CommonHealth | Podcasts

Study: Hard To Shop For Hip Surgery, Even With $100K At Stake

Carey Goldberg — Tue, 12 Feb 2013 18:33:57 +0000

As WBUR’s Martha Bebinger has reported repeatedly, it is hard, hard, hard to compare the price tags on medical procedures — even though the out-of-pocket costs to you could vary dramatically depending on where you get your care.

Now a new study in the journal JAMA Internal Medicine pins down this shopping problem for one particular procedure: elective hip surgery called total hip arthroplasty, or THA.

The researchers called hospitals around the country — and called and called and called, up to five times each — in search of the institution’s lowest price for a 62-year-old grandmother who lacked health insurance but could pay out of pocket. From the paper’s abstract:

Results Nine top-ranked hospitals (45%) and 10 non–top-ranked hospitals (10%) were able to provide a complete bundled price (P < .001). We were able to obtain a complete price estimate from an additional 3 top-ranked hospitals (15%) and 54 non–top-ranked hospitals (53%) (P = .002) by contacting the hospital and physician separately. The range of complete prices was wide for both top-ranked ($12 500-$105 000) and non–top-ranked hospitals ($11 100-$125 798).

Conclusions and Relevance We found it difficult to obtain price information for THA and observed wide variation in the prices that were quoted. Many health care providers cannot provide reasonable price estimates. Patients seeking elective THA may find considerable price savings through comparison shopping.

Oh, except, wait a minute, you can’t comparison shop very well when more than half of hospitals can’t give you their prices.

The latest health reform law in Massachusetts, passed last year, is supposed to address this problem and require greater price transparency from hospitals. Will it? Meanwhile, my friend Jeanne Pinder’s ClearHealthCosts.com uses crowdsourcing to help consumers help each other gather cost data. She blogs about the new study:

This is one of our favorite topics. If you haven’t recently, go to our PriceMap interactive page and play around with the search; for a range of procedures, in cities all over the United States, we show you what the government is paying via Medicare, the program for the elderly and disabled. You’ll be shocked at the range.

Study Finds ‘Protective’ Weight Just As Diet Resolutions Kick In

Carey Goldberg — Wed, 02 Jan 2013 16:20:37 +0000

Whoopsie. Just as all those New Year’s dieting resolutions are kicking in, along comes the latest salvo in the confusing obesity-mortality wars. “Oh, my,” I said this morning when I heard Harvard nutrition expert Walt Willett call this latest study a bunch of “rubbish” on NPR. “They’re playing rough.”

At issue is this simple question: Does being overweight make you die sooner, or might it actually be protective? But of course, very little is simple in the world of nutrition studies, or when links between Body Mass Index and health are concerned. Here’s the conclusion from the study, that in effect, very obese people tend to die earlier, but more mildly overweight people may tend to live a bit longer:

Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

And here’s Walt Willett on NPR today:

“This study is really a pile of rubbish and no one should waste their time reading it,” he says.

Willett says it’s not helpful to look simply at how peoples body mass indexes, or BMIs, influence their risk of death — as this paper did without knowing something about people’s health or fitness. Some people are thin because they’re ill, so of course they’re at higher risk of dying. The study doesn’t tease this apart.

Also, he says the analysis doesn’t address the bigger, more important issues of quality of life. If an overweight person does live longer — is he or she living with chronic diseases?

If you’re hard-core, read the study yourself here, The New York Times report on it here or the boston.com report that explains more of the methodological issues here, and let us know what you think in the comments below.

My personal takeaway: The study’s lead author, Katherine M. Flegal of the CDC, strikes me as brave to take on accepted wisdom about ideal weight. But Walt Willett is a towering figure in nutrition research. So I think I’m going to use the ambiguities raised by this study and Flegal’s earlier work to reinforce the resolution I wanted to make anyway: This year, I’ll try to eat better but not make myself crazy about it.

A Must-Read On Health Insurance If You’re Traveling Abroad

Rachel Zimmerman — Tue, 20 Nov 2012 15:23:29 +0000

Many of us — for better or worse — are traveling in the coming weeks or months. And if you’ve ever had to bring a sick child to a health clinic in a country where you don’t speak the language, you know how harrowing getting medical care while on “vacation” can be. (Not to mention the sticker shock when you get the bill.) Here’s a really helpful post on Healthcare Savvy by Sue (Sunni) Patterson that offers everything you’ll need to know about health insurance coverage if you’re out of the U.S. The bottom line: plan ahead as best you can.

You may be closing out 2011 with a holiday trip, domestically or internationally. If you plan to leave the country, you may want to consider the following when it comes to your health:

You may not have health insurance coverage for illnesses or injuries that are treated abroad, even if you have U.S. based medical coverage. Confirm with your benefits administrator.

Generally, Medicare does not provide coverage for hospital or medical costs incurred abroad, however, rare circumstances may be covered.

AARP can assist with obtaining foreign medical coverage and offers valuable travel tips.

U.S. consulate personnel will help you locate health care providers and facilities and even contact family members, if necessary.
You can purchase travel insurance that covers health care needs and pays for medical evacuation if you need to be transported back to the US for treatment.

Obtaining medical treatment in another country can be expensive and a medical evacuation can cost over $50,000. Plus, you may encounter challenges with deciphering charges while abroad. Be vigilant, prepared, and follow the same self-advocacy steps you would while receiving medical care in your home state.

If you choose to purchase medical expense coverage while traveling abroad, double check you’ve carefully researched the following:

–Trip cancellation clauses or reasons. You may want to choose an optional ‘cancel for any reason rider’.
–Inclusion of a waiver to a pre-existing condition exclusion.
–Plan coverage exclusions, situations and conditions.
–Save all receipts and document everything from the start of a condition; contact your plan representative immediately.
–Does the policy include medical evacuation coverage? If not, you may want to consider purchasing this optional coverage.
–Purchase travel insurance at the same time you pay for your trip. It’s too late after you’ve had an accident or become sick.

For more information about international travel preparation, visit the U.S. Department of State website.

Physician’s Group Denounces IOM On Health Coverage, Says Financial Conflicts Abound

Rachel Zimmerman — Fri, 02 Dec 2011 13:37:43 +0000

Physician’s For A National Health Program, a group that advocates a single-payer health system, yesterday charged that the influential Institute of Medicine’s recommendations for “essential” health coverage under the new national health law are “skimpy” and biased and could “cause much suffering” for patients.

In response to the accusations, detailed in a letter sent to U.S. Health and Human Services Secretary Kathleen Sebelius, a spokesperson for the IOM, Christine Stencel, wrote this in an email message:

The committee’s report lays out the solid rationale for each of its recommendations and speaks for itself. We invite all interested people to download a free electronic copy and read it to see exactly what it said in terms of balancing coverage and cost.

Here’s the full news release from the national physician’s group:

More than 2,400 doctors, nurses and health advocates denounce Institute of Medicine’s health coverage recommendations

IOM panel ‘riddled with conflicts of interest’ in violation of agency’s own guidelines, signers of protest letter charge

In a letter sent to Secretary of Health and Human Services Kathleen Sebelius and posted on the Internet today, more than 2,400 physicians, nurses and other health advocates condemn the recommendations of an Institute of Medicine (IOM) committee regarding the “essential benefits” to be mandated under the 2010 federal health reform law.

The signers, most of whom are physicians, charge the committee’s recommendations amount to prescribing skimpy coverage that would “sacrifice many lives and cause much suffering,” and urge the Obama administration to reject them.

“The IOM panel endorsed insurance coverage similar to that offered by small employers rather than the more comprehensive coverage offered by large employers,” said Dr. Danny McCormick, an internist, assistant professor at Harvard Medical School and former IOM fellow who helped circulate the letter. “The recommendation was widely viewed as a victory for the health insurance industry, which has long opposed mandating comprehensive benefits.”

The panel also recommended that coverage under the new law be defined by a premium target – an approach often called “defined contribution” – rather than by a list of medically necessary benefits, McCormick said.

The protest letter accuses the IOM panel of being “riddled with conflicts of interest” and notes that many of the panel members have “amassed personal wealth through their involvement with health insurers and other for-profit health care firms” whose businesses would be affected by the panel’s recommendations.

The IOM committee’s members include Sam Ho, executive vice president of UnitedHealthcare; Leonard D. Schaeffer, director of the biotechnology company Amgen and former chairman and CEO of WellPoint (Schaeffer’s family foundation donated $2 million to the IOM in 2010); as well as executives from 3M Health Information Systems, a medical supplier, Milliman Inc., an actuarial consulting firm with close ties to the insurance industry, and The Blackstone Group, a private equity firm with major health care interests. The IOM’s full list of panel’s members, with a partial listing of their affiliations, is accessible here.

“Many committee members’ strong ties to the health industry violate the guidance offered in a 2009 report issued by the IOM which recommended that those with industry conflicts of interest should generally be excluded from such panels,” said Dr. Steffie Woolhandler, professor of public health at the City University of New York and visiting professor of medicine at Harvard Medical School, who served as an IOM fellow in 1990-1991. Woolhandler also circulated the letter.

The signers of the protest letter include several prestigious members of the IOM, as well as several former fellows. The letter was first circulated to colleagues by attendees at the IOM’s annual meeting near Washington in October. After learning of the letter, IOM officials instructed security officers to block its distribution at the meeting.

The letter was also circulated by Physicians for a National Health Program, which advocates for a single-payer health system, and by other health professional groups.

Besides being submitted to Secretary Sebelius and other administration officials, the letter has been accepted for publication in the International Journal of Health Services, Woolhandler said.

Podcast Friday: Sex After Cancer, New Cystic Fibrosis Drug

Keosha Johnson — Fri, 13 May 2011 16:52:53 +0000

In this week’s podcast, audio versions of two recent CommonHealth hits:

Sex After Cancer: Among the nearly 12 million cancer survivors in the U.S., many suffer from sexual problems related to their cancer of the treatment to fight it. Rachel Zimmerman details the problems, talks to patients and tracks one psychologist’s efforts to bring pleasure back to patients.

New Drug For Cystic Fibrosis: A still-experimental drug, called VX-770, while not a cure, is being called a “major advance” in CF research. VX-770 attacks the basic defect in cystic fibrosis, and right now helps only 4 percent of those living with cystic fibrosis. Carey Goldberg explains what VX-770 does, and how it’s helped one woman do things she’s never done before — like shovel snow.

Podcast Friday: Storytelling As Patient Therapy; ‘Better Care, Cheaper’ Experiment

Fri, 11 Mar 2011 17:03:45 +0000

Our podcast this week features an interview with Dr. Annie Brewster, a Boston internist who became interested in storytelling as a kind of therapy for patients, and a Massachusetts General Hospital program that saves money while also giving better care to chronically ill older patients.

A recent study published in The New York Times found that patients listening to other patients telling their own stories can be therapeutic. We spoke to Annie Brewster, a doctor living with multiple sclerosis, about her project documenting the lives of patients and their families in the midst of serious illness.

(Check out Dr. Brewster’s “Listening Project,” here, here and here.)

Is Better Care Cheaper? Older patients with multiple chronic diseases are the biggest consumers of health care. We explore how the next phase of Gov. Deval Patrick’s health care plan aims to cut this cost down, and hear one doctor’s perspective about whether it will actually work.

Podcast Friday: Patrick’s Health Care Overhaul, Bright Spots In Stroke Research

Keosha Johnson — Fri, 25 Feb 2011 14:01:50 +0000

Yep, it’s about that time…Podcast Friday! This week we have two big stories:

Reform 2011: Gov. Deval Patrick announced his plan to overhaul the Massachusetts health care system. He’s proposing going from a system that rewards doctors based on the quantity of services to one that emphasizes quality and integrated care. But will his proposal actually work? We look into it.
10 Steps Forward On Stroke Research: For Carey, the issue of stroke is personal (read her story here). But it also affects an astounding number of people. Stroke is the second-biggest killer worldwide, and the biggest disabler of American adults. Yet the progress in stroke research seems to be slim. We discuss 10 relatively bright spots and what they mean for stroke survivors.