It’s all about your money… or is it?
There are many reasons healthcare is as expensive as it is, including the advance of science and technology. But the absence of a competitive marketplace, overwhelming government regulations, and uncompensated mandates are also central to the problem.
Prior to government’s intrusion into the “sickness” market back in 1965 with the Medicare and Medicaid programs, patients could exchange a chicken for a tetanus shot. Patients knew their family physician as a friend. They did not find themselves waiting for hours in waiting rooms and they did not receive a surprise bill from the hospital when their insurance didn’t pay. Most often, they paid for their care at the door and it was affordable.
That said, a homeless person, injured on the street, would likely be able to walk out of the hospital after receiving emergent treatment after suffering an epidural hematoma (bleeding in the head). But, all the money in the world could not have saved Nastasha Richardson because she was unlucky enough to have hit her head in Canada, a government run and government rationed healthcare system where patients may not pay for their care.
In contrast, Americans decided that in the event of catastrophe, everyone will get care and every emergency room will be equipped to take care of a “real” emergency. It is a public commitment and we pay taxes to support that effort.
As we watch our government take over our lives and our health without debate or deliberation, we can only hope that Congress might start to take their “let’s deal with reality” medications and settle down to consider the precarious future they are navigating for America’s citizens.
Bear in mind that rationing in the case of Canada is not just about waiting in line to have your blood drawn or suffering an extra 3 years with back pain before your surgery is scheduled. Government run systems do make sure that treatment is NOT just about the money (our money). All the money in the world could not have saved Ms. Richardson. The government had already decided that helicopter transportation was NOT “appropriate or necessary” to move patients to medical centers where their lives would be saved.
In England, NICE, a group of so called experts, not unlike our new CER (Comparative Effectiveness Research) Committee, decided recently that a drug would NOT be made available for the treatment of some kinds of breast cancer. There is some good news in the case of British women who are diagnosed with breast cancer. They can still come to the United States and pay for treatment because we have not (yet) allowed our government to take over and destroy our most valuable possession, our RIGHT to make choices about our life and wellbeing and to pay for those choices personally.
Patients from all over the world who want to make a personal choice about their health care can still go outside their own government provided programs and insurance directed health care systems and purchase what they need in the marketplace, particularly if they are buying elective and routine services. On the other hand, American seniors who receive their care thru Medicare cannot purchase care from a Medicare provider (hospital or doctor) if the service is a “covered service.”
You can buy a mammogram for $75.00 and yearly lab work is less than $50. If a patient were to use their insurance to pay the claims, the mammogram would have been well over $200 and the lab over $200 and the claims would have paid as part of the deductible. Medicare pays the hospital (for the x-ray and the reading) $131.50 on average. Buying healthcare is not as much fun as shoe shopping but I would argue both are a necessity for our better health. As long as you are a non-Medicare senior, health care is affordable and negotiable.
If Americans would follow the trail of dollars spent in healthcare, they would soon
realize it is government mandates, regulations, and price setting that have accelerated the
rise in costs in health care, the same government who wants to tax and spend its way into our hearts and medicine bottles. The Massachusetts experience reinforces the fact that government intrusions only increase the cost of care. But, America’s free market, available to the world, remains the best opportunity to invest in our health. It isn’t about the money; it’s about our freedom to make life choices. It’s about life and death, America’s life and death and the preservation of our basic liberties.
Monday, May 11, 2009
Tuesday, April 7, 2009
Ordinary People
I’m sorry for Mr. Daschle. After lobbying the entire country, giving speeches to the tune of over 5 million dollars over several years, and writing a book, Mr. Daschle, his Senate partners and the president thought that he would be “the person” to redirect the delivery of American health care. But, President Obama reconsidered his nomination when it was clear that Mr. Daschle had stepped outside the “acceptable” and the Senator withdrew his nomination.
I understand that our elected officials really believe that they are “prominent.” Whether its paying taxes or how they drive or fly to work, they don’t do it like we do. The President said it all when he referred to you and to me as “ordinary.”
I am an “ordinary” doctor and I take care of what President Obama describes as “ordinary” patients. That said, there is not a day when government regulations and mandates get in the way of my opportunity to give my patients a better day. Every day, I spend hours filling out forms so that the government directed Medicare Part D pharmacy plan might approve the medication that my patient has taken for the last 10 years. A person (I’m sure ordinary) who has never met my patient and has no specific education will decide if we might continue my patient’s life saving medication. This is the plan that Congress has written for us ordinary people.
Every day, my patients share their most innermost secrets and I deliberate a life strategy with them. It’s a great job, a privileged profession. And it works wonderfully when the government doesn’t think that they know better.
The recently published survey by the Physicians’ Foundation demonstrated that the ordinary doctor has just about had enough. 150,000 physicians are predicted to be leaving the clinical practice of medicine within the next 3 years mostly because of regulatory restrictions and obstructions to care. In the meantime, our elected officials have voted to expand the SCHIP program by millions of patients. The SCHIP program is heavily regulated and not many physicians accept SCHIP and Medical insurance. Who will take care of these ordinary people?
Personally, I am NOT comforted by the idea that Barney Frank or Harry Reid will be voting on the appropriate treatment for colon cancer. Nor, do I believe Congress has any business in the personal lives of ordinary people.
As part of the stimulus package, Congress wants to spend taxpayer dollars to assist physicians in their purchase of office based EMR (electronic medical records) systems even though it has been clearly demonstrated that the systems currently available decrease productivity and may actually increase medical errors. In exchange for government assistance, we would be required to give the government patient data. No thank you … I took an oath. Congress and CMS (Medicare) continue to push P4P (Pay for Performance) systems when government studies show that these programs don’t increase quality and decrease cost. Cynically, I wonder if this is part of a stimulus package to push paper.
What we do know is that individualized, personalized care based on the patient-doctor relationship reduces cost, decreases hospitalizations in number and length of stay, increases the quality of care, and increases patient productivity.
Just today, I had the most inspiring experience. An 86 year-old teacher who has been my patient for over two decades completed CT scans of his lung, abdomen, and pelvis to evaluate his cancer. 14 months ago, this otherwise very healthy teacher and sailor had faith in our relationship and agreed to have his hepatoma (liver cancer) surgically removed, not the usual treatment for a man his age. A year later, when he developed metastasis, we asked him to consider chemotherapy. Together and with his oncologist, we strategized his chemotherapy and his general care, again a protocol that was not written anywhere. We believed he could decrease his lung lesions and improve his air hunger. Today, his scans show that he is clear of cancer. I cried.
I’m sorry Mr. Daschle. I’m sorry for all those who will follow you. You can write books about government run health care systems and the government can continue to create any number of regulations hoping to control our patients’ private lives. But you will never feel the ecstasy that I feel right now. Ordinary patients who have indefatigable trust in their ordinary doctors will always have faith in the miracles we make happen every day.
I understand that our elected officials really believe that they are “prominent.” Whether its paying taxes or how they drive or fly to work, they don’t do it like we do. The President said it all when he referred to you and to me as “ordinary.”
I am an “ordinary” doctor and I take care of what President Obama describes as “ordinary” patients. That said, there is not a day when government regulations and mandates get in the way of my opportunity to give my patients a better day. Every day, I spend hours filling out forms so that the government directed Medicare Part D pharmacy plan might approve the medication that my patient has taken for the last 10 years. A person (I’m sure ordinary) who has never met my patient and has no specific education will decide if we might continue my patient’s life saving medication. This is the plan that Congress has written for us ordinary people.
Every day, my patients share their most innermost secrets and I deliberate a life strategy with them. It’s a great job, a privileged profession. And it works wonderfully when the government doesn’t think that they know better.
The recently published survey by the Physicians’ Foundation demonstrated that the ordinary doctor has just about had enough. 150,000 physicians are predicted to be leaving the clinical practice of medicine within the next 3 years mostly because of regulatory restrictions and obstructions to care. In the meantime, our elected officials have voted to expand the SCHIP program by millions of patients. The SCHIP program is heavily regulated and not many physicians accept SCHIP and Medical insurance. Who will take care of these ordinary people?
Personally, I am NOT comforted by the idea that Barney Frank or Harry Reid will be voting on the appropriate treatment for colon cancer. Nor, do I believe Congress has any business in the personal lives of ordinary people.
As part of the stimulus package, Congress wants to spend taxpayer dollars to assist physicians in their purchase of office based EMR (electronic medical records) systems even though it has been clearly demonstrated that the systems currently available decrease productivity and may actually increase medical errors. In exchange for government assistance, we would be required to give the government patient data. No thank you … I took an oath. Congress and CMS (Medicare) continue to push P4P (Pay for Performance) systems when government studies show that these programs don’t increase quality and decrease cost. Cynically, I wonder if this is part of a stimulus package to push paper.
What we do know is that individualized, personalized care based on the patient-doctor relationship reduces cost, decreases hospitalizations in number and length of stay, increases the quality of care, and increases patient productivity.
Just today, I had the most inspiring experience. An 86 year-old teacher who has been my patient for over two decades completed CT scans of his lung, abdomen, and pelvis to evaluate his cancer. 14 months ago, this otherwise very healthy teacher and sailor had faith in our relationship and agreed to have his hepatoma (liver cancer) surgically removed, not the usual treatment for a man his age. A year later, when he developed metastasis, we asked him to consider chemotherapy. Together and with his oncologist, we strategized his chemotherapy and his general care, again a protocol that was not written anywhere. We believed he could decrease his lung lesions and improve his air hunger. Today, his scans show that he is clear of cancer. I cried.
I’m sorry Mr. Daschle. I’m sorry for all those who will follow you. You can write books about government run health care systems and the government can continue to create any number of regulations hoping to control our patients’ private lives. But you will never feel the ecstasy that I feel right now. Ordinary patients who have indefatigable trust in their ordinary doctors will always have faith in the miracles we make happen every day.
a medical home
THE MEDICAL HOME- a perspective
I remember growing up in a small community in Ohio and feeling comforted by the fact that my mom was always home to greet me after school or to pick me up to take me to my special activity. Dad was consistently home for dinner. Life was routine. I felt secure and comfortable. That’s probably what most of us feel when we think of home: a place where we are comforted, where there is some sort of stability. That place where we can close our eyes and know where the refrigerator is. Home is the place where we know we belong.
When I became a doctor, I tried to give my patients that same feeling about my office. I understood that healthcare was about relationships, communication, and cooperation: the patient/doctor relationship, doctor/doctor communications, and doctor/nurse cooperation.
I chose not to employ a nurse practitioner because I want my patients to always know that I am there for them. I chose to make most of my own calls to colleagues because I feel that is the best means of communication. Patients who choose me as their doctor know how our office works because we are purposely transparent; no need to lock up the food in this office. We invite all our patients to come in sit down and get to know us.
Over four years ago, I divorced myself from the “care follows financing” healthcare delivery system that has overcome our industry. I started to work directly for my patients as a concierge physician in order to “practice my profession.” I retrofitted a better medical home. Since that time, my patients and I live in a comfort zone; knowing that 24/7, there is someone to answer the phone and it’s usually me.
You can imagine the sick feeling that overwhelmed me when I was asked by experts leading the government’s conversation in health care reform, “who was on my team?” Team? Had my cozy medical home suddenly become an orphanage of residents in need of a team (presumably of social workers and case managers)?
Those of us engaged in the practice of “direct care” have built a business around a medical home that belongs to our patients. Our model is built to provide care in a comfortable and consistent setting. It is not just the pictures on the walls that make our (medical) homes peaceful and personal. It’s the welcoming gestures and the mutual respect that comes with taking the time to really listen to our patients and to coordinate a strategy that offers them that better day.
It’s helpful that the reception area is not overflowing with waiting patients exchanging detached glances but rather there is great coffee, cheese and crackers, and plenty of great big comfy chairs that are not chained to the wall. No patient appreciates or deserves a cold chair, a chilling stare, or that awful closed glass window when they are anticipating bad news. Visions of the movie “Home Alone” do not conjure up an image of paper gowns or cold empty rooms. That’s why we use thick jersey spa gowns when we ask our patients to change into their exam attire.
And just like families, medical homes come in all sizes and shapes. Mostly they suit the needs of the professional and his or her patients. Most of the practices are limited in number in order to provide the time necessary to do our jobs. Sharing is an integral part of most every home and it’s a part of most direct practices. While charity is not common in government run institutions, it is a natural element in the lives of most professionals the world over.
Over 10% of the patients in my practice pay me nothing and they get precisely the same care as the patients who pay me. It’s a pleasure and a privilege to give back and know that I have the time to offer my expertise, my life is enhanced and the lives of my patients are improved as well. My patients donate time to 501C-3 organizations in exchange for my scholarship. Everyone wins.
An open door policy isn’t as brutal as people seem it think. It isn’t hard being available 24/7. Usually, it means a phone call from a friend in need: someone I know well. When asked, most Americans say that they want access to affordable health care, the knowledge that their doctor is available. It’s always nice to have a key to the front door, so to speak.
The passion that my colleagues and I have to preserve the medical home and the sanctity of the relationship(s) that we have with our patients is as real as our patients’ trust and love. The necessity to safeguard the professionalism that we have earned so that we can provide the discretionary judgment to assist our patients with decisions about life and death is indispensable to the conservation of the integrity of the science.
America was built around the principle of a supportive family. Over the years, reams have been written about the disintegration of the family unit as the root of much of our cultural chaos. I don’t really think it takes a community if the comforts of home are maintained with consistency.
Healthcare is not much different. The inability for a patient to have their own personal doctor, someone who knows him (or her) who will advocate for them is probably the greatest frustration suffered by Americans in need of care. I would hope that America would work hard to maintain the “old fashioned” medical home before we purposely turn mom and dad into matrons of an orphanage where no one has a place to call their own and everyone is served the same dull pabulum in place of a nutritious meatloaf every Monday.
Home sweet home is not an institution to be judged by the federal government. It is a place we go to belong, to reinvigorate, to strategize and build our lives. Medical homes belong to our patients and must never become government fashioned institutions. Dickens wrote fiction about a failed cultural era that dehumanized children and sanctioned disrespect and cruelty. We must not allow his historical perspective to become a 21st century American reality.
I remember growing up in a small community in Ohio and feeling comforted by the fact that my mom was always home to greet me after school or to pick me up to take me to my special activity. Dad was consistently home for dinner. Life was routine. I felt secure and comfortable. That’s probably what most of us feel when we think of home: a place where we are comforted, where there is some sort of stability. That place where we can close our eyes and know where the refrigerator is. Home is the place where we know we belong.
When I became a doctor, I tried to give my patients that same feeling about my office. I understood that healthcare was about relationships, communication, and cooperation: the patient/doctor relationship, doctor/doctor communications, and doctor/nurse cooperation.
I chose not to employ a nurse practitioner because I want my patients to always know that I am there for them. I chose to make most of my own calls to colleagues because I feel that is the best means of communication. Patients who choose me as their doctor know how our office works because we are purposely transparent; no need to lock up the food in this office. We invite all our patients to come in sit down and get to know us.
Over four years ago, I divorced myself from the “care follows financing” healthcare delivery system that has overcome our industry. I started to work directly for my patients as a concierge physician in order to “practice my profession.” I retrofitted a better medical home. Since that time, my patients and I live in a comfort zone; knowing that 24/7, there is someone to answer the phone and it’s usually me.
You can imagine the sick feeling that overwhelmed me when I was asked by experts leading the government’s conversation in health care reform, “who was on my team?” Team? Had my cozy medical home suddenly become an orphanage of residents in need of a team (presumably of social workers and case managers)?
Those of us engaged in the practice of “direct care” have built a business around a medical home that belongs to our patients. Our model is built to provide care in a comfortable and consistent setting. It is not just the pictures on the walls that make our (medical) homes peaceful and personal. It’s the welcoming gestures and the mutual respect that comes with taking the time to really listen to our patients and to coordinate a strategy that offers them that better day.
It’s helpful that the reception area is not overflowing with waiting patients exchanging detached glances but rather there is great coffee, cheese and crackers, and plenty of great big comfy chairs that are not chained to the wall. No patient appreciates or deserves a cold chair, a chilling stare, or that awful closed glass window when they are anticipating bad news. Visions of the movie “Home Alone” do not conjure up an image of paper gowns or cold empty rooms. That’s why we use thick jersey spa gowns when we ask our patients to change into their exam attire.
And just like families, medical homes come in all sizes and shapes. Mostly they suit the needs of the professional and his or her patients. Most of the practices are limited in number in order to provide the time necessary to do our jobs. Sharing is an integral part of most every home and it’s a part of most direct practices. While charity is not common in government run institutions, it is a natural element in the lives of most professionals the world over.
Over 10% of the patients in my practice pay me nothing and they get precisely the same care as the patients who pay me. It’s a pleasure and a privilege to give back and know that I have the time to offer my expertise, my life is enhanced and the lives of my patients are improved as well. My patients donate time to 501C-3 organizations in exchange for my scholarship. Everyone wins.
An open door policy isn’t as brutal as people seem it think. It isn’t hard being available 24/7. Usually, it means a phone call from a friend in need: someone I know well. When asked, most Americans say that they want access to affordable health care, the knowledge that their doctor is available. It’s always nice to have a key to the front door, so to speak.
The passion that my colleagues and I have to preserve the medical home and the sanctity of the relationship(s) that we have with our patients is as real as our patients’ trust and love. The necessity to safeguard the professionalism that we have earned so that we can provide the discretionary judgment to assist our patients with decisions about life and death is indispensable to the conservation of the integrity of the science.
America was built around the principle of a supportive family. Over the years, reams have been written about the disintegration of the family unit as the root of much of our cultural chaos. I don’t really think it takes a community if the comforts of home are maintained with consistency.
Healthcare is not much different. The inability for a patient to have their own personal doctor, someone who knows him (or her) who will advocate for them is probably the greatest frustration suffered by Americans in need of care. I would hope that America would work hard to maintain the “old fashioned” medical home before we purposely turn mom and dad into matrons of an orphanage where no one has a place to call their own and everyone is served the same dull pabulum in place of a nutritious meatloaf every Monday.
Home sweet home is not an institution to be judged by the federal government. It is a place we go to belong, to reinvigorate, to strategize and build our lives. Medical homes belong to our patients and must never become government fashioned institutions. Dickens wrote fiction about a failed cultural era that dehumanized children and sanctioned disrespect and cruelty. We must not allow his historical perspective to become a 21st century American reality.
Saturday, January 3, 2009
Dear Santa letter 2008
Dear Santa:
This is truly a monumental moment for me. Being Jewish, I have never had the urge to write to you, but in the spirit of "change" and crossing over, I had this overwhelming need for audacious hope and a prayer. Being Jewish, I accept the stereotype of sometimes arriving late to the party. That said, my wishes are priceless if not timeless.
My list is short. I am only asking for reason and sensibility to come to our nation and our leaders. And, if you'll throw in ethical behavior and a sense of morality, I'll leave extra milk and cookies.
You see, even as a graduate of Wellesley in Economics, I can't grasp the concept of purchasing a "legal" swap in the face of selling short. Isn't that sort of like buying fire insurance while your house is burning and knowing that with the taxpayer's help, you'll recover your mortgage and enough to buy another luxury condo? I mean, talk about Christmas. Rep. Barney Frank and his buddies in Congress must have had a few too many hot toddies when they were thinking that they could actually regulate and mandate "toxic" mortgages for the poor and get the taxpayer to pay for their "vision."
My concern is that this same "team" is going to continue to make decisions affecting my future and the future of all our children. They are about to embark on decisions regarding the health of the nation.
To date, this discussion about health care reform really has me guessing what medication combination this country has been taking... clearly an overdose. It is not clear how we can rationally discuss "health" insurance. Health is not an insurable commodity. Rather, sickness is the unpredictable event that we might insure and health is an investment, like buying good shoes or wearing a warm coat (with a wool lining in the winter months).
Trying to insure the health of all Americans is likely to bankrupt the nation for sure. Massachusetts, a state smaller than the county of Los Angeles is already in financial trouble and they are only two years into their state system having insured an additional 3% of their residents. Hawaii had to pull the plug this year on its new state-funded health insurance program for children when it found out that virtually all of the children in the program previously had insurance, but their parents had dropped it in order to sign the children up for for the new taxpayer-funded program. (Now you see why I am asking for "reason.")
If you could just inject good sense into Secretary-designate Daschle's brain, maybe he would see the way to suggesting that the government might only provide catastrophic insurance (even in the Medicare program) and only for those who are not able to make their own purchase. I know that you can help our leaders with the intellectual argument that government controlled, population based health care is just not good for any individual person. It is politically correct and very expensive egalitarianism. But, if in the end, the reform we engage is reforming our government mandated insurance opportunities to mean ONLY catastrophic insurance for sickness or accident, we will have allowed for the purchase of valued additional health benefits in a free market. Santa, this is the rational conversation that I am putting at the top of my list of wishes. Americans deserve no less.
Reason would suggest that all Americans should make their own personal investment in their life and in their health. That was the intent of our forefathers when they constructed the constitution and established our protected rights. Those rights did NOT include any obligations on the part of the government to impose the services of hospitals, physicians, or employers to guarantee a level of health or preventive care. Our rights are our opportunities to engage and do not include obligations of any professional to serve us.
If we are going to legitimately engage reform, we must first confirm our duty to deal with confirmed fact. (I guess that is another wish. Could you spread a whiff of intellectual integrity over all the conversations about health reform?) Health is indefinable on a "population basis.” We resort to the discussion about insurance when we really want to talk about affordable accessible care. We have never been able to successfully "sell" health across a population. Let's stop that conversation before it bankrupts us further.
Reason would have us believe that every American deserves health care choices and that those choices should be "value based.” Reason would suggest that we need to make our health care delivery system transparent (that does not mean that the government has a right to any patient's health record). It is time that hospitals and doctors post retail prices. Rational health care purchases can only be made with information about cost and the specific utility for an individual patient.
And finally, Santa, as long as we are "facing the facts,” I would ask that we engage a societal debate about the morality of establishing law that defacto creates a class of citizens who are forced into retirement and Medicare at a defined age. Morally, the nation has decided to pay for the continued "health" for those seniors who are mandated into a (relative) non-productive state of co-dependence. But, that decision fails to protect the working public and sanctions an economically unsound system that robs the elderly of their opportunity for continued productivity and taxes "pre-seniors" far too heavily. That 1965 decision was about power and lacked reason and forethought.
It would seem that any debate about health care reform must include a much fuller discussion about all the social systems the government has mandated since 1965 when the nation established this new sense of moral collectivism… but forgot to fund it. Unfortunately, in that new "morality" the rights of individualism that were truly the basis of our constitution were thrown overboard, much like tea from a ship moored in Boston.
Santa, it is reason, rational thought, and responsible debate that every American deserves to hear in the Congressional deliberations about reforming the means by which we deliver sickness insurance and health opportunities to America’s patients. Most important, please infuse a new sense of respect for the rights of every individual to make their own choices for their health and for their life.
PS: next year… if all goes well, you’ll find physicians’ waiting rooms filled with patients eager to speak with their individual doctor about their personal health choices and that better day that our forefathers dreamt would be every American’s dream: the right to personally invest in life and health in pursuit of happiness.
Marcy Zwelling-Aamot, MD FACEP
562-596-7584
Los Alamitos, California
This is truly a monumental moment for me. Being Jewish, I have never had the urge to write to you, but in the spirit of "change" and crossing over, I had this overwhelming need for audacious hope and a prayer. Being Jewish, I accept the stereotype of sometimes arriving late to the party. That said, my wishes are priceless if not timeless.
My list is short. I am only asking for reason and sensibility to come to our nation and our leaders. And, if you'll throw in ethical behavior and a sense of morality, I'll leave extra milk and cookies.
You see, even as a graduate of Wellesley in Economics, I can't grasp the concept of purchasing a "legal" swap in the face of selling short. Isn't that sort of like buying fire insurance while your house is burning and knowing that with the taxpayer's help, you'll recover your mortgage and enough to buy another luxury condo? I mean, talk about Christmas. Rep. Barney Frank and his buddies in Congress must have had a few too many hot toddies when they were thinking that they could actually regulate and mandate "toxic" mortgages for the poor and get the taxpayer to pay for their "vision."
My concern is that this same "team" is going to continue to make decisions affecting my future and the future of all our children. They are about to embark on decisions regarding the health of the nation.
To date, this discussion about health care reform really has me guessing what medication combination this country has been taking... clearly an overdose. It is not clear how we can rationally discuss "health" insurance. Health is not an insurable commodity. Rather, sickness is the unpredictable event that we might insure and health is an investment, like buying good shoes or wearing a warm coat (with a wool lining in the winter months).
Trying to insure the health of all Americans is likely to bankrupt the nation for sure. Massachusetts, a state smaller than the county of Los Angeles is already in financial trouble and they are only two years into their state system having insured an additional 3% of their residents. Hawaii had to pull the plug this year on its new state-funded health insurance program for children when it found out that virtually all of the children in the program previously had insurance, but their parents had dropped it in order to sign the children up for for the new taxpayer-funded program. (Now you see why I am asking for "reason.")
If you could just inject good sense into Secretary-designate Daschle's brain, maybe he would see the way to suggesting that the government might only provide catastrophic insurance (even in the Medicare program) and only for those who are not able to make their own purchase. I know that you can help our leaders with the intellectual argument that government controlled, population based health care is just not good for any individual person. It is politically correct and very expensive egalitarianism. But, if in the end, the reform we engage is reforming our government mandated insurance opportunities to mean ONLY catastrophic insurance for sickness or accident, we will have allowed for the purchase of valued additional health benefits in a free market. Santa, this is the rational conversation that I am putting at the top of my list of wishes. Americans deserve no less.
Reason would suggest that all Americans should make their own personal investment in their life and in their health. That was the intent of our forefathers when they constructed the constitution and established our protected rights. Those rights did NOT include any obligations on the part of the government to impose the services of hospitals, physicians, or employers to guarantee a level of health or preventive care. Our rights are our opportunities to engage and do not include obligations of any professional to serve us.
If we are going to legitimately engage reform, we must first confirm our duty to deal with confirmed fact. (I guess that is another wish. Could you spread a whiff of intellectual integrity over all the conversations about health reform?) Health is indefinable on a "population basis.” We resort to the discussion about insurance when we really want to talk about affordable accessible care. We have never been able to successfully "sell" health across a population. Let's stop that conversation before it bankrupts us further.
Reason would have us believe that every American deserves health care choices and that those choices should be "value based.” Reason would suggest that we need to make our health care delivery system transparent (that does not mean that the government has a right to any patient's health record). It is time that hospitals and doctors post retail prices. Rational health care purchases can only be made with information about cost and the specific utility for an individual patient.
And finally, Santa, as long as we are "facing the facts,” I would ask that we engage a societal debate about the morality of establishing law that defacto creates a class of citizens who are forced into retirement and Medicare at a defined age. Morally, the nation has decided to pay for the continued "health" for those seniors who are mandated into a (relative) non-productive state of co-dependence. But, that decision fails to protect the working public and sanctions an economically unsound system that robs the elderly of their opportunity for continued productivity and taxes "pre-seniors" far too heavily. That 1965 decision was about power and lacked reason and forethought.
It would seem that any debate about health care reform must include a much fuller discussion about all the social systems the government has mandated since 1965 when the nation established this new sense of moral collectivism… but forgot to fund it. Unfortunately, in that new "morality" the rights of individualism that were truly the basis of our constitution were thrown overboard, much like tea from a ship moored in Boston.
Santa, it is reason, rational thought, and responsible debate that every American deserves to hear in the Congressional deliberations about reforming the means by which we deliver sickness insurance and health opportunities to America’s patients. Most important, please infuse a new sense of respect for the rights of every individual to make their own choices for their health and for their life.
PS: next year… if all goes well, you’ll find physicians’ waiting rooms filled with patients eager to speak with their individual doctor about their personal health choices and that better day that our forefathers dreamt would be every American’s dream: the right to personally invest in life and health in pursuit of happiness.
Marcy Zwelling-Aamot, MD FACEP
562-596-7584
Los Alamitos, California
Letter to the editor
Below is a letter to the editor in reference to this article..
Thank you so much for some very good suggestions about saving money while maintaining good health in your article Cut health costs, not your care, (December 9, 2008). I would like to add that investing in a medical home thru a physician engaged in a "direct practice" is another means of investing in your health. Providing a retainer up front to pay for all your care is a wonderful means of making sure that you have an ongoing relationship with a caring physician thru the year for relatively few dollars. Imagine being able to talk to your physician thru an email or having your doctor's cell phone number. Why waste money and time in a waiting room or an emergency room? Investing in a relationship with a primary care physician with your HSA or FSA dollars is a great opportunity to get the best care for fewer dollars and the cost of catastrophic insurance is far less than the usual HMO or PPO. Personal choice is not expensive and the value is "priceless."
Marcy L Zwelling-Aamot, MD FACEP
562-596-7584
Marcy@choicecare.md
From the Los Angeles Times
Cut health costs, not your care
Balancing your budget shouldn't mean your health pays the price. Here are smart ways to manage both.
This is an expanded first installment of an ongoing Health feature on cutting costs, not care--with tips for balancing your health and budget needs. Part one covers: Drugs, Doctor visits, Surgery, Flexible spending accounts, Preventive care, and Insurance.
By Francesca Lunzer Kritz
December 29, 2008
Amber Eyerly, 32, says she's never been much good at saving money. But with only minimal raises, at best, expected for 2009 at the Los Angeles public relations firm where she works, Eyerly carefully studied her health insurance benefits package this year to see where she could trim costs.
She made one cut for 2009 by signing up for a medical flexible spending account, which takes money, pre-tax, from each paycheck to spend on healthcare costs and reduces her taxable income. And when she read that, unlike trips to a specialist, visits to her primary care doctor don't require her to first pay down a health insurance deductible, Eyerly arranged to have her dermatology records for a minor skin condition sent to her primary care physician, who now writes prescriptions for any dermatology medicines the young executive needs.
Eyerly's personal health cost review is being repeated across the country, as the economic downturn worsens and jobs -- and the benefits that often come with them -- get slashed. "Millions of consumers are weighing their medical costs and trying to see what expenses they can jettison to save some money," says Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt. A Watson survey of 2,500 U.S. employees released this month found that 17% of those surveyed had avoided a recommended doctor's visit this year to save costs (the question was not asked in the firm's 2007 survey). And 17% did not fill a prescription or skipped doses of prescribed medicine, an increase from 13% in 2007.
But healthcare leaders worry that short-term savings could lead to serious illness, and even deaths. "We're seeing that consumers are willing to take risks by not doing what they perceive to be small things, such as putting off going to the doctor and deciding not to pay for medicines," says Dana Goldman, head of health economics at research firm Rand Corp. in Santa Monica. "That puts the individual at risk, but the potential harm doesn't stop with them," Goldman says. "It also becomes a problem for society if, for example, infections spread because some people don't fill a needed antibiotic prescription, or if an increase in hospitalizations for chronic illnesses places a deeper financial burden on a hospital or city."
Says J. James Rohack, president-elect of the American Medical Assn.: "Consumers need to take steps to stay healthy, such as getting exercise and losing weight, if necessary, and finding help through private and public channels to help pay for healthcare costs."
FLEXIBLE SPENDING ACCOUNTS
Save by reducing taxable income
Surprisingly, these accounts, offered by many companies, even small ones, are often not used by consumers -- so if you didn't sign up for 2009, consider it next time around. Employees of companies that offer the accounts can have set amounts (minimums and maximums are set by each company) taken from their paychecks pretax and put into these accounts to be used for health expenses as major as brain surgery or minor as contact lens solution. (Each company can decide what it will allow in its specific plan; you can get a good idea of allowed expenses under the federal government's flexible spending program at www.fsafeds.com/fsafeds/eligibleexpenses.asp. According to Laurie Brubaker, a benefits expert with Aetna, which administers some of these accounts for businesses, setting aside $2,000 from a salary of $25,000 will create a tax savings of $450. Use Aetna's calculator to match your allocation with your salary at www.aetnafsa.com/fsa/index.php.
Spend it or lose it
Many people often don't open an account because any money left at the end of the year is forfeited. Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt, suggests making a list of medical needs for the year, including prescription sunglasses and new contact lenses or a visit to the doctor to check on an allergy, and making those appointments before the benefit year ends. And remember: The money is deducted over the course of 12 months, but the full amount you choose to set aside is available to you from the first day of your benefit year.
DRUGS
Review what you take with a doctor
Shopping for lower prices isn't necessarily the first step you need to take if you want to lower your prescription drug bill, says Michael Cohen, president of the Institute for Safe Medication Practices in Horsham, Penn. First, review the drugs you take (a good practice once each year regardless, doctors say), to determine whether you still need the drug or that dose and whether you could safely substitute a less expensive option for the drug.
A visit with your doctor to review the drugs is your best bet. If you're concerned about the cost of the visit, you can ask if the doctor will go over your list by phone. (And see below for strategies to reduce the cost of an office visit.) A local pharmacist can also review your drug list and make suggestions to your physician for changes, but never stop taking a drug unless the doctor has specifically given you the OK.
Ask your pharmacist if your particular medicines can be split or if you can use two lower doses to make up the dose you need. Review the costs, including any co-pays. Those options can sometimes save money over the cost of buying the exact dose prescribed. Then . . .
Price shop
Sure, the corner drugstore may be convenient, but it may also be expensive. According to the National Center for Policy Analysis in Washington, D.C., comparing prices among local pharmacies can save consumers almost 10% on brand-name drugs and up to 81% on generic drugs. You can check comparison prices in your area at www.destinationrx.com, but also call the local pharmacy to confirm. And some pharmacies may match competitors' prices. Costco's prices for brand-name drugs often rank among the lowest, and the warehouse store doesn't require a membership fee for people buying only prescription medicines.
Don't assume Internet prices are cheapest. Local pharmacy prices for a 30-day supply of the cholesterol drug Lipitor (80-milligram dose) hovered around $83 recently. The same drug cost $119.99 at drugstore.com.
Go for the generic
This year, many pharmacies, supermarkets and big retail stores such as Walgreens, Ralphs and Target began offering hundreds of generic drugs for as low as $3 per month per prescription. Not all stores offer all generics for the low price, and the list can vary from chain to chain, so check by phone or at the store's website. CVS charges $10 per year for a savings pass that entitles cardholders to buy 90-day supplies of more than 400 generic drugs for $9.99 each. That fee also gets you some discounts on nonprescription drugs and on visits to its Minute Clinics, staffed by nurses who can give some vaccinations and treat minor illnesses. As the economy continues to falter, expect more deals from drugstore chains. Kmart, for example, lets many customers at most stores buy one of several nonprescription products such as pain relievers and a decongestant for the discounted price of $1 each time you buy a prescription, for a savings of about $3 to $6. Find the website addresses for the stores you frequent and sign up for alerts.
Buy in bulk
Sixty- and 90-day supplies of drugs are often cheaper by mail order and at retail stores than a 30-day supply. That's especially true for people with insurance coverage for prescription drugs; buy a 90-day supply and most insurers charge only a two-month co-pay, which can be a savings of at least $20 per year for each generic drug you take, and at least $80 per year for brand-name drugs. Consumer Reports Best Buy Drugs advises checking online prices, for U.S. and foreign pharmacies, at pharmacychecker.com. Use the price per pill to compare the costs on the site, and factor in the shipping costs that most sites charge. The Food and Drug Administration offers advice at www.fda.gov/buyonlineguide on buying drugs online through only verified Internet pharmacies.
Scout for coupons and offers
You can get discounts on some brand-name drugs by looking for coupons on the drug's website (plug the drug name into a search engine to find the site) or at www.internetdrugcoupons.com. Discounts can sometimes apply to co-pays as well.
Check out other cost-saving programs
Additional deals that can save you money include the Together Rx Access card, sponsored by 10 drug companies and offering discounts on many brand-name drugs, and the SunRx Discount health pass, sponsored by pharmacy benefits manager SunRx. Checkwww.togetherrxaccess.com or call (800) 444-4106 for income eligibility and the current list of drugs that qualify. Anyone without insurance (as well as many small business owners) can sign up and print out the SunRx card, which offers -- at participating pharmacies -- up to 15% on many brand-name drugs, up to 70% on many generic drugs and some money off nonprescription drugs. Sign up at www.sunrxdiscount.com/Healthpass or call (800) 650-3184.
DOCTOR VISITS
Delay may lead to serious problems
Even if you have insurance and are paying only a co-pay to see a physician, the costs can mount, especially if you have young children. But not seeing the doctor when necessary could result in a far more serious illness -- and far more serious costs, says Carolyn Clancy, head of the federal Agency for Healthcare Research and Quality (AHRQ). So . . .
Talk with your doctor
J. James Rohack, president-elect of the American Medical Assn., advises people facing economic problems to be upfront with their physicians about cost concerns. "The doctor cannot waive a co-pay required by insurance -- that's a part of his or her contract with insurers -- but doctors may be able to help with some costs, such as providing samples of certain medicines," he says. Consumer advocacy groups such as the Medicare Rights Center, based in Washington, D.C., and New York City, suggest trying to negotiate the fee if you're paying out of pocket. Doctors have to wait weeks to months for payment from insurers, and may be willing to forgo some profit for faster payment, says Paul Precht, communications and policy director for the group.
Insured? Stay in your network
If you do have insurance and have been seeing doctors outside your plan, ask physicians, colleagues or friends if they can recommend doctors from your list. That may mean saying goodbye to a trusted physician, but it can save you more than $100 on a single visit. Ask your out-of-network doctor if you can stay in touch by e-mail or phone if you have questions, and also ask if the doctor would consider joining your insurance network.
Try bartering
People who own their own business, such as plumbers or lawyers, may consider barter to help pay doctor fees. Joanne Levine, who owns a PR firm in Chicago, does public relations for a few companies in exchange for barter credits that go into an account with a bartering firm. Levine has used the credits to pay for care by a periodontist, an optometrist, a surgeon and a dermatologist. "But not very many general practitioners are registered with the firm I use," she says. There may be fees involved in maintaining a barter account, so this option may be best for people who pay for other expenses through bartering as well. Find information about barter memberships at www.bartermax.com or the International Reciprocal Trade Assn. at www.irta.com.
Go to a retail clinic
If you or a child has a minor problem such as a low fever, a scratchy throat or a minor skin infection, a retail clinic may be all you need. They're staffed by experienced health professionals, typically registered nurses or physicians' assistants. Fees are about $50 to $65 for a visit, often well below doctors' offices, and if you have insurance, you may be charged just a $10 or $20 co-pay, well below the cost of an emergency room visit co-pay or fee. Check the websites of clinics, such as Minute Clinic (owned by CVS), at www.minuteclinic.com and Take Care (owned by Walgreens), at www.takecarehealth.com; there may be a discount offer that can save you an additional $5 or $10.
Visit community health centers
These local clinics offer care on a sliding scale, based on income. If you're not eligible for free care, the centers will work with you on payment options, which could include helping you find financial assistance in your area.
INSURANCE
How to get -- or keep -- a policy
In danger of losing your job, and the health insurance that comes with it, in 2009? Take a breath. This is a topic we'll revisit often in 2009, but we have some basic advice right now.
Take COBRA
If you lose your job in 2009, before you officially leave the premises, ask the firm if it would consider paying for your health coverage for an extended period of time, says Emily Spitzer, executive director with the National Health Law Program in Washington, D.C. If not, and if the firm offers a COBRA (Consolidated Omnibus Budget Reconciliation Act) plan, sign up for it for at least in the short term. It's an opportunity to pay for the same health insurance you've had while employed with the company. Though firms are allowed to charge up to 102% of what they pay to cover you, and, if applicable, any dependents, it is likely to be the most comprehensive coverage for the least amount of money, Spitzer says. During that period, you can look at other health-insurance possibilities, including an employed spouse's insurance options, an individual policy and public assistance, if you qualify. But buy yourself that time. Remaining insured is important; not just because of a possible emergency, but also because an interruption in coverage for you, or for a dependent who has an ongoing medical problem, could mean a delay in coverage for a preexisting condition, even when you get the new job and its benefits.
Then do your research
Here are some resources that should help:
California's Health Consumer Alliance:
www.healthconsumer.org, a partnership of consumer-assistance programs;
Families USA:
www.familiesusa.org/consumer-info, a nonprofit seeking affordable healthcare for all Americans;
HealthCareCoach:
www.healthcarecoach.com, a project of the National Health Law Program.
SURGERY
Ask financial questions first
The AHRQ's Clancy says too often the only question patients have about surgery is where to park on the day of the operation. But many hospitals offer free parking for one car (with a patient's identification number), so don't worry excessively about that . . .
Talk with the hospital brass
Whether or not you have insurance, a meeting with a financial officer at the hospital could help with costs. Showing a willingness to pay, even if over time, can generate goodwill, says Mark Rukavina, executive director of the Access Project, based in Boston, an affordable healthcare advocacy group. Some hospital financial staff workers may work with your insurer ahead of time to let you know what costs will be covered and what you will have to pay out of pocket. If you can't pay, the financial office may be able to direct you to financial assistance options, or set up a payment schedule.
Don't agree to use a credit card or retirement account
Recently, articles in the Wall Street Journal and Business Week have reported on some hospitals running credit checks on patients seeking care, before treatment is even provided. In some cases the check has turned up assets such as an available credit limit on a credit card, or a 401(k) account, and the hospitals have asked patients to use those assets to guarantee and then pay their bill. Rukavina of the Access Project advises against using credit cards to pay medical bills unless you plan to pay the bill in full by the end of the month. If not, your medical bill rises by the monthly interest fee you pay, and not paying it can result in penalties and higher fees on all of your credit cards because of the changes to your credit score. And any early use of a 401(k) account will trigger penalties and leave you without resources for retirement, the reason you set up the account in the first place. If you are asked to use these resources, Rakavina advises asking to see the hospital's chief financial officer and to insist that you be allowed to set up an extended payment plan. Consumers who find themselves in this predicament can visit the Access Project website for assistance at www.accessproject.org.
Consider surgery in a foreign country
Medical tourism, having surgery in a foreign country such as Singapore or Thailand, has been making headlines as a lower-cost option for people without insurance -- surgeries can cost as much as 90% less, according to the Medical Tourism Assn., a trade organization. However, the National Business Group on Health, which advises large corporations about healthcare expenses, recently issued a brief that pointed out concerns about medical tourism, in addition to benefits, such as a risk to patients who speak English only but must interact with medical staff who do not. The American Medical Assn. says people who opt for surgery in a foreign country should arrange for a doctor to monitor them on their return. That, of course, would involve additional fees, especially if the doctor thinks follow-up care or even a repeat surgery is necessary.
So far, most insurance companies don't cover surgeries overseas, though WellPoint, which insures millions of Californians, is doing a trial run with a small company in Seattle. If successful, WellPoint and others could cover the option for a larger number of people beginning in 2010. Because of the huge cost savings, largely due to lower salaries and lower-cost malpractice insurance in many foreign countries, insurers could decide to waive all co-pays for foreign surgeries, in addition to covering travel and lodging costs for the patient, and, often for a travel companion as well. For more information, have a look at the Medical Tourism Assn.'s website at www.medicaltourismassociation.com, or contact PlanetHospital, a firm in Calabasas that arranges surgical care overseas.
At least one company, North American Surgery Inc., based in Vancouver, Canada ( www.northamericansurgery.com), negotiates on behalf of individuals and small companies and is able to offer prices for many surgeries at U.S. hospitals that can rival foreign rates. The company checks on accreditation and even patient outcomes before signing on with surgeons and hospitals, but you'll want to check on your own as well, and ask your primary-care doctor to speak with the surgeon you choose.
PREVENTIVE CARE
Early detection can pay off
Even if you have no known health problems, certain tests such as mammograms and prostate exams should be done regularly so that any indication of a problem can be detected as early as possible, Clancy says. AHRQ recently created test checklists for men,www.ahrq.gov/ppip/men50.htm, and for women, www.ahrq.gov/ppip/women50.htm. And . . .
Look for free or low-cost screenings
Many associations offer free screenings for many conditions at certain times of the year. Type the name of the condition and the word "screening" into a search engine to see what's available. In the Los Angeles area, screening dates are often posted at www.healthycity.com, or you can find some free tests by calling 211. Type in "health observation days" at healthfinder.gov and you'll find a calendar with an observance day for just about every disease. Organizations often hold screening programs on those days, and websites for hundreds of organizations that offer information, and, often, free or low-cost tests are listed.
Look after yourself
The AMA recently introduced a program called Healthier Life Steps -- a guide for consumers with or without their physicians. Go to www.ama-assn.org/ama/pub/category/18471 .html. The point here is that by stopping smoking, losing weight, exercising and controlling chronic diseases, Americans can save money on healthcare and be healthier. For example, when Mike Huckabee, the former governor of Arkansas and a presidential candidate, was diagnosed with diabetes, he opted for losing weight and exercising and never took -- and so never spent money on -- any medication.
health@latimes.com
___
Thank you so much for some very good suggestions about saving money while maintaining good health in your article Cut health costs, not your care, (December 9, 2008). I would like to add that investing in a medical home thru a physician engaged in a "direct practice" is another means of investing in your health. Providing a retainer up front to pay for all your care is a wonderful means of making sure that you have an ongoing relationship with a caring physician thru the year for relatively few dollars. Imagine being able to talk to your physician thru an email or having your doctor's cell phone number. Why waste money and time in a waiting room or an emergency room? Investing in a relationship with a primary care physician with your HSA or FSA dollars is a great opportunity to get the best care for fewer dollars and the cost of catastrophic insurance is far less than the usual HMO or PPO. Personal choice is not expensive and the value is "priceless."
Marcy L Zwelling-Aamot, MD FACEP
562-596-7584
Marcy@choicecare.md
From the Los Angeles Times
Cut health costs, not your care
Balancing your budget shouldn't mean your health pays the price. Here are smart ways to manage both.
This is an expanded first installment of an ongoing Health feature on cutting costs, not care--with tips for balancing your health and budget needs. Part one covers: Drugs, Doctor visits, Surgery, Flexible spending accounts, Preventive care, and Insurance.
By Francesca Lunzer Kritz
December 29, 2008
Amber Eyerly, 32, says she's never been much good at saving money. But with only minimal raises, at best, expected for 2009 at the Los Angeles public relations firm where she works, Eyerly carefully studied her health insurance benefits package this year to see where she could trim costs.
She made one cut for 2009 by signing up for a medical flexible spending account, which takes money, pre-tax, from each paycheck to spend on healthcare costs and reduces her taxable income. And when she read that, unlike trips to a specialist, visits to her primary care doctor don't require her to first pay down a health insurance deductible, Eyerly arranged to have her dermatology records for a minor skin condition sent to her primary care physician, who now writes prescriptions for any dermatology medicines the young executive needs.
Eyerly's personal health cost review is being repeated across the country, as the economic downturn worsens and jobs -- and the benefits that often come with them -- get slashed. "Millions of consumers are weighing their medical costs and trying to see what expenses they can jettison to save some money," says Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt. A Watson survey of 2,500 U.S. employees released this month found that 17% of those surveyed had avoided a recommended doctor's visit this year to save costs (the question was not asked in the firm's 2007 survey). And 17% did not fill a prescription or skipped doses of prescribed medicine, an increase from 13% in 2007.
But healthcare leaders worry that short-term savings could lead to serious illness, and even deaths. "We're seeing that consumers are willing to take risks by not doing what they perceive to be small things, such as putting off going to the doctor and deciding not to pay for medicines," says Dana Goldman, head of health economics at research firm Rand Corp. in Santa Monica. "That puts the individual at risk, but the potential harm doesn't stop with them," Goldman says. "It also becomes a problem for society if, for example, infections spread because some people don't fill a needed antibiotic prescription, or if an increase in hospitalizations for chronic illnesses places a deeper financial burden on a hospital or city."
Says J. James Rohack, president-elect of the American Medical Assn.: "Consumers need to take steps to stay healthy, such as getting exercise and losing weight, if necessary, and finding help through private and public channels to help pay for healthcare costs."
FLEXIBLE SPENDING ACCOUNTS
Save by reducing taxable income
Surprisingly, these accounts, offered by many companies, even small ones, are often not used by consumers -- so if you didn't sign up for 2009, consider it next time around. Employees of companies that offer the accounts can have set amounts (minimums and maximums are set by each company) taken from their paychecks pretax and put into these accounts to be used for health expenses as major as brain surgery or minor as contact lens solution. (Each company can decide what it will allow in its specific plan; you can get a good idea of allowed expenses under the federal government's flexible spending program at www.fsafeds.com/fsafeds/eligibleexpenses.asp. According to Laurie Brubaker, a benefits expert with Aetna, which administers some of these accounts for businesses, setting aside $2,000 from a salary of $25,000 will create a tax savings of $450. Use Aetna's calculator to match your allocation with your salary at www.aetnafsa.com/fsa/index.php.
Spend it or lose it
Many people often don't open an account because any money left at the end of the year is forfeited. Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt, suggests making a list of medical needs for the year, including prescription sunglasses and new contact lenses or a visit to the doctor to check on an allergy, and making those appointments before the benefit year ends. And remember: The money is deducted over the course of 12 months, but the full amount you choose to set aside is available to you from the first day of your benefit year.
DRUGS
Review what you take with a doctor
Shopping for lower prices isn't necessarily the first step you need to take if you want to lower your prescription drug bill, says Michael Cohen, president of the Institute for Safe Medication Practices in Horsham, Penn. First, review the drugs you take (a good practice once each year regardless, doctors say), to determine whether you still need the drug or that dose and whether you could safely substitute a less expensive option for the drug.
A visit with your doctor to review the drugs is your best bet. If you're concerned about the cost of the visit, you can ask if the doctor will go over your list by phone. (And see below for strategies to reduce the cost of an office visit.) A local pharmacist can also review your drug list and make suggestions to your physician for changes, but never stop taking a drug unless the doctor has specifically given you the OK.
Ask your pharmacist if your particular medicines can be split or if you can use two lower doses to make up the dose you need. Review the costs, including any co-pays. Those options can sometimes save money over the cost of buying the exact dose prescribed. Then . . .
Price shop
Sure, the corner drugstore may be convenient, but it may also be expensive. According to the National Center for Policy Analysis in Washington, D.C., comparing prices among local pharmacies can save consumers almost 10% on brand-name drugs and up to 81% on generic drugs. You can check comparison prices in your area at www.destinationrx.com, but also call the local pharmacy to confirm. And some pharmacies may match competitors' prices. Costco's prices for brand-name drugs often rank among the lowest, and the warehouse store doesn't require a membership fee for people buying only prescription medicines.
Don't assume Internet prices are cheapest. Local pharmacy prices for a 30-day supply of the cholesterol drug Lipitor (80-milligram dose) hovered around $83 recently. The same drug cost $119.99 at drugstore.com.
Go for the generic
This year, many pharmacies, supermarkets and big retail stores such as Walgreens, Ralphs and Target began offering hundreds of generic drugs for as low as $3 per month per prescription. Not all stores offer all generics for the low price, and the list can vary from chain to chain, so check by phone or at the store's website. CVS charges $10 per year for a savings pass that entitles cardholders to buy 90-day supplies of more than 400 generic drugs for $9.99 each. That fee also gets you some discounts on nonprescription drugs and on visits to its Minute Clinics, staffed by nurses who can give some vaccinations and treat minor illnesses. As the economy continues to falter, expect more deals from drugstore chains. Kmart, for example, lets many customers at most stores buy one of several nonprescription products such as pain relievers and a decongestant for the discounted price of $1 each time you buy a prescription, for a savings of about $3 to $6. Find the website addresses for the stores you frequent and sign up for alerts.
Buy in bulk
Sixty- and 90-day supplies of drugs are often cheaper by mail order and at retail stores than a 30-day supply. That's especially true for people with insurance coverage for prescription drugs; buy a 90-day supply and most insurers charge only a two-month co-pay, which can be a savings of at least $20 per year for each generic drug you take, and at least $80 per year for brand-name drugs. Consumer Reports Best Buy Drugs advises checking online prices, for U.S. and foreign pharmacies, at pharmacychecker.com. Use the price per pill to compare the costs on the site, and factor in the shipping costs that most sites charge. The Food and Drug Administration offers advice at www.fda.gov/buyonlineguide on buying drugs online through only verified Internet pharmacies.
Scout for coupons and offers
You can get discounts on some brand-name drugs by looking for coupons on the drug's website (plug the drug name into a search engine to find the site) or at www.internetdrugcoupons.com. Discounts can sometimes apply to co-pays as well.
Check out other cost-saving programs
Additional deals that can save you money include the Together Rx Access card, sponsored by 10 drug companies and offering discounts on many brand-name drugs, and the SunRx Discount health pass, sponsored by pharmacy benefits manager SunRx. Checkwww.togetherrxaccess.com or call (800) 444-4106 for income eligibility and the current list of drugs that qualify. Anyone without insurance (as well as many small business owners) can sign up and print out the SunRx card, which offers -- at participating pharmacies -- up to 15% on many brand-name drugs, up to 70% on many generic drugs and some money off nonprescription drugs. Sign up at www.sunrxdiscount.com/Healthpass or call (800) 650-3184.
DOCTOR VISITS
Delay may lead to serious problems
Even if you have insurance and are paying only a co-pay to see a physician, the costs can mount, especially if you have young children. But not seeing the doctor when necessary could result in a far more serious illness -- and far more serious costs, says Carolyn Clancy, head of the federal Agency for Healthcare Research and Quality (AHRQ). So . . .
Talk with your doctor
J. James Rohack, president-elect of the American Medical Assn., advises people facing economic problems to be upfront with their physicians about cost concerns. "The doctor cannot waive a co-pay required by insurance -- that's a part of his or her contract with insurers -- but doctors may be able to help with some costs, such as providing samples of certain medicines," he says. Consumer advocacy groups such as the Medicare Rights Center, based in Washington, D.C., and New York City, suggest trying to negotiate the fee if you're paying out of pocket. Doctors have to wait weeks to months for payment from insurers, and may be willing to forgo some profit for faster payment, says Paul Precht, communications and policy director for the group.
Insured? Stay in your network
If you do have insurance and have been seeing doctors outside your plan, ask physicians, colleagues or friends if they can recommend doctors from your list. That may mean saying goodbye to a trusted physician, but it can save you more than $100 on a single visit. Ask your out-of-network doctor if you can stay in touch by e-mail or phone if you have questions, and also ask if the doctor would consider joining your insurance network.
Try bartering
People who own their own business, such as plumbers or lawyers, may consider barter to help pay doctor fees. Joanne Levine, who owns a PR firm in Chicago, does public relations for a few companies in exchange for barter credits that go into an account with a bartering firm. Levine has used the credits to pay for care by a periodontist, an optometrist, a surgeon and a dermatologist. "But not very many general practitioners are registered with the firm I use," she says. There may be fees involved in maintaining a barter account, so this option may be best for people who pay for other expenses through bartering as well. Find information about barter memberships at www.bartermax.com or the International Reciprocal Trade Assn. at www.irta.com.
Go to a retail clinic
If you or a child has a minor problem such as a low fever, a scratchy throat or a minor skin infection, a retail clinic may be all you need. They're staffed by experienced health professionals, typically registered nurses or physicians' assistants. Fees are about $50 to $65 for a visit, often well below doctors' offices, and if you have insurance, you may be charged just a $10 or $20 co-pay, well below the cost of an emergency room visit co-pay or fee. Check the websites of clinics, such as Minute Clinic (owned by CVS), at www.minuteclinic.com and Take Care (owned by Walgreens), at www.takecarehealth.com; there may be a discount offer that can save you an additional $5 or $10.
Visit community health centers
These local clinics offer care on a sliding scale, based on income. If you're not eligible for free care, the centers will work with you on payment options, which could include helping you find financial assistance in your area.
INSURANCE
How to get -- or keep -- a policy
In danger of losing your job, and the health insurance that comes with it, in 2009? Take a breath. This is a topic we'll revisit often in 2009, but we have some basic advice right now.
Take COBRA
If you lose your job in 2009, before you officially leave the premises, ask the firm if it would consider paying for your health coverage for an extended period of time, says Emily Spitzer, executive director with the National Health Law Program in Washington, D.C. If not, and if the firm offers a COBRA (Consolidated Omnibus Budget Reconciliation Act) plan, sign up for it for at least in the short term. It's an opportunity to pay for the same health insurance you've had while employed with the company. Though firms are allowed to charge up to 102% of what they pay to cover you, and, if applicable, any dependents, it is likely to be the most comprehensive coverage for the least amount of money, Spitzer says. During that period, you can look at other health-insurance possibilities, including an employed spouse's insurance options, an individual policy and public assistance, if you qualify. But buy yourself that time. Remaining insured is important; not just because of a possible emergency, but also because an interruption in coverage for you, or for a dependent who has an ongoing medical problem, could mean a delay in coverage for a preexisting condition, even when you get the new job and its benefits.
Then do your research
Here are some resources that should help:
California's Health Consumer Alliance:
www.healthconsumer.org, a partnership of consumer-assistance programs;
Families USA:
www.familiesusa.org/consumer-info, a nonprofit seeking affordable healthcare for all Americans;
HealthCareCoach:
www.healthcarecoach.com, a project of the National Health Law Program.
SURGERY
Ask financial questions first
The AHRQ's Clancy says too often the only question patients have about surgery is where to park on the day of the operation. But many hospitals offer free parking for one car (with a patient's identification number), so don't worry excessively about that . . .
Talk with the hospital brass
Whether or not you have insurance, a meeting with a financial officer at the hospital could help with costs. Showing a willingness to pay, even if over time, can generate goodwill, says Mark Rukavina, executive director of the Access Project, based in Boston, an affordable healthcare advocacy group. Some hospital financial staff workers may work with your insurer ahead of time to let you know what costs will be covered and what you will have to pay out of pocket. If you can't pay, the financial office may be able to direct you to financial assistance options, or set up a payment schedule.
Don't agree to use a credit card or retirement account
Recently, articles in the Wall Street Journal and Business Week have reported on some hospitals running credit checks on patients seeking care, before treatment is even provided. In some cases the check has turned up assets such as an available credit limit on a credit card, or a 401(k) account, and the hospitals have asked patients to use those assets to guarantee and then pay their bill. Rukavina of the Access Project advises against using credit cards to pay medical bills unless you plan to pay the bill in full by the end of the month. If not, your medical bill rises by the monthly interest fee you pay, and not paying it can result in penalties and higher fees on all of your credit cards because of the changes to your credit score. And any early use of a 401(k) account will trigger penalties and leave you without resources for retirement, the reason you set up the account in the first place. If you are asked to use these resources, Rakavina advises asking to see the hospital's chief financial officer and to insist that you be allowed to set up an extended payment plan. Consumers who find themselves in this predicament can visit the Access Project website for assistance at www.accessproject.org.
Consider surgery in a foreign country
Medical tourism, having surgery in a foreign country such as Singapore or Thailand, has been making headlines as a lower-cost option for people without insurance -- surgeries can cost as much as 90% less, according to the Medical Tourism Assn., a trade organization. However, the National Business Group on Health, which advises large corporations about healthcare expenses, recently issued a brief that pointed out concerns about medical tourism, in addition to benefits, such as a risk to patients who speak English only but must interact with medical staff who do not. The American Medical Assn. says people who opt for surgery in a foreign country should arrange for a doctor to monitor them on their return. That, of course, would involve additional fees, especially if the doctor thinks follow-up care or even a repeat surgery is necessary.
So far, most insurance companies don't cover surgeries overseas, though WellPoint, which insures millions of Californians, is doing a trial run with a small company in Seattle. If successful, WellPoint and others could cover the option for a larger number of people beginning in 2010. Because of the huge cost savings, largely due to lower salaries and lower-cost malpractice insurance in many foreign countries, insurers could decide to waive all co-pays for foreign surgeries, in addition to covering travel and lodging costs for the patient, and, often for a travel companion as well. For more information, have a look at the Medical Tourism Assn.'s website at www.medicaltourismassociation.com, or contact PlanetHospital, a firm in Calabasas that arranges surgical care overseas.
At least one company, North American Surgery Inc., based in Vancouver, Canada ( www.northamericansurgery.com), negotiates on behalf of individuals and small companies and is able to offer prices for many surgeries at U.S. hospitals that can rival foreign rates. The company checks on accreditation and even patient outcomes before signing on with surgeons and hospitals, but you'll want to check on your own as well, and ask your primary-care doctor to speak with the surgeon you choose.
PREVENTIVE CARE
Early detection can pay off
Even if you have no known health problems, certain tests such as mammograms and prostate exams should be done regularly so that any indication of a problem can be detected as early as possible, Clancy says. AHRQ recently created test checklists for men,www.ahrq.gov/ppip/men50.htm, and for women, www.ahrq.gov/ppip/women50.htm. And . . .
Look for free or low-cost screenings
Many associations offer free screenings for many conditions at certain times of the year. Type the name of the condition and the word "screening" into a search engine to see what's available. In the Los Angeles area, screening dates are often posted at www.healthycity.com, or you can find some free tests by calling 211. Type in "health observation days" at healthfinder.gov and you'll find a calendar with an observance day for just about every disease. Organizations often hold screening programs on those days, and websites for hundreds of organizations that offer information, and, often, free or low-cost tests are listed.
Look after yourself
The AMA recently introduced a program called Healthier Life Steps -- a guide for consumers with or without their physicians. Go to www.ama-assn.org/ama/pub/category/18471 .html. The point here is that by stopping smoking, losing weight, exercising and controlling chronic diseases, Americans can save money on healthcare and be healthier. For example, when Mike Huckabee, the former governor of Arkansas and a presidential candidate, was diagnosed with diabetes, he opted for losing weight and exercising and never took -- and so never spent money on -- any medication.
health@latimes.com
___
Doing the numbers on medical tourism - is it worth it?
Carol Lloyd
Friday, January 2, 2009
What with the glories of the new, new economy, it's easy to imagine consigning "health and fitness" to the ash heap of personal history. Remember when we could afford yoga and Pilates? Or when we didn't price-shop for vitamins?
During rough economic times, big-ticket treatments not covered by insurance pose an even greater challenge. If you need knee surgery, or back rehab, or God forbid, the dental nightmare my husband faced last year - two crowns, two fillings and two root canals to the tune of $3,700 - it may be time to think selfishly, act globally and consider the benefits of medical travel.
Patients have been crisscrossing the globe in search of better, cheaper and more expedient health care for centuries. Legend has it that ancient Greeks traveled to the coastal city of Epidaurus for cures. Twenty years ago, the phrase "medical tourism" generally evoked images of bargain-basement boob jobs, not state-of-the-art heart surgery. But in the past few years, increasing numbers of Americans (along with Canadians and Europeans weary of long waiting periods) have begun globetrotting for pricey procedures.
With more countries - from Singapore to South Korea - building modern hospitals catering to First-World patients and accreditation organizations vetting them for quality, the industry is developing the standards and protocols that will allow medical tourism to go mainstream.
"For a long time, some people said it was just a fad," says Melissa Skelton with the Medical Tourism Association, a nonprofit organization that sponsors the Medical Travel Congress and publishes Medical Tourism Magazine. "Now with the economy and the credit crisis, more people are waking up and paying attention."
Indeed, for the 47 million uninsured Americans, boarding a plane to see the doctor already offers an irresistible two-for-one: travel the world and save money. But if insurance companies and employers embrace and incentivize medical outsourcing, the profile of the medical tourist will change. Joining the armies of un- and under-insured Americans will be fully insured patients who are getting extra perks to cross borders for treatment.
A recent study by Deloitte Center for Health Solutions concluded that the number of Americans traveling for medical care will soar: from 750,000 last year to 6 million in 2010. Although some experts question that prediction, most agree that medical tourism has the potential to transform the way Americans access health care.
"I'm not sure the numbers will rise that fast, but it's growing," said Patricia Look, a benefits and compensation analyst with J. J. Keller & Associates, whose recent white paper explored the rise of institution-sponsored medical tourism. In her paper she profiled a handful of early-adopting employers and insurance companies that are offering elements of medical tourism as a part of their health plans. "Institutions are slowly jumping on the bandwagon."
Not surprisingly, the good doctors at the American Medical Association haven't issued a ringing endorsement of this medical outsourcing. They rightly caution that a lack of legal recourse in case of medical malpractice and doctor and hospital credentialing makes medical trips potentially dangerous. Yet earlier this year they did issue guidelines suggesting that they know which way the trade winds are blowing. (The guidelines recommend seeking care from accredited hospitals, bringing medical records, learning about legal rights regarding malpractice and understanding the risks of long-distance travel after procedures.) Also, a number of major medical centers - including Duke Medical Center, John Hopkins Medical Center and Columbia University Medical Center - have partnered with international hospitals, indicating a growing awareness that medical tourism is here to stay.
While experts calculate medical tourism's benefits for institutions, my family's experience offers testimony of its appeal for individuals. During a recent trip to Costa Rica, my husband got his dental work done for a fraction of the American price - about $950 - paying for the price of the rest of the trip. Encouraged by his gleaming smile, I subjected myself to "Chequeos Medicos Plan B" - one of several preventive health exams offered at CIMA, a brand-new hospital in San José, run by the Dallas-based hospital chain. In six hours, I received a mammogram, full blood work, fecal and urinalysis, cardio stress test, abdominal ultrasound, chest X-rays, eye exam, meeting with an internist, consultation with a nutritionist and breakfast for $397. By my calculations, I would have spent several thousand dollars for the same number of tests and it would have taken no fewer than 10 visits to the doctor spread over weeks or even months.
No trip into any hospital nowadays guarantees a safe return for your body, but some certainly promise a better return on your buck.--
Freelance writer Carol Lloyd is the author of "Creating a Life Worth Living."
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/02/CM6314G2BV.DTL
This article appeared on page P - 4 of the San Francisco Chronicle
© 2009 Hearst Communications Inc. | Privacy Policy | Feedback | RSS Feeds | FAQ | Site Index | Contact
Friday, January 2, 2009
What with the glories of the new, new economy, it's easy to imagine consigning "health and fitness" to the ash heap of personal history. Remember when we could afford yoga and Pilates? Or when we didn't price-shop for vitamins?
During rough economic times, big-ticket treatments not covered by insurance pose an even greater challenge. If you need knee surgery, or back rehab, or God forbid, the dental nightmare my husband faced last year - two crowns, two fillings and two root canals to the tune of $3,700 - it may be time to think selfishly, act globally and consider the benefits of medical travel.
Patients have been crisscrossing the globe in search of better, cheaper and more expedient health care for centuries. Legend has it that ancient Greeks traveled to the coastal city of Epidaurus for cures. Twenty years ago, the phrase "medical tourism" generally evoked images of bargain-basement boob jobs, not state-of-the-art heart surgery. But in the past few years, increasing numbers of Americans (along with Canadians and Europeans weary of long waiting periods) have begun globetrotting for pricey procedures.
With more countries - from Singapore to South Korea - building modern hospitals catering to First-World patients and accreditation organizations vetting them for quality, the industry is developing the standards and protocols that will allow medical tourism to go mainstream.
"For a long time, some people said it was just a fad," says Melissa Skelton with the Medical Tourism Association, a nonprofit organization that sponsors the Medical Travel Congress and publishes Medical Tourism Magazine. "Now with the economy and the credit crisis, more people are waking up and paying attention."
Indeed, for the 47 million uninsured Americans, boarding a plane to see the doctor already offers an irresistible two-for-one: travel the world and save money. But if insurance companies and employers embrace and incentivize medical outsourcing, the profile of the medical tourist will change. Joining the armies of un- and under-insured Americans will be fully insured patients who are getting extra perks to cross borders for treatment.
A recent study by Deloitte Center for Health Solutions concluded that the number of Americans traveling for medical care will soar: from 750,000 last year to 6 million in 2010. Although some experts question that prediction, most agree that medical tourism has the potential to transform the way Americans access health care.
"I'm not sure the numbers will rise that fast, but it's growing," said Patricia Look, a benefits and compensation analyst with J. J. Keller & Associates, whose recent white paper explored the rise of institution-sponsored medical tourism. In her paper she profiled a handful of early-adopting employers and insurance companies that are offering elements of medical tourism as a part of their health plans. "Institutions are slowly jumping on the bandwagon."
Not surprisingly, the good doctors at the American Medical Association haven't issued a ringing endorsement of this medical outsourcing. They rightly caution that a lack of legal recourse in case of medical malpractice and doctor and hospital credentialing makes medical trips potentially dangerous. Yet earlier this year they did issue guidelines suggesting that they know which way the trade winds are blowing. (The guidelines recommend seeking care from accredited hospitals, bringing medical records, learning about legal rights regarding malpractice and understanding the risks of long-distance travel after procedures.) Also, a number of major medical centers - including Duke Medical Center, John Hopkins Medical Center and Columbia University Medical Center - have partnered with international hospitals, indicating a growing awareness that medical tourism is here to stay.
While experts calculate medical tourism's benefits for institutions, my family's experience offers testimony of its appeal for individuals. During a recent trip to Costa Rica, my husband got his dental work done for a fraction of the American price - about $950 - paying for the price of the rest of the trip. Encouraged by his gleaming smile, I subjected myself to "Chequeos Medicos Plan B" - one of several preventive health exams offered at CIMA, a brand-new hospital in San José, run by the Dallas-based hospital chain. In six hours, I received a mammogram, full blood work, fecal and urinalysis, cardio stress test, abdominal ultrasound, chest X-rays, eye exam, meeting with an internist, consultation with a nutritionist and breakfast for $397. By my calculations, I would have spent several thousand dollars for the same number of tests and it would have taken no fewer than 10 visits to the doctor spread over weeks or even months.
No trip into any hospital nowadays guarantees a safe return for your body, but some certainly promise a better return on your buck.--
Freelance writer Carol Lloyd is the author of "Creating a Life Worth Living."
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/02/CM6314G2BV.DTL
This article appeared on page P - 4 of the San Francisco Chronicle
© 2009 Hearst Communications Inc. | Privacy Policy | Feedback | RSS Feeds | FAQ | Site Index | Contact
Tuesday, August 26, 2008
Letter to AMA... Privacy considerations
Dear Mr. Nelson:
My name is Marcy Zwelling. We have not met. I am a delegate to the AMA from California and a passionate advocate for my patients and quality health care.
I am aware of a series of lawsuits in the Northeast involving IMS, a vendor of my patients' private health care data and physician prescribing habits. I know that the AMA has intimate details of the lawsuit(s) and that the case is now at the Appeals Level. I believe that the AMA allows physicians to opt out of the AMA Rx data mining program but not many doctors know about this. That said, I absolutely appreciate the fact that the AMA has made it is so much easier to find the opt out on the website. I opted out months ago and had to "re-do" my efforts today. I don't know how that glitch happened.
The conflicts of interest are huge. I believe that the AMA suffers these conflicts more and more as our membership numbers go down. It is publicly quoted that the AMA made $46 million dollars on the "sale of data". I think that this lawsuit presents the proverbial "fork in the road". The AMA has the opportunity to finally stand up for physicians, our rights, and our patients privacy by standing with the State of New Hampshire against data mining.
I want nothing more that the AMA's continued success but we cannot be successful if we continue to live in this world of conflict. Our AMA's patient privacy policies are well conceived and I applaud the efforts of those before me who had the wisdom to articulate the "line in the sand". I believe that this data mining violates our privacy policy and is only the tip of the iceberg. Companies like SureScripts (now Rx-Hub) sell my patients' data to any "covered entity" under HIPAA. This practice is a huge invasion of privacy, all legal under HIPAA. I would love for the AMA to work to legislate against any sale of any patient data but... to get to that place, I think you first must take a position in this appeals case. As they say....... "what are you going to do? Not what do you say or think?"
We all know that clinical health data can be used wisely. We all want clinical data to be used by the right people in the right studies and at the point of service for individual patients. But, that is NOT what happens now. It is, however, the "umbrella" that others are using in order to give themselves access and that is wrong.
The licensure to utilize patient data MUST be authorized on a case by case, one event at a time basis, with FULL disclosure to our patients. HIPAA, as you know allows for the use of data by "business associates" [Business associate services to a covered entity are limited to legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services.] We are all aware that patients receive inquiries from all "business associates" all the time proving to me that identified data is sold at will. Patients have brought this to my attention. (I don't bill insurance so if anyone has information about my patient that is privileged to THIS office it would be thru their PBM and an Rx).
I was shocked to here that even Dr. Robert Kolodner, the current Coordinator of the Office of National Health Information Technology, was surprised to know that data was being exchanged and sold so freely (or so he said). it seems that there has been little conversation about this violation of our patients' privacy. Shouldn't this be a priority of the AMA? I took an oath. Every Medical Doctor receiving an MD degree in the US took that oath "All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal."
I believe that the AMA has at its core the obligation to stand up for the profession and our patients and put a stop to the practice of data "mining" and the practice of data distribution and sale. Our patients' data is just that... belonging to our patients. It is a privilege to have the data and to use it for the specific betterment of their health and not for the utility of any other entity. While I believe that we must find a way to safely license the use of CLINICAL data after full disclosure and with our patients' informed consent, that must come after we have secured their privacy.
This is our moment. We must seize it. The AMA has an amazing opportunity to re-examine its core values and to do the right thing.
I eagerly await your reply and I thank you for your most serious consideration.
Marcy
My name is Marcy Zwelling. We have not met. I am a delegate to the AMA from California and a passionate advocate for my patients and quality health care.
I am aware of a series of lawsuits in the Northeast involving IMS, a vendor of my patients' private health care data and physician prescribing habits. I know that the AMA has intimate details of the lawsuit(s) and that the case is now at the Appeals Level. I believe that the AMA allows physicians to opt out of the AMA Rx data mining program but not many doctors know about this. That said, I absolutely appreciate the fact that the AMA has made it is so much easier to find the opt out on the website. I opted out months ago and had to "re-do" my efforts today. I don't know how that glitch happened.
The conflicts of interest are huge. I believe that the AMA suffers these conflicts more and more as our membership numbers go down. It is publicly quoted that the AMA made $46 million dollars on the "sale of data". I think that this lawsuit presents the proverbial "fork in the road". The AMA has the opportunity to finally stand up for physicians, our rights, and our patients privacy by standing with the State of New Hampshire against data mining.
I want nothing more that the AMA's continued success but we cannot be successful if we continue to live in this world of conflict. Our AMA's patient privacy policies are well conceived and I applaud the efforts of those before me who had the wisdom to articulate the "line in the sand". I believe that this data mining violates our privacy policy and is only the tip of the iceberg. Companies like SureScripts (now Rx-Hub) sell my patients' data to any "covered entity" under HIPAA. This practice is a huge invasion of privacy, all legal under HIPAA. I would love for the AMA to work to legislate against any sale of any patient data but... to get to that place, I think you first must take a position in this appeals case. As they say....... "what are you going to do? Not what do you say or think?"
We all know that clinical health data can be used wisely. We all want clinical data to be used by the right people in the right studies and at the point of service for individual patients. But, that is NOT what happens now. It is, however, the "umbrella" that others are using in order to give themselves access and that is wrong.
The licensure to utilize patient data MUST be authorized on a case by case, one event at a time basis, with FULL disclosure to our patients. HIPAA, as you know allows for the use of data by "business associates" [Business associate services to a covered entity are limited to legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services.] We are all aware that patients receive inquiries from all "business associates" all the time proving to me that identified data is sold at will. Patients have brought this to my attention. (I don't bill insurance so if anyone has information about my patient that is privileged to THIS office it would be thru their PBM and an Rx).
I was shocked to here that even Dr. Robert Kolodner, the current Coordinator of the Office of National Health Information Technology, was surprised to know that data was being exchanged and sold so freely (or so he said). it seems that there has been little conversation about this violation of our patients' privacy. Shouldn't this be a priority of the AMA? I took an oath. Every Medical Doctor receiving an MD degree in the US took that oath "All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal."
I believe that the AMA has at its core the obligation to stand up for the profession and our patients and put a stop to the practice of data "mining" and the practice of data distribution and sale. Our patients' data is just that... belonging to our patients. It is a privilege to have the data and to use it for the specific betterment of their health and not for the utility of any other entity. While I believe that we must find a way to safely license the use of CLINICAL data after full disclosure and with our patients' informed consent, that must come after we have secured their privacy.
This is our moment. We must seize it. The AMA has an amazing opportunity to re-examine its core values and to do the right thing.
I eagerly await your reply and I thank you for your most serious consideration.
Marcy
Subscribe to:
Comments (Atom)
