesses on track between doctor’s appointments? The answer has historically required high-cost, high-touch programs, but now technology is helping those programs scale.

Founder and CEO Stephanie Tilenius and Chief Medical Officer Connie Chen sat down with Matthew Holt to explain how Vida works, how it’s currently being used, and what’s on the road map for the young, San Francisco-based company.

Kim Krueger is a Research Analyst at Health 2.0.

Matthew Holt Interviews Regina Holliday at HIMSS

Sep 1, 2018

By PRIYA KUMAR

Another in a series of interviews that should have been posted months ago, but Matthew Holt is just getting to now.

If you don’t Regina Holliday, well you should. Regina is a patient rights activist and artist, and she founded The Walking Gallery of Healthcare in 2009 after attending her first medical conference. We are also pretty sure that Health 2.0, in 2010, was the first conference she was invited to speak at! She is on a mission to amplify patients’ voice by painting jackets for patients and providers.

Several companies and individuals are now asking Regina Holliday to paint their story. Today, The Walking Gallery has a total of 43 artists and 400+ painted jackets. Individuals who believe in the movement are asked to join Regina at Salt and Pepper Studios in Maryland, and are able to paint their patient narrative. Matthew Holt caught up with Regina at HIMSS back in February, where her painting was sponsored by Xerox Health for the first time at the conference. A very interesting woman with a different approach to supporting patient rights.