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.

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.

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.

Kudos to the Nashville Business Journal Health Affairs Editor-in-Chief Susan Dentzer for her insightful comments on many issues surrounding healthcare at the recent Nashville Healthcare Council gathering.

The attention grabbing headline of her corresponding article about the potential for healthcare to be the next sub-prime mortgage crisis rings true though I’m not sure it can all be pinned on HSAs as she does in her article.

Compare the two industries and beyond the similarities in dollars paid out, there are some disturbing lessons begging to be learned.

Housing runs in the hundreds of thousands of dollars for a family. Healthcare has the potential to do the exact same.

Mortgages can easily hit $1200 per month in expense. And at $1200-1400/month for family healthcare coverage, average healthcare premium costs alone are comparable to the size of a mortgage note for many families.

And houses have to be maintained. You need a new roof or air conditioning (that’s where I’m living right now). Those are not small expenses running $5K-$10K per instance. Under all too common circumstances, a major illness can generate bills into the tens and hundreds of thousands of dollars beyond premium.

The financial implications of healthcare are clear. They are equal to if not greater than housing expenses for most Americans. But that’s where many of the the similarities end. And this is where it starts to get worrisome. It is potentially far worse than the mortgage crisis.

With housing, you can see it, feel it, touch it. Now ask yourself if you know what tests your doctor ran that last time you saw them.

With housing you decide when to buy. You decide what the right size house is and the best schools. Healthcare is often times unplanned or in a best case scenario, that pregnancy might give you 7-8 months forewarning, but the cancer did not nor did the broken leg (don’t tell me you were planning on breaking your leg unless of course you had a ski trip planned).

In buying a home, you do your research. Find out what other people are paying. Compare features. Ever tried to find out the price of a strep throat test? Pretty basic, but we’ve tried it, and it’s all across the board. For that hip replacement surgery, did your doc ask if you wanted a plastic of a titanium hip, or did he put in what your insurance would cover or simply what he was trained on and what he knows?

With housing you get all sorts of disclosure information about costs. In fact law requires it. Pardon the uncontrolled laughter, but do you have any idea what you are going to be charged walking into your doctor or the ER? There is no pricetag on healthcare for the most part. Cost transparency does NOT exist and what you pay and what someone else pays for the exact same service can vary dramatically.

In buying a home, you budget for it. It’s a big expense. You don’t go outside of your means and say “Damn it all, that’s what I want and by gosh I’m going to get it even if it’s five times what I can afford.” (OK so those days only recently ended in housing). In healthcare, other than premiums, do you have a budget? Are you on a plan with a deductible? Do you have a co-insurance that saddles you with 10 or 20% of the costs incurred? That can be an unbudgeted $500 or even $10 thousand dollars or more.

Which leads to the terms. For a home, you set up terms. You pay out over 30 years or so. Truth in lending requires them to show you how much you will actually pay out in interest, etc. over the 30 years (try to avoid passing out when you see that one by the way). In home-buying, you set up terms that you are (at least theoretically) able to meet with your income. Healthcare is potentially a home-sized expense. And it generally runs its course within 60-90 days. Not a lot of time for an expense that is potentially the size of your home.

So if you default on your home loan, they repossess it. That’s the pledged asset because on debts that size, no one is going to give you the money for the purchase without securing an asset. Healthcare is really different. They can’t make you take back that nasty gall bladder or break your leg again (though the collections tactics they use sometimes border on that). There is no asset pledged against the expense. Hospital wants the money? You don’t have it. their option is to try to force you to liquidate your assets – like your home. The one you lost in the mortgage crisis?

Does healthcare have the potential to be the next sub-prime mortgage crisis?

No, it has far more potential.

Once again I had the privilege this morning to hear Sen. Bill Frist speak, this time at a breakfast held at Lipscomb University.  Though last time the topic was highly focus, today the slate was clear and anything to do with health care was on the table.  Although our time was limited, Frist managed to cover a lot of important topics and share his vast amount of experience and knowledge with us in the crowd.

The conversation began with a reminder that the US, compared to other countries, ranks poorly when it come to life expectancy and infant mortality, despite spending twice as much as other comparable countries.  Why is that?  Well consider what makes up health and life expectancy: 40% Life style and Behavior, 30% Genetics, 15% Socioeconomic status, 10% Health Services and Technology, 5% Environment.  Unless you have been living under a rock, its no shock…  we live in a country where our life style choices are not the greatest, a large portion of our country is obese and many people do not regularly exercise.  Add poor lifestyle choices to our lack of desire to change our behaviors, its no wonder we rank so low.

Anyways, from there we managed to discuss cost shifting, Medicare and the pending 10.6% reimbursement cut,  and the uninsured among other things.

My most important take away was his belief in consumerism and the public sectors ability to affect change.  In most all markets, with very few exceptions, competition and consumerism drive down or at the very least maintain costs.

Transparency… the new industry buzz word… connects right into this and refers to the idea that information regarding cost, quality, outcomes, and experience should be readily available to all consumers of healthcare (cost and quality being the top two, considering they are what we are having the hardest time controlling).

By making the industry more transparent, especially how much a physician is really being reimbursed for their services and how much a procedure will cost them before having it done, consumers have a better idea of the true cost and quality of the care they receive.

Wonder what the result is?? Well it’s believed that transparency in the industry will make consumers more inclined to take responsibility and accountability for their own health and health care. Now here’s the reality,  not everyone is going to care about how much their health care cost – Just like not everyone is going to care about “global warming”.

However the industry just really needs to see an emergence of “the prudent shopper”… the group of people that begin talk, begin taking note, and begin to care about their health care and its cost.

If you think you might be the next “prudent shopper” of health care, visit www.changehealthcare.com and see what you think… tell us what you think! We are moving into the world of transparency and engaging consumers… be part of that change.  That’s my advice.

Transparency, accountability, and competition… I must say – I am always happy to keep my feet moving, rather than be left behind.

The best thing about this job is that we get to meet some really great people. Today we met some outstanding folks who are going to make a difference.

Cover America made a stop right here in Nashville today and a few of the change:healthcare team had a chance to catch up with them. The cross country trek to capture stories of consumers’ difficulties with the healthcare system is part of a Consumer Reports effort on the healthcare front.

We really enjoyed meeting Meg, Blake, Pauline and Liz. Even got our photo with the RV in Centennial Park, in the shadow of Hospital Corporation of America (oh, how we love the irony of that one). Many thanks to these folks for what they are doing – fighting for the healthcare consumer.

Meg is getting a much deserved break after three weeks on the road, and we wish her a happy mini-vacation.

The rest of the crew is headed on to eastern Kentucky before hitting Virginia. We are going to try and hook them up with our favorite West Virginian, Bob Coffield of the Health Care Law Blog when they hit Charleston.

I guess I’m a little confused with all of this concern over socialized healthcare. Seems like we’ve already got it . So what’s the big fuss?

Insurance = Socialism

Insurance is based on the concept of socialism.  Assemble a group and they all contribute to the group for the better of the whole to protect the individual. That’s what insurance is. We all pay in. Some really need it and use it and benefit from the group spread of the risk. Others don’t need it as much and they help cover the others who do with an eye toward having their future needs covered. Insurance is based on the most core principles of socialism.

Medicare = Socialism

Medicare is socialized healthcare. The government groups all people over 65 into a single pool. Everyone paid in with taxes and the government covers the majority of costs. So Medicare is already socialized. Ask anyone using it what they think of it. Most will say they are thankful that it is there, but that it does not do it all.

Medicare = Private Healthcare

Private healthcare rates are generally set based on Medicare rates. There are so many services and procedures that it would be terribly time-consuming and inefficient for an insurance company to negotiate each batch of services with a provider on a case by case basis. So they set most of the rates based on a percentage above what Medicare would pay. In essence, they let Medicare lead as the largest insurer in the market (a socialized one at that) and then just follow their lead. The larger an insurer’s group, the closer their reimbursements are to Medicare’s. The small the group, the more they pay.

Insurance = Socialism = Medicare = Private Insurance

So following through the equation, it’s pretty obvious that we already have socialized healthcare. Getting it more socialized will not solve the problems we have – overuse of the system, high costs, quality of care, and inaccessibility to care.

With fully socialized medicine, anyone can go any time is the idea people have. That will not breed discretion, it will only create more overuse as an “all you can buffet.”

The governement is inefficient and overpays at every turn for things. Costs will not be held in check.

Quality – controlled by the government? Oh my. Anyone ever heard the phrase “Close enough for government work? Look at the VA and its recent struggles.

And where are the additional doctors to address this new open buffet? I see nothing where the effort is being made to bring in more physicians to help address what will be an increased demand.

Does everyone deserve healthcare? Absolutely.

Do we want the governement running it? Absolutely not.

There is much the governement could do to improve healthcare, but taking it over is not part of it. Look for some ideas on where they might be able to help in  the next post.

Because he’s authentic , sincere , yet doesn’t take himself too seriously.

I feel like we share a similar vision about what is right vs. stupid.  My hat goes off to Jay for simply being really honest and avoiding the complexity that the healthcare system tends to swirl in. Keep on cutting through the crap, sir.

If you haven’t downloaded Jay’s HIMMS presentation , do it. Albeit 460 slides, like Jay, the presentation is simple and honest.

Also, I wanted to point out the long stream of comments from an article about Jay in the WSJ here that reinforces the angst and anxiety faced by Physicians and Providers when presented with change… like anything there are those who react with

1. fight/flight
2. acknowledge/question
3. embrace/rejoice

No matter what your position is (mine is c. obviously), the mere notion that people are discussing and presenting their heated position for/against the notion of evolving a healthcare delivery model is … well, it’s terrific!

btw… helloHealth needs …ummm a nashville office!

* Updated the post with the correct link to Jay’s presentation, duh?! how could I forget that.

NASHVILLE, Tenn., (February 26, 2008) – A consortium of nine US-based healthcare technology companies and healthcare providers has announced it will lead adoption of a new consistent file format standard for collecting, storing and exchanging of healthcare provider data.

To be called a dCard — short for doctor card — the new technology criterion is intended to establish basic data collection standards where they currently do not exist. Along with improved ease of collaboration, the partnership will help ensure consistency and accuracy among users of this information.

“In today’s healthcare marketplace, basic identifier information about a physician or hospital is scattered in different formats and in different places across the internet,” said Christopher Parks, co-founder/CEO of change:healthcare, one of the companies working on the standard. “And there’s no certainty of the information being timely, accurate or consistent. As more consumer healthcare information is pushed out to end-users, how can we expect people to make good healthcare decisions if the information they’re basing them on is inaccurate? The first step towards transparency in this industry is the very basic foundation of all parties agreeing on consistent labeling of information. The dCard standard will help all of us do that.”

Joining change:healthcare, a Nashville-based technology firm focused on bringing transparency throughout the healthcare industry, in developing the dCard, are:

• Within3 (Online professional network for health science professionals and organizations)(www.within3.com);
• OrganizedWisdom Health (First human-powered, physician-reviewed search service for health information, products and services on the web) (www.organizedwisdom.com);
• VerusMed (Providers of clinical briefs for 150,000+ physicians and healthcare professionals)(www.verusmed.com);
• Peerclip (Online tool that enables physicians to organize, share, discuss and discover relevant medical information)(www.peerclip.com);
• Ozmosis (Online platform that unites physicians and healthcare organizations in a collaborative environment to improve patient care) (www.ozmosis.com);
• Enurgi (Online healthcare services company that connects families and patients-in-need with 1 million+ local, clinical caregivers across the country) (www.enurgi.com);
• J. Parkinson, M.D. (Leading healthcare consumerism advocate and New York-based family practice physician)(www.jayparkinsonmd.com);
• ReliefInsite (Secure, online pain management services) (www.reliefinsite.com).

“All of us have a burning desire to ensure healthcare information is correct,” Parks continued. “And that’s why we’ve agreed to work together to improve the consistent capture of that information on the front end.”

The nine companies/providers will begin compiling currently available information on physicians into this new dCard format, which will contain four sections: personal information, professional information, educational information and training information. Personal information includes the physician’s correct names, specialty, certification, license number, etc.; professional information includes (among others) office information, office hours and insurance accepted; education information includes country/organization where the physician studied; and training information includes residency, fellowship and societies.

“With the growth of online resources for physicians and consumers, accuracy and consistency of provider information is key,” said Scott McQuigg, CEO of PeerClip and VerusMed, two members of the consortium. “With the dCard, information on physicians and other health providers will be more complete and consistent, allowing both groups to have one portable profile to use across the internet.”

“From the provider perspective, it’s not uncommon for a healthcare professional to have upwards of 10 places or more on the internet where their professional information is presented,” said Michael J. Markus, Ph.D., co-Founder and president of Within3. “It’s nearly impossible to keep all of this information current and accurate without a standard. In addition, healthcare professionals should have the ability to control their information both on the internet and offline. The dCard is a first step in establishing ownership and data portability – giving healthcare professionals the ability to easily manage and share their information with employers, insurers, tenure committees, societies, abstract review committees, colleagues and more.”

Work on the dCard standard will culminate later this spring with a summit intended to finalize, approve and adopt the dCard standard. Parks stated that any individual, practitioner or company interested in participating in the dCard is welcome to join the development process.
The dCard is expected to be functional by May 1, 2008.

Other comments from consortium participants:

“As a physician, I recognize the importance of adopting open standards and promoting knowledge exchange in healthcare. Ozmosis supports the dCard as an important step in achieving these goals.”
- Jason Bhan, MD and co-Founder of Ozmosis

“As a human-powered health search service, the dCard initiative is aligned directly with our mission of bringing simplicity to the complex world of online healthcare. As we hand-craft search results on physicians and other healthcare providers, it has become apparent that provider information such as address, phone number and accepted insurance plans are inconsistent and inaccurate from site to site. Without any industry standard to keep all of this information current and accurate, it’s an easy decision for OrganizedWisdom to support the dCard file format that will help make this happen.”
- Steven H. Krein, CEO of OrganizedWisdom Health

“Enurgi is excited to join the leaders of the healthcare community in developing the dCard. The vision of this tool will allow all licensed caregivers across the country including nurses, certified nursing assistants, therapists and nurse practitioners to carry individual caregiver profiles wherever they are employed. This is critical as nursing staffing shortages continue to plague the healthcare industry and will enable employers in a healthcare setting to have a standardized, electronic profile record for all caregivers on staff.”
- Chiara Bell, Founder and CEO of Enurgi.