Re: American values to blame for health care crisis

[Guest guest]

Outstanding. I try and try to find out what something will cost, but it takes so much time, and usually ends-up with no reliable answer. I have found a useful tool for price-checking drugs: ePocrates website includes a brief paragraph on Average Retail Price for every drug listed, even on the free on-line version I am nibbling in my office; rapidly accessible (although my computer skills are still rudimentary) ... Mostly, I learn by mistake: the patient calls back, 4 days after a visit, and tells me he couldn't afford that pill I prescribed, or that ointment, and can I please come-up with a cheaper alternative. That is a slow way to deal with a problem ... worse than the waste of my time, is the realization that we just gave 4 days of extra time, for that GNR to swim from the bladder to the kidney, off Levaquin. I discovered that the 25-OH-Vitamin-D assay costs ~ $125 (and that some insurance companies won't pay for it, even when I try to link it to a good universal diagnosis like "fatigue"); I discovered that an I.C.D. cost a patient $240,000 ... (or, at least that was the starting point in negotiation between the hospital and the Blue Cross folks, on the E.O.B. the patient saw ... if he ever needed a defibrillation shock, that probably would have triggered a little charge, that day ! ...). Patients call in, and say, "I want you to order an M.R.I. for little ny, because he is having headaches" -- that $1,000 picture may be covered by the family's insurance (especially the H.M.O. covered-lives), but they don't want to bring him to my office, to ask him about his daily (on school-days) math-class headaches, and to look in his eyes with my funduscope, because their co-pay for office visits went up to $30 this year ... Of course, it may take me (or my staff) longer to fill-out the forms and make the phone calls to get prior auth for the M.R.I., than it would to complete a visit with the kiddo. The problem certainly does involve the attitudes of the average American patient, stimulated by the newest scare on television, the newest advertisement for bigger and better boner drugs, the billboards touting the swell instant care at the big city major medical center (just a short helicopter/limo ride from our small town). Somedays, I think about Canada ... -- Rian Mintek, M.D. -- Allegan, Michigan.Posted on another list serve:Public release date: 4-Dec-2008[ Print Article | E-mail Article | Close Window ]Contact: Elaine Schmidteschmidtmednet (DOT) ucla.eduUniversity of California - Los Angeles UCLA expert blames American values for health-care crisisReforming the system will require strong medicine, tough choicesTo heal our ailing health care system, we need to stop thinking like Americans. That's the message of two articles by UCLA's Dr. Marc Nuwer, a leading expert on national health care reform, published this week in Neurology, the journal of the American Academy of Neurology."Americans prize individual choice and resist limiting care," says Nuwer, a professor of clinical neurology at the Geffen School of Medicine at UCLA. "We believe that if doctors can treat very ill patients aggressively and keep every moment of people in the last stages of life under medical care, then they should. We choose to hold these values. Consequently, we choose to have a more expensive system than Europe or Canada."Consider these statistics:The United States boasts the world's most expensive health care system, yet only one-sixth of Americans are insured. Medical expenditures exceed $2 trillion annually, making health care the economy's largest sector, four times bigger than national defense.By 2015, the U.S. government is projected to spend $4 trillion on health care, or 20 percent of the nation's gross domestic product.An aging population will boost spending. Half of Medicare costs support very sick people in their last stages of life, and experts estimate that Medicare funds will be exhausted by 2018.31 percent of U.S. health care funds go toward administration. "We push a lot of paper," Nuwer says. "We spend twice as much as Canada, which has a more streamlined health care system that demands doctors complete less paperwork."10 percent of U.S. expenses are spent on "defensive medicine" — pricey tests ordered by doctors afraid of missing anything, however unlikely. "Doctors don't want to be accused in court of a delayed diagnosis, so they bend over backwards to find something — even if it's a rare possibility — in order to cover themselves," Nuwer says.Reforming the U.S. health care system with the goal of providing universal, affordable, high-quality care will require rethinking our overall values and paying greater attention to care-related expenditures, according to Nuwer.Part of the current problem, he says, is that doctors are oblivious to the price tags of options they're prescribing for patients. He recommends educating physicians about the costs of care, including imaging, blood tests and specific drugs."Does a fancy electric wheelchair cost $500 or $50,000?" Nuwer asks. "Most doctors have no clue. We need to give physicians feedback about the dollar signs behind their orders."###Nuwer's co-authors on both articles include Dr. G.L. Barkley (Henry Ford Hospital, Detroit); Dr. G.J. Esper (Emory University School of Medicine, Atlanta); Dr. P.D. Donofrio (Vanderbilt University School of Medicine, Nashville); Dr. J.P. Szaflarski (University of Cincinnati Academic Health Center); and Dr. T.R. Swift (Medical College of Georgia, Augusta).UCLA is California's largest university, with an enrollment of nearly 38,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university's 11 professional schools feature renowned faculty and offer more than 323 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Four alumni and five faculty have been awarded the Nobel Prize. For more news, visit the UCLA Newsroom. [ Print Article | E-mail Article | Close Window ]

[Guest guest]

Outstanding. I try and try to find out what something will cost, but it takes so much time, and usually ends-up with no reliable answer. I have found a useful tool for price-checking drugs: ePocrates website includes a brief paragraph on Average Retail Price for every drug listed, even on the free on-line version I am nibbling in my office; rapidly accessible (although my computer skills are still rudimentary) ... Mostly, I learn by mistake: the patient calls back, 4 days after a visit, and tells me he couldn't afford that pill I prescribed, or that ointment, and can I please come-up with a cheaper alternative. That is a slow way to deal with a problem ... worse than the waste of my time, is the realization that we just gave 4 days of extra time, for that GNR to swim from the bladder to the kidney, off Levaquin. I discovered that the 25-OH-Vitamin-D assay costs ~ $125 (and that some insurance companies won't pay for it, even when I try to link it to a good universal diagnosis like "fatigue"); I discovered that an I.C.D. cost a patient $240,000 ... (or, at least that was the starting point in negotiation between the hospital and the Blue Cross folks, on the E.O.B. the patient saw ... if he ever needed a defibrillation shock, that probably would have triggered a little charge, that day ! ...). Patients call in, and say, "I want you to order an M.R.I. for little ny, because he is having headaches" -- that $1,000 picture may be covered by the family's insurance (especially the H.M.O. covered-lives), but they don't want to bring him to my office, to ask him about his daily (on school-days) math-class headaches, and to look in his eyes with my funduscope, because their co-pay for office visits went up to $30 this year ... Of course, it may take me (or my staff) longer to fill-out the forms and make the phone calls to get prior auth for the M.R.I., than it would to complete a visit with the kiddo. The problem certainly does involve the attitudes of the average American patient, stimulated by the newest scare on television, the newest advertisement for bigger and better boner drugs, the billboards touting the swell instant care at the big city major medical center (just a short helicopter/limo ride from our small town). Somedays, I think about Canada ... -- Rian Mintek, M.D. -- Allegan, Michigan.Posted on another list serve:Public release date: 4-Dec-2008[ Print Article | E-mail Article | Close Window ]Contact: Elaine Schmidteschmidtmednet (DOT) ucla.eduUniversity of California - Los Angeles UCLA expert blames American values for health-care crisisReforming the system will require strong medicine, tough choicesTo heal our ailing health care system, we need to stop thinking like Americans. That's the message of two articles by UCLA's Dr. Marc Nuwer, a leading expert on national health care reform, published this week in Neurology, the journal of the American Academy of Neurology."Americans prize individual choice and resist limiting care," says Nuwer, a professor of clinical neurology at the Geffen School of Medicine at UCLA. "We believe that if doctors can treat very ill patients aggressively and keep every moment of people in the last stages of life under medical care, then they should. We choose to hold these values. Consequently, we choose to have a more expensive system than Europe or Canada."Consider these statistics:The United States boasts the world's most expensive health care system, yet only one-sixth of Americans are insured. Medical expenditures exceed $2 trillion annually, making health care the economy's largest sector, four times bigger than national defense.By 2015, the U.S. government is projected to spend $4 trillion on health care, or 20 percent of the nation's gross domestic product.An aging population will boost spending. Half of Medicare costs support very sick people in their last stages of life, and experts estimate that Medicare funds will be exhausted by 2018.31 percent of U.S. health care funds go toward administration. "We push a lot of paper," Nuwer says. "We spend twice as much as Canada, which has a more streamlined health care system that demands doctors complete less paperwork."10 percent of U.S. expenses are spent on "defensive medicine" — pricey tests ordered by doctors afraid of missing anything, however unlikely. "Doctors don't want to be accused in court of a delayed diagnosis, so they bend over backwards to find something — even if it's a rare possibility — in order to cover themselves," Nuwer says.Reforming the U.S. health care system with the goal of providing universal, affordable, high-quality care will require rethinking our overall values and paying greater attention to care-related expenditures, according to Nuwer.Part of the current problem, he says, is that doctors are oblivious to the price tags of options they're prescribing for patients. He recommends educating physicians about the costs of care, including imaging, blood tests and specific drugs."Does a fancy electric wheelchair cost $500 or $50,000?" Nuwer asks. "Most doctors have no clue. We need to give physicians feedback about the dollar signs behind their orders."###Nuwer's co-authors on both articles include Dr. G.L. Barkley (Henry Ford Hospital, Detroit); Dr. G.J. Esper (Emory University School of Medicine, Atlanta); Dr. P.D. Donofrio (Vanderbilt University School of Medicine, Nashville); Dr. J.P. Szaflarski (University of Cincinnati Academic Health Center); and Dr. T.R. Swift (Medical College of Georgia, Augusta).UCLA is California's largest university, with an enrollment of nearly 38,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university's 11 professional schools feature renowned faculty and offer more than 323 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Four alumni and five faculty have been awarded the Nobel Prize. For more news, visit the UCLA Newsroom. [ Print Article | E-mail Article | Close Window ]

[Guest guest]

Graham, I hope you realize that I certainly agree with you. I have lost patients, because of disagreements like this, but I cannot imagine ordering an M.R.I. (or even an x-ray) without at least a brief history and physical exam. I get steamed, when a neurosurgeon refuses to even see a patient until I have ordered an M.R.I. for him/her, but I see that as a cost-shifting maneuver -- their time is too expensive to waste, in gathering the details they would need to feed to their staff, to get an insurance company to give a blessing for neuro-imaging studies. So, even if I don't think a patient needs M.R.I. or surgery, but that patient wants to talk about his back pain with a neurosurgeon, he has to go through a $1,000 charade first. Then, if the study shows a minor bulge of a disc, that patient gets to go see the neurosurgeon's P.A., who then orders 6 weeks of Physical Therapy (my idea, 3 weeks earlier) ... if it looks like that disc is pretty severely extruded, then the neurosurgeon's staff will move the patient more swiftly into the actual Presence of that physician ... My residency director (Don Whitenack, a man never at a loss for an appropriate homily) used to always-and-often say, "good medicine starts with a history and physical", and that x-rays, lab tests, etc. usually are not really necessary, if we really listen to our patients. He was right. -- Rian Mintek, M.D. -- Allegan, Michigan.EBM will only be acceptable if it's an adequate defence in a mal-practice suit.If it is, then lots of waste can be removed.Ordering an MRI for a kid's headache without even examining the childis a flagrant waste of resources.On Sun, Dec 7, 2008 at 7:51 AM, llyonmd <llyonmd> wrote:> as doctors, let's engage our patients in promoting good health, let's> stick to evidence-based medicine, stay away from pretending to be> economists, and tell our patients like it is. we are experts in the-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

[Guest guest]

Graham, I hope you realize that I certainly agree with you. I have lost patients, because of disagreements like this, but I cannot imagine ordering an M.R.I. (or even an x-ray) without at least a brief history and physical exam. I get steamed, when a neurosurgeon refuses to even see a patient until I have ordered an M.R.I. for him/her, but I see that as a cost-shifting maneuver -- their time is too expensive to waste, in gathering the details they would need to feed to their staff, to get an insurance company to give a blessing for neuro-imaging studies. So, even if I don't think a patient needs M.R.I. or surgery, but that patient wants to talk about his back pain with a neurosurgeon, he has to go through a $1,000 charade first. Then, if the study shows a minor bulge of a disc, that patient gets to go see the neurosurgeon's P.A., who then orders 6 weeks of Physical Therapy (my idea, 3 weeks earlier) ... if it looks like that disc is pretty severely extruded, then the neurosurgeon's staff will move the patient more swiftly into the actual Presence of that physician ... My residency director (Don Whitenack, a man never at a loss for an appropriate homily) used to always-and-often say, "good medicine starts with a history and physical", and that x-rays, lab tests, etc. usually are not really necessary, if we really listen to our patients. He was right. -- Rian Mintek, M.D. -- Allegan, Michigan.EBM will only be acceptable if it's an adequate defence in a mal-practice suit.If it is, then lots of waste can be removed.Ordering an MRI for a kid's headache without even examining the childis a flagrant waste of resources.On Sun, Dec 7, 2008 at 7:51 AM, llyonmd <llyonmd> wrote:> as doctors, let's engage our patients in promoting good health, let's> stick to evidence-based medicine, stay away from pretending to be> economists, and tell our patients like it is. we are experts in the-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

[Guest guest]

Graham, I hope you realize that I certainly agree with you. I have lost patients, because of disagreements like this, but I cannot imagine ordering an M.R.I. (or even an x-ray) without at least a brief history and physical exam. I get steamed, when a neurosurgeon refuses to even see a patient until I have ordered an M.R.I. for him/her, but I see that as a cost-shifting maneuver -- their time is too expensive to waste, in gathering the details they would need to feed to their staff, to get an insurance company to give a blessing for neuro-imaging studies. So, even if I don't think a patient needs M.R.I. or surgery, but that patient wants to talk about his back pain with a neurosurgeon, he has to go through a $1,000 charade first. Then, if the study shows a minor bulge of a disc, that patient gets to go see the neurosurgeon's P.A., who then orders 6 weeks of Physical Therapy (my idea, 3 weeks earlier) ... if it looks like that disc is pretty severely extruded, then the neurosurgeon's staff will move the patient more swiftly into the actual Presence of that physician ... My residency director (Don Whitenack, a man never at a loss for an appropriate homily) used to always-and-often say, "good medicine starts with a history and physical", and that x-rays, lab tests, etc. usually are not really necessary, if we really listen to our patients. He was right. -- Rian Mintek, M.D. -- Allegan, Michigan.EBM will only be acceptable if it's an adequate defence in a mal-practice suit.If it is, then lots of waste can be removed.Ordering an MRI for a kid's headache without even examining the childis a flagrant waste of resources.On Sun, Dec 7, 2008 at 7:51 AM, llyonmd <llyonmd> wrote:> as doctors, let's engage our patients in promoting good health, let's> stick to evidence-based medicine, stay away from pretending to be> economists, and tell our patients like it is. we are experts in the-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

[Guest guest]

Along those lines, how easy is it for patients to find out what WE charge for our services? At the urging of one of my patients, I recently posted a fee schedule (see attachment) of my most common services online on my web site. I think if we are to call for greater transparency in healthcare pricing/costs, then we have to be part of that transparency, too. Also, if every doctor were to post their prices for all to see, we would no longer have to worry about not being able to mention how much we charge for this or that for fear of being seen as "colluding". Seto, MDOutstanding. I try and try to find out what something will cost, but it takes so much time, and usually ends-up with no reliable answer.