Waiting For A Single Payer System

Single-payer health care would be great if it can:

1)  Reduce health insurance and medical costs.  (According to Bernie, it will) and

2)  Avoid the very long waits for getting healthcare (as is the case for the UK and Canada).

I don't know how Bernie's proposal addresses point #2.  But it's a real problem in other countries.  An opinion piece on CNN Why Single Payer Health Is A Terrible Option discusses some of the challenges that other countries face with a single payer system. 

 For example, in Canada's single-payer system:

• The 2016 median wait for neurosurgery after already seeing the doctor was a shocking 46.9 weeks -- about 10 months.
• The 2016 median wait for a referral from a general practitioner appointment to the specialist appointment was 9.4 weeks

In England:  "...over 362,000 patients waited longer than 18 weeks for hospital treatment in March 2017, an increase of almost 64,000 on the previous year; and 95,252 have been waiting more than six months for treatment -- all after already waiting for and receiving initial diagnosis and referral." 

When my wife's neurosurgeon decided it was time for surgery, it took only 5 days to get the surgery done.  Three of those days were doing pre-op tests.  Two of those days were a weekend.  I would have gone nuts if we had to wait months to get the surgery. 

A single payer health system may be the eventual way to go. Provided, of course, that we can learn  from the challenges that similar systems have had in other countries and not fall into the same traps.

You Down With O.O.P?

About this time of year, kids are going back to school and summer vacation photos are being looked at nostalgically.  Autumn is also a good time to take a look at your OOP benefits on your medical insurance policy.

"OOP" stands for "out of pocket".  (Don't confuse this with the hit song by Naughty By Nature:  "I'm Down with O.P.P.").  It is a very important benefit of health insurance policies that can really help insured that have high amounts of medical bills.  That's because insurance policies put a limit on the total OOP expenses an insured has to spend in a calendar year.  After that limit (or cap) is met, then the insurance company will pay 100% of medical services.

Those with a modest amount of medical issues are likely still seeing if their annual deductible has been met.  But those with a greater need for medical care are looking at their OOP about now.  If you have met your OOP limit, then essentially all of your medical care for the rest of the year is free.

But there's a catch.  (Isn't there always?)  When you go to a doctor's office or a facility, they will check your insurance coverage and ask for your applicable co-pay.  DON'T PAY IT!  The typical office staff will not be able to see if your OOP maximum is met.  They only see what the co-pay is and how much the insurance coverage will pay.

It's up to YOU to know when your OOP cap is met.  It's up to YOU to inform the front office that you are covered 100%.  It's up to YOU to say "No" to the requested co-pay.

You should know that if you do pay the co-pay (even when it is not necessary), you will almost certainly get this money back at some time after the bill has been processed by the insurance company.  But why overpay and wait for a refund?  It's your money.  Keep it in your pocket.

So, are you down with your O.O.P.?  Check and find out.

Lowering Medical Bills

"You always miss 100% of the shots you don't take" - Wayne Gretsky

Deductibles are rising for nearly every insured American.  According to the Business Insider:  "In 2016, 83% of workers have a deductible — an amount that they have to pay themselves for medical care before insurance covers it — with an average of $1,478. The average deductible for workers has gone up $486, or 49%, since 2011."

Out-of-pocket (OOP) caps are also on the rise.  The Department of Health and Human Services (HSS) determines what the maximum OOP limits are for each calendar year for ACA plans.  According to them, the out-of-pocket maximum will have increased by 12.6% since 2014.  For an ACA plan in the year 2017, it $7,150 for an individual, and $14,300.  (If you have a non-ACA plan, then your OOP may be even more.)

What does this mean?  The average insured American is paying more OOP healthcare related expenses.  You will be paying 100% of your costs until your deductible is reached.  Then you will be paying your co-insurance (10, 20 or 30%) until your OOP is reached.  So a person with a $1000 deductible and a $7150 OOP max could wind up paying up to $8150 per year in addition to their health insurance premiums.

I don't care what anyone says (politicians, healthcare experts, etc.). Insurance premiums are not going down...ever.  (When was the last time that you had any type of insurance go down??)  I might be wrong in thinking this.  But let's assume that I am not.

At least for the time being, there's only way to save on your medical costs 

1. Negotiate the initial costs
2. Negotiate the left over balances

Option 1 rarely works unless you are a cash-paying customer.  Otherwise, providers are usually obligated to charge the rates that  have pre-negotiated with insurance companies.  You should note that sometimes it is cheaper to pay cash on a discounted bill than it is to pay your deductible and co-insurance balances.  This is difficult to determine since price transparency is sorely lacking in the healthscare [sic] system.  But if you are having a procedure, it never hurts to ask about the costs prior to giving your insurance card over to the receptionist.  However, once you do so, you can't go back to paying a cash discount.

Option 2 is, perhaps, the most effective means to lower your OOP costs.

When faced with a high left-over balance (e.g., surgery, outpatient procedures, etc.), most institutions will allow you to structure the payments over time.  But this doesn't save you any money.  Many institutions also have a process to offer a hardship discount.  But this doesn't apply to most middle class families and above who make too much money to be eligible for a discount.

I suggest two strategies. It will take a little guts and a lot of confidence to pull it off.

First, almost every institution will offer a discount if you pay "now".  For some, that means before leaving the facility.  For others, that might mean immediately after getting your bill.  It's not unusual to get a 10-15% discounts.

Don't stop there!  

I had an experience where they offered me a 15% discount on a bill from my wife's surgery.  Very graciously, I thanked them.  Then, I asked if they could do any better.  After a few minutes on hold, they said that they could offer me a 20% discount.  "Wow, that's great.  Thanks so much.  But is there any way you give me more of a break?" I asked.

The agent said that she would have to go to her supervisor to go any higher.  So I politely asked if she could do that.  She did.  I ended up with a 33% discount. This saved me over $500.  Just for asking! 

This same strategy also applies if you wind up falling behind on a structured payment plan and end up getting a notice from a collections agency.  Please know that such notices are preliminary and generally do not affect your credit as long as you respond immediately.  

Again, the agency will generally offer you a discount.  Don't accept the first offer! Also be humble, sincere and grateful.  But keep asking.  You'll know when you've reached their best number.

Today, I just saved $360 on a bill related to my wife's surgery in January of last year.  Took me only 15 minutes to do this. So, let's say the patient is in the 25% tax bracket (just to choose a middle ground).  $360 saved is the equivalent of $480 pre-tax earnings.  If you are making $60k a year, that is 2 days worth of pay.  Or you can look at it as getting paid $1440/hr for your time.  (The equivalent of a $3millon/year salary!)  Either way, it still is a good return on your time.  

It doesn't matter the size of the bill.  If the bill is below $100, most people will simply pay it because they don't think it's worth their time to negotiate a 20-30% savings.  But just think about what an extra $20-30 in your pocket feels like.  If you saw a $20 bill on a sidewalk, would you step over it and go on your way?  Likely, not.  I wouldn't.

2017 HTF Innovation Conference at Stanford

I attended this conference last year and it was incredibly informative.  I'm going again this year.  It's not too late to register.  Just follow the link below.

Hope to see you there!

The 6th Annual Health Technology Forum Innovation Conference explores health and wellness enhancements made possible through technology and implementation of key health policies and strategies. Our program will highlight next generation technology, innovative solutions and practices providing better access, and availability and outcomes in care innovations, all with an eye towards sustainability. Important use-cases demonstrating barriers and break-throughs impacting healthcare delivery will be explored.

HTF Common Good Conference

Rowdy Townhalls Focus on Healthcare

Saturday, I went to a townhall meeting by my congressman, Brad Sherman.  Nearly all of the 1300 people who showed up (his largest townhall ever) were obvious supporters of Sherman.  Of course in a district of 771,000 people, there were bound to be some non-supporters as well.  This vocal minority made for some very contentious moments (as to be expected).

The more passionate elements of the crowd were not focused on Trump, his cabinet, or even Russia. They were focused on healthcare.  The majority of signs being waived had slogans like: "HEALTHCARE FOR ALL", "FIGHT REPEAL AND REPLACE", "YES TO SINGLE PAYER" and "SUPPORT SB-562" (a single-payer bill in the California Senate).

As stated in Modern Healthcare

"In crowded town halls around the country, congressional Republicans had many eye-opening encounters this past week with Americans who voiced fear and anger over the prospect that they will lose their health insurance if the Affordable Care Act is repealed." 

The feeling of uncertainty is not limited to just Republicans, of course, and Brad Sherman's townhall is a testament to the general concern that people have about their healthcare.  With threats of global war, human rights violations, and terrorism (domestic and abroad), health insurance is probably on the top of everyone's list of worries.

All these other threats are incredibly important and vital problems to solve.  But when you are sick and can't afford treatment, somehow you don't worry about illegal immigration as much.

There is a vast divide between the two sides on the best approach to health insurance.  Let's not forget that we have but a single goal regardless of who you voted for.  We all want to know that when we or a loved one gets sick, we have access to proper care without the fear of going bankrupt.

FamilyDoctor.org

I just discovered this website www.familydoctor.org and I love it.  Until now, I've used a variety of sites when researching medical information:  WebMD, LiveStrong, Drugs.com, RxList, etc.

My main complaint about these sites is that they are all, to various degrees, very user-unfriendly.  They try to include so much information that it makes the UX very unsatisfying and confusing.  One particular issue the prominent display ads that infest most of these sites.  All too often, they are designed so that they look like actual content instead of ads.  So you click on it and are sent off site thinking that you are merely entering another section of the original site.

So while researching content for my new company (www.metisadvantage.com), whose beta is coming soon, I came across FamilyDoctor.org.  This is a site run by the American Academy of Family Physicians.

My first impression is that it is incredibly easy and clear to use.  There are very few ads (although I'm not sure if that is intentional or due to a lack of advertisers).  The navigation is simple and easy.

But what I really like about it is the Disease and Conditions section.  Once you find your particular condition, the article that pops up is easy to read, clear, and loaded with practical information.  If there were a "Dummy's guid to Diseases and Conditions", this is how it would be displayed.

So, I highly recommend visiting this site.  It's relief from the crowded world of medical information.

Who was that doctor?

So who was that doctor that treated my daughter in the ER and the hospital this past weekend??  Who was the radiologist that discovered that object?  Who was the nurse that made the ER visit so bearable?

Easy, right?  Not so much.

My daughter got sick over the Thanksgiving weekend.  She had two ER visits and one overnight hospital stay.  Fortunately, we averted what could have been a critical situation and she is now fully recovered.

This was due partially to serendipity.  We were simply lucky that I took her to the ER in time.  Had I waiting another 12 hours, her condition would have worsened and it's quite possible that the unthinkable might have happened.  But it was more than just luck which prevented that catastrophe.  I credit the many doctors, nurses and technicians who treated my daughter with saving her life.

I want to send a note commending the CT technician who decided to extend the field of view beyond my daughter's abdomen (which caught the potentially dangerous condition).  I want applaud the nurses and phlebotomists who worked so hard to get a good venipuncture.  I want to credit the X-ray technician who decided, on a hunch, to take an x-ray of her colon when all that was ordered was an esophagram.  I also want to find out more about the GI doctor who consulted on the case.

Unfortunately, I don't have this information.  Since my daughter was admitted to the hospital directly from the first ER visit, we never got ER discharge papers and I can't remember the name of the ER doctors or nurses (not an unusual event).  But even if we got discharge papers (such as we did from the second ER visit), it would not have included the nurse's name.  The hospital discharge papers did include the attending physician. But it did not include any consulting physicians.

The only way to give credit where credit is due is get my daughter's medical records and read thru the volumes of pages.  This requires a physical visit to the hospital with my daughter.  I am not even certain that the technicians and nurses' names would be included.

Maybe it's not that important to know the names of all of the team members.  Perhaps, I should simply be content with the positive outcome.  On the other hand, the entire healthcare system is moving quickly towards measured outcomes and accountable care.  This requires access to data on individuals as well as institutions.

Now, I am a big believer in providing constructive feedback not only when something goes wrong but also when something goes right.  I feel that I don't have the right to complain if I don't also acknowledge success.  This belief probably stems from a small poster my father (a CPA) had in his office which said:  "When I'm right no one remembers.  But when I'm wrong no one forgets."

Perhaps institutions want to protect the identities of these people from overzealous patients.  That would certainly be reasonable if an error was made.  Yet, I feel that is the patient's right to know who treated them and who performed the procedures and tests. It should be a lot easier to find out this information.

So who was that doctor?  I don't know.  (Third base.)

P.S.:  Surveying the successes and failures of hospitals is the main mission of Hospital Consumer Assessment of Hospitals Provider and Systems (HCAHPS).  (The data here is great and I wish that more people would access it.)