How expensive is your hospital?

I had no idea how expensive my hospital, Lahey Health (formerly known as Lahey Clinic) is compared to other hospitals. Its one of those hidden numbers that your insurance company and hospital conspire to keep unknown as they negotiate rates and fees.

I live just outside Boston, which is home to a few big name hospitals, and refuse to go into the city for treatment. The traffic would drive me crazy. And if I am not feeling well, I refuse to deal with the traffic and feel like crap at the same time.

I have friends who went into the city for treatment and whined about all the traffic they sat in and how early in the day they would have to start to get to a 9am infusion. I just assumed all hospitals cost about the same - namely a hell of a lot because nothing is cheap around here.

But now I know... and drum roll... its 12%-40% less than the big hospitals with the fancy names in town. They have a strategy of creating a network of community hospitals where most patients can go for care leaving the big teaching hospital for the sickest people. (Guess which one I go to?) They have been expanding their network over recent years.

Here is a comparison of the costs from 2012 for an inpatient stay.

 

The two hospitals that are lower than Lahey are located away from metropolitan Boston.

I will say I am happy to learn my medical care is not straining my insurance plan as much as if I went in town. And I am happier to enjoy my 10-12 minute drive through back roads with no traffic to medical care.

How much would you pay to heal yourself?

Current pharmaceutical pricing of new cancer drugs are sky rocketing. $100,000 for a new medication designed to extend life by months or weeks is crazy. Here is a very long article on cancer drug pricing and all the issues surrounding it. I say read it, its worth it to get a better understanding of the issues surrounding the high prices.

My few points are:

• Pharma companies spend billions on research, required testing to meet FDA standards, and then can only expect to reap the benefits through the length of their patent which is ten years.
• If they lowered prices, their share holders would be unhappy and less likely to fund additional research for new drugs which would result in fewer new drugs in the future even though the short term benefit of reduced pricing would benefit patients. But the shareholders would be happy.
• In their research process, numerous discoveries do not make it FDA approval and are tossed, throwing out years of research and billions of lost costs.
• And the most appalling: "The high cost of current cancer therapies is at least limited by the relatively small patient populations they treat.  Next generation immunotherapies, including CTLA-4, PD-1 (programmed cell death), and chimeric antigen receptor therapies (CARTs), appear to deliver much improved outcomes (in some cases including complete remissions) with limited side effects – and may also be used to treat many more cancer types and much larger patient populations than current therapies.  Given their inherent value to patients, they could easily command prices well in excess of $100,000 per course of treatment." Please reread that last sentence: Given their inherent value to patients, they could easily command prices well in excess of $100,000 per course of treatment.

I can accept that lots of research can end up in the trash bin if drugs do not perform as expected. I can buy that happy, rich, healthy share holders help companies stay on track. But I cannot and will not accept pricing based on the 'inherent value to patients'. That is basically saying that they are charging what they think a patient would pay.

This is like saying when you break a leg, how much would you pay to have it set and mending with pain under control? At the second of pain, you would probably pay $2000 for that first shot of morphine....

That's insane. Go get some morals and charge patients correctly.

Medical advances come at a cost

We hear about these great new advances in medicine that are finally released on the market. Maybe its a new drug, a new test, a new device. It doesn't really matter. It is hailed as progress. But progress often comes at a cost - we are slowly learning.

When any medical advance comes with a price tag, the question is then who pays? It comes from one of two places - the patient's pocket through a higher payment or through the insurers pocket which really means all of us pay for it.

So new diabetes pumps were introduced that offer more features, blah, blah, blah. The medical device marketing companies promote them heavily to patients. Each one costs $2500 and has a planned obsolescence every three years. Insurance companies will replace them every four years.

Diabetes is not an inexpensive disease. Patients with insurance spend more than $4000 annually even with insurance. Another $20,000 plus is covered by insurance (or the rest of us). This is called progress.

What kills me about this in an age where recycle/reuse has become more and more important, why are companies introducing something that has a planned obsolescence in three years? Wouldn't it be better to create something that might be upgradable and would last ten years? Thus reducing costs for all of us.

So every time we hear about a new medical device, tests, medication or whatever, we need to ask ourselves - what is the cost? Being covered by insurance is not the right answer.

The real answer should be: the per patient cost per dose/year of coverage is $X so we can see the real cost. Transparency should be required for all new advances and all new developments in the pipeline should have a plan for end patient cost that is justifiable and medical devices should focus on long term use instead of planned obsolescence.

The polar bear is not the remarkable part of the story

This young woman was returning from a Halloween party in Churchill, Manitoba and was attacked by a polar bear. She survived due to the efforts of her friends, a neighbor who came out and hit the bear with a shovel and due to the medical flight that took her to the major medical center to be saved.

While this woman is very fortunate to survive. She will be okay in the long term but has to pay of $10,000 for the cost of transport to the medical center for treatment. I would have thought Canada's national healthcare system would cover this type of cost. Never would I believe that the patient would be stuck with this type of cost.

I assumed, wrongly, that Canada's healthcare provided everything, even if it came with a delay. Her friends are helping raise the money to pay for the transportation and time lost at work.

But I hope the bear is okay even though he was hit by a shovel..

So are you an inpatient or an outpatient?

The hospital and Medicare get to decide. Not your doctor who is actually treating you.

I found this pretty appalling. Medicare patients can be in the hospital for DAYS and be called and an outpatient because they are only being 'observed'. They get the same care as everyone else. But then they get a big fat bill if they were an outpatient.

Their doctor can even admit them and make them an inpatient but then the hospital can change it back to outpatient. Hospitals like this because they get reimbursed more that way.

"Medicare originally intended observation care as a way to give doctors time to evaluate whether a patient should be admitted to the hospital or is stable enough to go home, usually within 24 to 48 hours. But hospitals are increasingly keeping patients in observation status longer: 8 percent of Medicare recipients had observation stays longer than 48 hours in 2011, up from 3 percent in 2006.
Apparently the government can tell by looking at a rule book to figure out how sick you are, not but diagnosing you and reading your chart. Or, God forbid, even talking to you.

That increase may partly be a response to aggressive reviews of hospital billing practices in recent years. Medicare contractors have demanded refunds from hospitals that admit patients the government believes should have been treated as observation patients or outpatients. Medicare pays hospitals less for those patients."

And also hospitals are now rated on their readmission rates. If you aren't admitted the first time, you are not readmitted later on.

"Toby Edelman, senior policy attorney at the Center for Medicare Advocacy in Washington, D.C., said she believes hospitals also could be trying to avoid readmission penalties, which are assessed if too many patients are readmitted within 30 days. Harold Engler, for example, went home after five days, grew sicker, and then returned for another five-day observation stay. If he had been an inpatient, he would have counted as a readmission within 30 days."

Hospitals claim they are working on it because they computer tells them what to do. The computer even knows more than the government:

"Dr. James Hart, who heads a Beth Israel Deaconess committee that makes sure the hospital follows Medicare rules, said he could not comment on Engler’s case. But he said the hospital uses a sophisticated computer program that tries to match patients with the correct Medicare designation based on their illness and the intensity of hospital services required. “We are very focused on getting the level of care accurate,’’ he said."

Medicare knows this is a problem and even has created a brochure on this telling patients the difference. But if you are sick in bed, do you really care about semantics? No.

"Case managers generally inform patients of their status, especially if they require skilled nursing care, he said. But that doesn’t mean patients digest the information, at a time when they have so much to focus on. “Part of the challenge from a patient perspective is there really is an information overload,’’ Hart said."


You just want to feel better and go home where you can be in your own bed eating real food instead of the crappy hospital food they serve.

I knew Medicare had its issues but I didn't think it was out to impoverish seniors. I thought it was supposed to be the other way around. Clearly some changes need to be made here.

Update: 8/30/13 - One of the former heads of Medicare wants the rule on observation to be abolished.

How much would you pay to heal yourself?

Current pharmaceutical pricing of new cancer drugs are sky rocketing. $100,000 for a new medication designed to extend life by months or weeks is crazy. Here is a very long article on cancer drug pricing and all the issues surrounding it. I say read it, its worth it to get a better understanding of the issues surrounding the high prices.

My few points are:

• Pharma companies spend billions on research, required testing to meet FDA standards, and then can only expect to reap the benefits through the length of their patent which is ten years.
• If they lowered prices, their share holders would be unhappy and less likely to fund additional research for new drugs which would result in fewer new drugs in the future even though the short term benefit of reduced pricing would benefit patients. But the shareholders would be happy.
• In their research process, numerous discoveries do not make it FDA approval and are tossed, throwing out years of research and billions of lost costs.
• And the most appalling: "The high cost of current cancer therapies is at least limited by the relatively small patient populations they treat.  Next generation immunotherapies, including CTLA-4, PD-1 (programmed cell death), and chimeric antigen receptor therapies (CARTs), appear to deliver much improved outcomes (in some cases including complete remissions) with limited side effects – and may also be used to treat many more cancer types and much larger patient populations than current therapies.  Given their inherent value to patients, they could easily command prices well in excess of $100,000 per course of treatment." Please reread that last sentence: Given their inherent value to patients, they could easily command prices well in excess of $100,000 per course of treatment.

I can accept that lots of research can end up in the trash bin if drugs do not perform as expected. I can buy that happy, rich, healthy share holders help companies stay on track. But I cannot and will not accept pricing based on the 'inherent value to patients'. That is basically saying that they are charging what they think a patient would pay.

This is like saying when you break a leg, how much would you pay to have it set and mending with pain under control? At the second of pain, you would probably pay $2000 for that first shot of morphine....

That's insane. Go get some morals and charge patients correctly.

Medical advances come at a cost

We hear about these great new advances in medicine that are finally released on the market. Maybe its a new drug, a new test, a new device. It doesn't really matter. It is hailed as progress. But progress often comes at a cost - we are slowly learning.

When any medical advance comes with a price tag, the question is then who pays? It comes from one of two places - the patient's pocket through a higher payment or through the insurers pocket which really means all of us pay for it.

So new diabetes pumps were introduced that offer more features, blah, blah, blah. The medical device marketing companies promote them heavily to patients. Each one costs $2500 and has a planned obsolescence every three years. Insurance companies will replace them every four years.

Diabetes is not an inexpensive disease. Patients with insurance spend more than $4000 annually even with insurance. Another $20,000 plus is covered by insurance (or the rest of us). This is called progress.

What kills me about this in an age where recycle/reuse has become more and more important, why are companies introducing something that has a planned obsolescence in three years? Wouldn't it be better to create something that might be upgradable and would last ten years? Thus reducing costs for all of us.

So every time we hear about a new medical device, tests, medication or whatever, we need to ask ourselves - what is the cost? Being covered by insurance is not the right answer.

The real answer should be: the per patient cost per dose/year of coverage is $X so we can see the real cost. Transparency should be required for all new advances and all new developments in the pipeline should have a plan for end patient cost that is justifiable and medical devices should focus on long term use instead of planned obsolescence.

How expensive is your hospital?

I had no idea how expensive my hospital, Lahey Health (formerly known as Lahey Clinic) is compared to other hospitals. Its one of those hidden numbers that your insurance company and hospital conspire to keep unknown as they negotiate rates and fees.

I live just outside Boston, which is home to a few big name hospitals, and refuse to go into the city for treatment. The traffic would drive me crazy. And if I am not feeling well, I refuse to deal with the traffic and feel like crap at the same time.

I have friends who went into the city for treatment and whined about all the traffic they sat in and how early in the day they would have to start to get to a 9am infusion. I just assumed all hospitals cost about the same - namely a hell of a lot because nothing is cheap around here.

But now I know... and drum roll... its 12%-40% less than the big hospitals with the fancy names in town. They have a strategy of creating a network of community hospitals where most patients can go for care leaving the big teaching hospital for the sickest people. (Guess which one I go to?) They have been expanding their network over recent years.

Here is a comparison of the costs from 2012 for an inpatient stay.

 

The two hospitals that are lower than Lahey are located away from metropolitan Boston.

I will say I am happy to learn my medical care is not straining my insurance plan as much as if I went in town. And I am happier to enjoy my 10-12 minute drive through back roads with no traffic to medical care.