health care costs

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Loving Our Parents To Death

By Fran Cronin
WBUR Intern

Seven years ago, my 78-year old mother lay dying from lymphoma in her New York City hospital room. Her body was giving up its fight for life after four long years of aggressive chemotherapy treatments. With faltering vital signs, it was clear this was not just one of the many battles she had fought to stave off the encroaching disease. With her organs failing, my mother rapidly transitioned from ill at home to dying in the hospital, with no time to obtain hospice care. Gathered together, my family and I kept vigil by my mother’s bedside.

Although it was clear my mother was dying, doctors doing rounds continued to bombard my three brothers and me with offers of tests and procedures. My father, overwhelmed with emotion and fear, would have agreed to all the young residents proffered if my twin brother, an MD, had not intervened.

With my brother’s guidance, we knew to ask if there was any benefit to additional testing and if the findings would have an impact on my mother’s prognosis. The attending doctors conceded that aggressive interventions would not reverse my mother’s decline. My family and I determined to use the time remaining to keep my mother comfortable and to say goodbye.

Echoing this real life experience is a longitudinal study released in April by the Dartmouth Atlas Project on trends and variation in end-of-life care. This geographically diverse report found an increase in the intensity of care for Medicare patients that were hospitalized and chronically ill. According to the analysis, hospice care is on the rise, but so is aggressive in-hospital care. Medicare patients diagnosed with severe chronic illnesses had more physician visits, especially with specialists, and spent more time in intensive care units.

This story isn’t new. Increasingly, studies are finding that in America, we continue to accept — even push for — aggressive, technology-heavy care even though it may do nothing for our health and undermine the short time we have left.

“In addition to its effects on patients’ quality of life, unnecessarily aggressive care carries a high financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last years of life,” said David C. Goodman, M.D., M.S., lead author and co-principal investigator for the Dartmouth Atlas Project and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. “It may be possible to reduce spending, while also improving the quality of care, by ensuring that patience preferences are more closely followed,” he said. Continue reading

Employers’ Group Launches Biggest Campaign In 20 Years: To Contain Health Costs


The biggest employers’ group in the state has just launched its biggest issue campaign in two decades: a push to stem the ever-spiraling growth in the cost of health care. From the Associated Industries of Massachusetts press release:

The Employers’ Campaign for Affordable Health will ensure that lawmakers, employers, doctors, hospitals and insurers seize what may be their best opportunity to restructure the financial underpinnings of the Commonwealth’s health care system. The initiative will include lobbying, grass-roots organizing and public information, along with educational programs designed to prepare employers for the difficult decisions they will have to make as part of the process of controlling their health premiums.

The campaign marks the largest single project undertaken by AIM and its thousands of member employers since the organization led the reform of workers compensation system in 1991. The close parallels between the workers compensation reform and the current health insurance crisis offer hope that the same business/government coalition that worked together to lower workers comp rates by 60 percent at the start of the Weld administration can do the same with health care at the dawn of the second Patrick administration.

“We believe that change is in the air for positive action to address the cost of health care now. Employers simply cannot wait any longer for relief.” Said Richard Lord, AIM’s president & CEO.

Continue reading

Kiplinger’s 30 Ways To Save On Health Care

Amid all the punditry surrounding the one-year anniversary of federal health reform, this extremely useful list of tips on saving health care money from the financial counselors at Kiplinger’s was the only bit that made me want to do the electronic equivalent of clipping it and taping it on the fridge. Among its 30 suggestions, all of which are available online:

Save big at independent facilities. Different facilities charge vastly different prices for x-rays and tests. For example, the average in-network cost of an MRI at a hospital is $1,145, but the average in-network cost at an independent radiology facility is just $560.

Find lower-cost after-hours care. The average in-network cost of an emergency-room visit is about $933 — which you’d likely pay out of pocket with a high-deductible policy. But a visit to an urgent-care center costs only $71, on average. And a trip to a convenience-care clinic (such as Minute Clinic at CVS) averages just $33.
Continue reading

Daily Rounds: Patrick’s Payment Reform Agenda; Lucky HIV Genetics; GOP Cuts To Science; Obesity’s Social Network

Patrick readies a sharply reduced agenda – The Boston Globe “Patrick signaled yesterday that the most ambitious item he wants to pursue in his second term will be reducing health care costs, a goal that is considered the second phase of the state’s universal health care law, which focused initially on extending coverage to the uninsured. If he is successful, Massachusetts would become the first state in the nation to scrap the current health care payment system, in which doctors and hospitals are typically paid a fee for every procedure and visit, and replace it with a system that will essentially put providers on a budget for each patient’s care.” (Boston Globe)

The Lucky Genetic Variants That Protect Some People From HIV : Shots – Health News Blog : NPR (Harvard AIDS researcher Bruce) "Walker and his colleagues…pinpointed genetic variations that change amino acid building blocks in key proteins in the immune system. These differences help explain why some patients can be infected with HIV for decades, never get treatment and yet never progress to AIDS." (npr.org)

Money for Science May Be Scarce With New Congress – NYTimes.com “In the Republican platform, Pledge to America, the party vows to cut discretionary nonmilitary spending to 2008 levels. ..An analysis by the American Association for the Advancement of Science looked at what would happen if all of the agencies were cut to the 2008 amounts. The National Institutes of Health would lose $2.9 billion, or 9 percent, of its research money. The National Science Foundation would lose more than $1 billion, or almost 19 percent, of its budget, and the National Oceanic and Atmospheric Administration would lose $324 million, or 34 percent.” (The New York Times)

Obesity rate will rise to 42% of the population based on contagion – latimes.com “Obesity rates in the United States, which some health experts have suggested may be stabilizing at about 34%, will continue to rise until at least 42% of American adults are obese, according to a new model that projects the increase based on "social contagion." The social contagion hypothesis garnered widespread attention in 2007 when researchers…documented that obesity can spread through a social network — just like viruses spread — because people "infect" each other with their perceptions of weight.” (Los Angeles Times)

Daily Rounds: Partners Cutting Costs; The Liberal Gene; Vanishing Money And Alzheimer’s; Free Birth Control Under Health Reform

Partners planning reduction of costs – The Boston Globe The state’s largest health care system says it will redesign care for thousands of patients and reduce administrative costs as part of a major new initiative intended in part to make treatment at its teaching hospitals more affordable. (Boston Globe)

Can a 'liberal gene' determine political stance? Researchers say it's so – Los Angeles Times (articles.latimes.com) “[Researchers] reported that ‘it is the crucial interaction of two factors – the genetic predisposition and the environmental condition of having many friends in adolescence – that is associated with being more liberal.’

Alzheimer’s Warning Sign – Money Problems – Vanishing Mind – NYTimes.com New research shows that one of the first signs of impending dementia is an inability to understand money and credit, contracts and agreements. (The New York Times)

Health Overhaul May Bring Free Birth Control : NPR Fifty years after the pill, another birth control revolution may be on the horizon: free contraception for women in the U.S., thanks to the new health care law…A panel of experts advising the government meets in November to begin considering what kind of preventive care for women should be covered at no cost to the patient, as required under President Barack Obama's overhaul. (npr.org)

Coming Soon: Haggling Over Health Care Costs

Will consumers engage more on cost when health insurance deductibles rise?

Imagine negotiating the price of your kid’s ankle surgery the same way you’d haggle over the cost of a new car: you don’t accept the original price quote of $37,000, so you appeal to the doctor in charge, and eventually, you manage to get the two-hour outpatient procedure done for $1,500.

That’s just how it happened for Jeff Rice, a Nashville MD and creator of the online tool, Health Care Blue Book, which allows consumers to figure out the true cost of treatment and, armed with comparison price data, helps them negotiate better deals with providers. Dr. Rice spoke to Here and Now’s Robin Young about his own negotiating experience and why, with health insurance deductibles rising, consumers are starting to get more engaged on the issue of cost.

CommonHealth would love to hear your story about negotiating health care costs. Please share it with us.

Cost Hike: Levy Blames Insurers For Lack Of Efficiency, Insurers Fight Back

Paul Levy, the perpetually newsworthy CEO of Beth Israel Deaconess Medical Center, makes a crisp argument today blogging about the rising cost of health care.

Levy says while insurers often whine about the “underlying rise in medical costs” as the key driver of higher health insurance premiums, there is, in fact, another critical culprit: outsized administrative expenses racked up by the major health insurers, on average about 9.3 percent annually.

Levy’s Exhibit A is a February 2010 report issued by the state Division of Health Care Finance and Policy on premium levels and trends in the private insurance market:

“How can this be the case?” Levy wonders. “In other financial services industries, unit costs of transactions have gone down, not up. What is it about health care that suggests the opposite should be the case?”

Not to be outdone, the Massachusetts Association of Health Plans gave me a fairly lengthy response. Touche:

Reducing administrative expenses in health care is important and efforts are underway, but those costs are not what is driving health plan premiums. More to the point, talking about administrative costs distracts from focusing on the the major cost driver, which is escalating medical expense. Continue reading