Many humble thanks to Elizabeth Cohen, CNN Medical Correspondent. In the latest edition of her Empowered Patient segment, she was kind enough to include us in the article on “6 Ways to Save Money on Drugs and Doctors.” And we’re slated to be included in the  “House Call with Dr. Sanjay Gupta” at 830 a.m. Saturday and Sunday ET.

As a result, we’ve seen a bit of spike in traffic (and a small amount of smoke issuing from the back of the servers). They also featured our recent book, and we’re getting loads of folks downloading the free PDF version of My Healthcare Is Killing Me.

It’s a wonderful compliment, and let’s be sure the credit goes where it is due. We have a great team that supports change:healthcare. THEY make it happen, while CP and I get the handshakes and backslaps that they all deserve (we’re supposed to just look good, so if you’ve seen the book cover, you know we’re not holding up our end of the deal very well).  And a special shout out to our PR Director, Frank Limpus whose own personal PR is some of the most understated you’ll ever see.

Some interesting stats from the big boys on how adoption of CDHP is going. The numbers are not staggering by any means, but it is reflective of the growing trend toward consumers having to take responsibility. The trend will only accelerate as employers shift to move consumer-centric plans.

Most of the larger companies we have spoken with have the PPO, HMO and now HSA plan options. However, as a bit of clarification, the HSA is generally just a type of PPO with a higher deductible. As companies look to shift to consumer-directed plans the pure PPO will eventually go away and become the HSA-PPO.

Plan design - or a steady reduction in the scope of benefits - has been the traditional approach to holding down healthcare costs. You may be old enough to remember having a dental plan, visions plan and behavioral health - all of which have been partial or total victims of the “plan design” cuts. Before long, we will be able to say, I remember when we used to have a PPO without a high-deductible. That day is just around the corner.

Great article from a freelance writer in The Morning Call. Richard has some of the ledgers from NY and Pennsylvania banks the 1950s to 1960s showing how household expenses were distributed. Of particular note is that the family paid all of their medical bills in cash. When someone came down with a more serious illness, there were more and more payments finally totally a whopping $1084 for a fairly serious medical condition. It offers a great idea of household life during those times prior to privatized medicine and reminds us as we see the shift to consumerism in healthcare that history always repeats itself.

The proof of our book is in and people have already started to latch onto the free downloadable PDF version at My Healthcare Is Killing Me.

Seems like we might have struck a bit of a nerve.

Thanks so much to Bob Coffield for the shout out on the book. Can’t wait to catch up with him at Health 2.0 in just a few weeks. Bob is a master of Twitter. If you don’t know him, he’s @bobcoffield.

We’ll probably catch a lot of hell from Steven Krein at OrganizedWisdom for not calling it change:healthcare, but we’re working on that as another title and hope to have it out before November .

And many thanks to the others like Frank Hone and “Why Healthcare Matters” and Zane Safrit who have started to pick up on the book.

We’ve come a long way from the days of the snake oil salesman doctors. We have metrics, proof, real information, process, procedure and healthcare is FAR better as a result.

But I’m reaching saturation point with the quality talk. The only available quality metrics are on the hospitals, but they are comprised of individual docs who make up the numbers. Those docs come and go. The fact that even USA Today points out, is that most are clustered around an “average.” And that means you get basically the same quality of healthcare service in the US wherever you go with few exceptions.

As for those exceptions, they are few and far between, so they’re not accessible for all of us. And if we all go them, their ability to provide that quality of service will suffer as they realize increased volume and stress on their systems.

And still, I can go to the best hospital in town, but it comes down to the doc. If I have a condition the doc has not seen before, the quality is arguably going to suffer. Or possibly worse, if they’ve hired on some quack, and I get stuck with them in the ER, my quality experience will suffer.

That means that failing reliable data on a specific doc if all healthcare clusters around “average,” then the only quantifiable differentiator is price. So what is reliable data? Malpractice information? Do I look at number of claims or size of awards or awards in aggregate? Or should it be malpractice claims for a certain condition versus number of times treating that condition?

Maybe outcomes data is more important. So do I look at number of deaths? Make sure it’s severity adjusted so you don’t knock the doc for seeing a higher number of really sick patients. And be sure you take into account if the doc has just picked up a new procedure that will improve those abysmal outcomes he/she has been having.

This is why Zagats has gotten into the ratings game - it’ subjective - entirely. The meal you get one night at a restaurant is not the same meal you get the next night. The chef may change. The steak may be fresher. There may be a larger crowd.

It’s the same with healthcare. Have a procedure done. You might have a better blood pressure and better conditioning than the other person. Certain procedures may be valid for you but not for someone else.

It’s subjective. Quality in healthcare is almost entirely subjective. The quantifiable metric is cost. That’s the primary reason we chose to pick up the Hospital Value Index in our application because they factor cost in where others do not. So since everyone is basically “average” without specific data on a doc, ask this simple question the next time you require healthcare, “How much should I pay for this snake oil?”

Saw this post on the DailyKos that just so perfectly illustrates the state of our healthcare system.

Jollygreen does a great job of breaking down his costs and pointing out how the hospitals have increased their chargemasters in an effort to drive up their reimbursement. To top it off, the hospitals are pushing through as many people as they want simply processing transaction with no regard for things in context such as sending the bill for an ultrasound along with the bill for the other services associated with the miscarriage of that child one week later.

This just underscores again what poor business people most healthcare companies are.

Their approach to smaller reimbursements is simply to increase the billing amount. The approach to dealing with them is to simply low-ball them. Go ahead. Call up the hospital billing office and ask for a discount. They did not feel bad about simply raising the price with no rationale as to the amount. You should not feel bad about not using any rational reason for the lower amount you want to pay.

So I just got an e-mail from our insurance company about our health insurance. I just HAD to share it with everyone. Bless their hearts, it takes s o little to get insurance folks excited, like when your premium goes up only a little bit. So here it is…
Robert, it is not often that I get excited about someone’s insurance renewal but without fail, it happens once per year. This year, you’re it. Your benefits are going to improve, the premium for an individual employee will go DOWN $13/month and the premium for a family will only increase $17/month. This net result is a total monthly premium for the ENTIRE group increasing ONLY $23/month.
All this being said, I would like to discuss these changes with you and I will need you to sign off on the changes. Please give me a call at your convenience. I can be reached on my mobile phone if you don’t get me here at the office.Thanks! If I don’t talk to you today, have a great weekend.

So with the high cost of energy and that subsequently driving the cost of many things including delivering goods and services, it is small wonder that healthcare is starting to see people cut back.

I’ve seen a good number of articles already on people allowing their insurance coverage to lapse. They are forgoing the premium cost in an effort to save money. That’s a big short-term gamble. It’s a HUGE long-term gamble. Chances are, if someone drops their coverage, they won’t see a need to pick it back up until, well, they really need it. And then it’s too late.

And people are starting to cut back in other ways, too. In the face of efforts by employers to implement wellness programs and disease management programs, people are starting to act counter to that arguably wise practice. A recent WSJ post documents how Americans have begun to forgo those screenings and well care visits. that’s like not putting a new roof on a house until the rain water coming in has rotted out the floors from the leaks.

There are lesser ways to cut healthcare costs. Find a lower cost provider of the service you require (sorry for the shameless self-promo, but it’s what we do). Find a provider closer to you, so you don’t incur the fuel costs (again, sorry for the shameless self-promo, but…). Shop your prescription prices (um, sorry…). Just get engaged with your health and be aware instead of being passive. After all, it is your health, and if you don’t have your health, what do you really have anyway?

People find it hard to believe that healthcare is far more like used car sales than well…even used car sales.

So here comes another article on it from Kiplinger’s on how negotiable those pesky healthcare bills can be. This one talks about  a nearly 70% discount on the hospital bill.

“The doctors said he’s comin’, but you’ gotta pay in cash”

-The Eagles

We’ve enjoyed a bit of a free ride for the past several decades when it comes to healthcare. Employers and the government have picked up much of the tab. But now we are starting to pay the price literally. Increasingly we are asked to pay for medical services. Locally, The Tennessean just featured a piece on a doc who is going to charge his patients $1,500 annually to maintain access to him. We had best get used to it.

I have nightmares of other businesses becoming like our current healthcare system. In these night terrors, I go to buy groceries, pay a $20 co-pay and then get the bill 30-45 days later, can’t understand what it is I got, have already consumed the product and am expected to pay far more than I would ever have dreamed it might cost.

Predictable costs in healthcare will have to become more the norm. Concierge healthcare is becoming more popular. Just ask Jay Parkinson, M.D. who has had a concierge practice in NYC and is starting Hello Health. He uses REAL docs, not nurse practitioners like the retail based clinics (RBCs), but like the RBCs, Hello Health has [gasp] transparent pricing. You will actually know what you are paying at the time of service. Novel concept.

It’s a different way of thinking and doing business on the healthcare front, but it has tremendous merit.

Our unfettered access to the healthcare system has taken much of the responsibility for our health off of our hands.  As partial proof of that, we can point to our obesity epidemic, overprescribing of drugs for any small ailment and overuse of the system (even I have kids who go to the doc at every sign of a sniffle, and then feel silly for being asked what I’ve done to treat it - I noticed it and brought them to the doc). Not only have we stopped being responsible for the cost, but we’ve also stoped being responsible as a society for understanding and managing our health. I’m guilty.

Now we are paying the price.