Tuesday, March 20, 2012

"WISE OLD MAN" REVISITED (AGAIN)

"Perhaps it is not that health care is expensive, it is that health insurance is expensive and drives up the cost of health care."
What do you think?

MEDICAL TOURISM

Sabriya Rice wrote about the increasing medical tourism (getting health procedures in other countries at significantly reduced charges) industry in the United States. The following are excerpts from her excellent article:

MEDICAL TOURISM

By Sabriya Rice, CNN
Shopping for cheap surgery

STORY HIGHLIGHTS
■The majority of medical tourists are uninsured
■About 878,000 Americans will travel internationally for a medical procedure this year
■Travelers should research the legal system of the country they are visiting
■Patients should make sure overseas hospital they’re considering is accredited

(CNN) — When Godfrey Davies learned he needed surgery to remove polyps blocking his nasal airways, the self-described bargain shopper set out on a mission to find an affordable surgeon. He quickly learned a good deal is hard to find.

“The total numbers they were throwing at me were just incredible. I couldn’t believe it,” he says.

Davies, who is semiretired from his real estate business and uninsured, says he received estimates from two surgeons. When hospital, anesthesia and incidental fees were all tallied, the cheapest price he could find in Indianapolis, Indiana, was $33,127 — which he would need to pay out of pocket.

“I was speechless.” Davies recalls. “It was absolutely out of the question financially for me to have this done under those circumstances.”

Frustrated that his bargain shopping saved him so little, Davies called on family in the United Kingdom for assistance. When they told him they had found a private hospital in Wales that would perform the surgery for $2,930 [or £1,897], Davies didn’t think twice.

He purchased a $768 round-trip ticket, and on March 18, he boarded a flight to the UK to have his polyps removed there at a savings of nearly $30,000.

Medical tourism on the rise

An estimated 878,000 Americans will travel internationally for a medical procedure this year, according to a report from the Deloitte Center for Health Solutions. That number is expected to nearly double by 2012.

The majority of medical tourists are uninsured; however, the cost of health care in this country has become so expensive that even some U.S. health insurance companies are coordinating with hospitals overseas.

“It is curious to a number of folks as to why an established American health insurance company would be interested in medical tourism,” says David Boucher, president of Companion Global Healthcare, a subsidiary of Blue Cross Blue Shield.

His pilot program launched in 2007 as a “medical travel facilitator,” allowing participating employers to add an international option to the health care plans they offer to staff. The company has partnered with 29 hospitals in 14 countries and offers negotiated rates that are lower than those offered at hospitals domestically.

Boucher says employers will sometimes waive co-pays or purchase airline tickets if an individual opts to travel abroad for expensive surgery because, ultimately, it benefits everyone.

“If you can save forty to fifty thousand on an employee’s surgery, it gets right to the company’s bottom line,” Boucher says.

Before you hop on a plane

1. Know your legal rights

“Each country has a different legal system,” points out Nathan Cortez, assistant law professor at Southern Methodist University and author of a 2009 study looking at the legal risks of medical tourism.

“If something goes wrong, you don’t have the same legal recourse as you have in the United States.”

2. Make sure the hospital is accredited

Accredited through the Joint Commission International. The joint commission inspects facilities to make sure they meet the necessary standards.

3. Negotiate locally one more time

“It’s a real issue with the economics of health care,” says Derek Fitteron, president and of the group Medical Cost Advocate. “But people can make it economically work by staying in the U.S.”

He says his group has helped to bargain down prices for many people who want to find affordable care in their own ZIP code. When Fitteron’s team investigated the cost of the procedure Godfrey Davies underwent, for example, they found that on the high end, the price should have been no more than about $17,850 in his state.

Fitteron says self-pay patients are “getting really aggressively overcharged,” as hospitals are trying to subsidize for money lost on things such as Medicare and Medicaid reimbursements.

Davies, who is originally from Wales and has been a U.S. citizen since 2002, says he was disappointed about having to travel more than 4,200 miles for such a simple procedure. But ultimately money was the deciding factor.

“$33,000 versus $3,600 … I can put up with a lot of inconvenience to save that kind of money.”

Monday, October 10, 2011

Data to provide better care

Physicians need to understand data to provide better and safer care
by Donald Tex Bryant | in Physician | 4 responses

inShare.30Patients expect excellent care from their physicians. Unfortunately, not all receive such care and most of us realize this. Many who do understand the wide variation in patient care probably believe it is due to the clinical knowledge and attitude of the provider—a very knowledgeable physician or nurse who is passionate about his or her job will deliver the best care. Although these ingredients are necessary for excellent patient care, today better care can be delivered with modern tools and methods, such as “smart” IV pumps, checklists, registries and EHR’s. Many of these are digital and based upon data. It is necessary for providers to understand data to provide better and safer care today.

Let me give you two examples of care, one assisted with data driven decision-making.


Dr. M is a primary care physician who has been practicing for over 20 years. He still is passionate about the care that he gives his patients. One of his focuses is on patients he has diagnosed with hypertension, as there seems to be an increase in patients with this chronic condition in the past few years. Dr. M believes that he is providing excellent care. He believes that most of his patients adhere to the drug regimen and diet that he has prescribed for them. In a recent visit by his EHR vendor his office was shown how to find population level data on the EHR and registry. The output on hypertension showed that only about 60% of his patients were adhering to their drug regimen and diet. His patients were experiencing more coronary problems than expected. There were a higher percentage of strokes among these patients than he realized too. In other words, many of his patients were not achieving outcomes which would enable active and enjoyable life styles.

Dr. S is also a primary care physician. She has been in practice for nearly 20 years. She is still passionate about her work and is always looking for ways to improve the care that she and her staff renders. She also focuses on patients she has diagnosed with hypertension. Because she and her staff had their EHR vendor demonstrate how to view population level data when they were implementing the EHR, she has kept track of the outcomes for her hypertension patients. Working from the baseline data that was available when the vendor demonstrated the software, she and her staff have continuously sought ways to improve the outcomes for her patients. They have investigated patient-centered care more thoroughly. One of the payers supplied them with information and contacts to help. They contracted with a process improvement specialist to teach them how to use the plan-do-check-act cycle to improve outcomes. The specialist also taught them how to use some other tools from Lean Healthcare to improve the quality and safety of care. The result is that between 85% and 90% of her patients adhere to the plan that she and the patient create to take care of the chronic condition. Her patients are much healthier and have fewer “healthcare crises”. She has more time to spend with each patient and the income at her site has increased about 10%.

The two physicians are much alike in experience and attitude. One of the main differences is that Dr. S uses data to understand the results of the care that she and her staff provide. Using this data, they have learned “to work smarter, not harder”. Using the baseline data, she and her staff sought out and adopted new methods and processes of providing patient care. The results were very pleasing.

The world of healthcare is evolving and will require the kind of skills that Dr. S and her staff employ. Recently, the American Medical Society issued a white paper, Pathways for Physician Success Under Healthcare Payment and Delivery Reforms, describing the new payment models that will likely be adopted by payers, both the government and private, and the skills that will be necessary for providers to successfully capitalize on them. Among the list of skills in the paper were:

•Having the skills/experience to efficiently/effectively implement a new/improved service
•Having the ability to obtain and analyze data on the quality of services
•Having the skills/experience to improve the quality of services
•Having adequate resources to support high-quality service delivery
•Having skills/experience in improving the efficiency of service delivery
•Having the ability to obtain and analyze data on the quantity and cost of services delivered by other providers
As you can see, many of the necessary skills are based upon understanding data and processes and using them to improve the delivery of care.

This approach to providing quality in services and products has been used for many years outside of healthcare. Toyota developed a unique approach based principally on plan-do-check-act (PDCA) and teamwork that resulted in a superior product that enabled them to be the standard of quality in production for many years. Some healthcare providers are starting to adopt data driven models such as PDCA to improve care. Advantage Health of west Michigan is having all of its primary care sites certified as medical homes.

With the advent of HIT products such as EHR’s, registries and “smart” hardware, it is now much easier to access data that can be used to drive improved outcomes. Most EHR’s can provide population level data that can be used to view the level of care presently rendered and to track changes in outcomes as new processes and hardware are adopted.

It will be necessary in the near future for providers to develop their skills in using data to modify processes at their site so that the patient outcomes are significantly better. New payment models based upon quality of care will require this. Successful employment of these techniques will be rewarding for all involved—patients, providers and payers.

Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.

Monday, October 4, 2010

NATIONAL INSTITUTE ON HEALTH POLICY/CANADIAN HEALTH SYSTEM VS U.S. HEALTH SYSTEM

CANADA’S HEALTH CARE SYSTEM IS MORE LIKE YOURS THAN YOU THINK

“Socialized medicine is a misnomer,” says Dr. Alan Goldbloom, CEO of Children’s Hospitals and Clinics of Minnesota, who practiced in Toronto for many years before coming to Minneapolis in 2003. “Canada has socialized health insurance, but most Canadian doctors do not work for the government.” In addition, Canadians have free choice of doctors and hospitals. Neither the governments nor the insurers dictate choices or require “prior approvals” as in the U.S. “Health bureaucracy in the U.S. is an industry itself, its…regulatory complexity is hundreds of time greater than anything in Canada,” swears Dr. Goldbloom.

The U.S. spends $7,290 per capita on health care vs. $3,895 in Canada. Both countries ration care, but the U.S. does it on the basis of economic status or insurability whereas in Canada it is strictly on the urgency of medical need. “The great joy of practicing in Canada,” says Goldbloom, “is I never had to even consider whether any family could afford the care I was recommending.” Much as Canadians demand improvements in their system, “they would never give up universal health insurance.” It’s a fundamental right of Canadian citizenship.

Commentary from Dave Durenberger


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MEDICARE INFORMATION RE: MINNESOTA FOLKS

Subject: Fast Facts for Minnesota in 2011 for Medicare Health and Drug plans
2011 Medicare Health and Drug Plans in Minnesota
Fast Facts for Minnesota in 2011

• 33 Medicare Prescription Drug Plans (PDPs) available

• 89% of people with Medicare have prescription drug coverage (including 68% with Part D)

• 26% of people with Part D get Extra Help (also called the low-income subsidy, or LIS)

• 92% of people with Part D can pay a lower premium in 2011 than they did in 2010

• 83% of people with Medicare have access to a MA plan for a $0 premium

• 13 PDPs have $0 deductibles

• $14.80 is the lowest monthly premium for a PDP

• $36.30 is the lowest monthly premium for a PDP with any generic coverage in the Coverage Gap

• 10 PDPs have a premium of $0 for people who qualify for Extra Help

Plan costs and coverage change each year, so all people with Medicare should check to make sure their plan still meets their needs and budget. There may be a Medicare health or drug plan available with better coverage or a lower deductible in 2011.
Important Dates in 2011
October

• Watch your mail for notices from Medicare, Social Security, and health and drug plans with information about changes in 2011

• Compare plans online at www.medicare.gov starting October 15

November

• “Medicare & You” 2011 arrives in your mail

• Open Enrollment starts November 15

December

• Open Enrollment ends December 31


All people with Medicare should:

• Review the 2011 costs and coverage of their current plans

• Compare with other plans in their area

• Choose a plan that meets their needs and budget

Wednesday, July 21, 2010

From Dr. Tor Dahl

Economists estimate that eighty percent of all capital is human capital. Those employers who view workers only as cost items miss out on the contributions of human capital and work experience that go out the door with layoffs and firings. Also - and notably - they lose out on the potential cooperation of employees if those employees associate productivity improvement with loss of jobs. Productive companies grow. They don't lay off workers. Productive companies invest in their human capital the training and education which will be needed for the challenge represented by new growth. This is what made it possible for Google to go from zero to more than $150 billion in market value in only six years. Some eighty percent of the U.S. economy belongs to the knowledge sector

to go to our website WWW.TORDAHL.COM

Thursday, May 13, 2010

"WISE OLD MAN" REVISITED

The 'Wise Old Man" is enjoyable to visit, based not on his intellect but his 'wisdom' of living life, observing, and sharing his thoughts of history and what we can learn from the lessons of history.

A few of his recent comments:

A French writer once wrote (not an exact quote) 'The success of America is not due to competition but to cooperation.' We now have political strategy to not cooperate - to work against democratic or republican party ideology - so the other party doesn't look good. The behavior is encouraged even if it is not in the best interest of the people (or America).

We pay the lowest personal taxes of any developed nation. Warren Buffet, one of the top BILLIONAIRES, states he pays less taxes than his secretary, and he should pay more. Tax breaks for the wealthy are not extended down to the middle class.

GREED is permeating society. It appears the more money one earns, the more one wants and if the rules have to bend a bit for ones success, so be it. The growth of America can be traced to the middle class. Unfortunately, we are shrinking the middle class.

It is interesting to me the number of 'blue collar' workers and the number of 'union' workers who have earned a high standard of living level over the last 40 years, due in part to their parents and brothers and sisters-have forgotten their roots. They take the position that if 'those people" want to enjoy a higher standard of living, they should work hard, like I did....They need to remember their roots, how they were helped and that "those people' need a friendly hand to help them. Our economy is moving into the 'knowledge economy." The blue collar and union workers who were born into a strong, thriving economy but have been negatively affected by the down turn, will not be able to recover without understanding the global impact of a knowledge economy. Let's hope they learn and make education for their children the top three priorities: 1) education, 2) education, and 3) education

People should read the Rise and Fall of the Roman Empire. We make recognize the behavior of our elected national leaders, our continual need for improved highways systems, and sports stadiums (gladiator arenas?) is similar today as it was during the fall of the Roman Empire. Perhaps we are in the midst of a 30 or 40 year decline. That should scare people and want them to work together for the good of the county.

Perhaps we can visit again with the "Wise Old Man" in a few months, and we will learn, if we listen.