Thursday’s Healthpopuli post caught my eye - Hospitals’ fiscal health is eroding. More than 50% of hospitals had a negative margin in Q4 2008. Sounds like the hospitals need wellness and disease management programs to address their ailing health just like patients are getting.

The main reason cited in Healthpopuli for the poor fiscal health is that admissions are down. Another oft-cited factor is the proliferation of HDHP (High Deductible Health Plans) where consumers are left with the first $1500, $2000 or even as much as $5000 of their healthcare expenses within a given year. 

It’s easy to place the blame on fewer people coming through the doors, but who knows, maybe we’re getting healthier or just using better judgement about what constitutes a needed procedure. Maybe our wellness and DM programs are working. Insurance companies and self-insured employers should be jumping for joy at the news because that SHOULD translate to lower healthcare expenses for them in the form of fewer claims - at least in the short term. Hospital should be taking a collective sigh of relief that they can finally slow down on adding yet another massive capital building project to meet the ever-increasing demand. That might save them some of their cash and get them closer to being profitable again.

It’s easy to place the blame on consumers not paying their bills, but perhaps it’s an opportunity for hospitals to take a good hard look at their processes and procedures and address ineffiencies. In reporting a negative earnings period, one hospital identified five reasons they were unprofitable, and there is no small amount of irony in the fact that they attributed $200K of their $1.6M shortfall to overruns in their self-insured health plan for the hospital as an employer.

With the average deductible rate topping $1000 for the first time in history and 20% of employers saying they are considering dropping their healthcare plan, it looks as if simply raising the rates at the hospital is not going to be a solution. Demand is already down. Payment is already off. Raising rates will only further stifle demand and higher rates will only result in increased non-payment. Blood will not flow from a stone no matter how deep you cut it.

Just as a physician must not allow themselves to treat the symptom, but instead identify the disease, hospitals find themselves in the same position. The health system as a whole is diseased - from patient, to insurer, to provider to government. As patients, we are being forced to take more responsibility through increased share of the burden of the costs, wellness and disease managemet programs. Insurers have work to do as well (that’s another post). Governement is studying where they need to go. Hospitals need to begin to look at what they can do in terms of equivalent wellness and disease management programs for their facilities. They need to trim the fat. They need to be more efficient. They need to proactively seek out better long-term solutions instead of resorting to quick fixes as the insurance company all too often forces them to do.

The poor fiscal health of hospitals is not the cause, it is the symptom. Time to get the diagnosis right, start treating the disease and not fixate on the symptoms.

And no sooner than I hit the publish button on this post, Jen McCabe Gorman tweets EXACTLY what I’m talking here on Henry Ford Clinic.

My Healthcare Is Killing Me has been getting a little bit of buzz lately, and it’s good to hear that people are finding the content useful.

Bernard Farrell from the Diabetes Technology Blog says, “While I’m talking about reading, here’s a free book that may be really useful if you’re dealing with the US healthcare system. I just started reading My Healthcare is Killing Me! earlier today and I’ve already got some ideas for better handling myself within our (sometimes challenging) system.”

Thanks Bernard!! We are happy to hear you are finding some useful tips. We would love to hear from other readers (like you), suggestions and criticism are always welcomed as well.

You can find the FREE PDF download at www.myhealthcareiskillingme.com under the heading “Read it”

In recent months, as the days pass and the election approaches, the future of our healthcare systems seems less and less stable.

In researching new developments in healthcare reform and activism, I came across a “haunting” video while exploring a new site geared toward engaging individuals in sustainable solutions to the impending healthcare crisis - SHOUTAmerica.

By haunting, I mean honest and accurate in that is paints the dark picture of our healthcare future.  Check it out.

The point of the video is not to be haunting but rather motivational.  I walked away from it thinking… if we do not start to consider our personal healthcare decisions (at the very least) we are allowing healthcare to control our country’s economic path and future. [Scary thought.]

On top of the video, SHOUTAmerica has a lot to offer. Community, awareness, action, education. In the first blog post Times are Changing, So Should Healthcare the author says “My interest in our cause runs especially deep… Upon my graduation from a top 20 university, I found myself too old to remain under the insurance of my parents and too easy to ignore the gravity of not having it… I have come across countless stories detailing the difficulties healthcare expenses bring to bear on millions of Americans and their families. But while it is important to sympathize with their plight, we must now also turn our focus to action… The long-term interest of this country is dependent upon comprehensive healthcare reform that has remained elusive now for decades, usually dying on the table on Capitol Hill.”

The more we can share and spread this type of sentiment, the sooner we will see change.  Unfortunately, this type of passion (displayed above) is not wide spread or at least those that feel this passionately have yet to unite.

To those that feel passionately about healthcare reform - Get involved!  I think that SHOUTAmerica will provide the much needed platform for unity.

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.

Recently we have published our healthcare consumer “survival guide” titled My Healthcare Is Killing Me. Though we have only recently received the hands on printed version… the PDF has been available (for FREE) online for about a week or so now. We have not really spoken of it much - we were waiting till we had real copies - but it looks like the cat is out of the bag thanks to Christopher!

So without further ado: Check out My Healthcare Is Killing Me at www.myhealthcareiskillingme.com. As I mentioned above, you can download a free PDF, read it online, or (if you like the real deal - as I do) you can purchase it through this site as well.

And - lets give some love to those individuals that have taken early note of the book…

Thanks to Zane Safrit (check out his post - make sure to scroll down) for writing such nice words.

He says, ” My Health Care is Killing Me is…a well-written resource for those like me, a consumer of our health care system, who look for help and hope as we navigate the maze of players who provide the services and the billing and the restrictions and yes, sometimes, quite often, the excellent care (if you can afford it, find it, negotiate with it…) that make up our health care system.”

Thanks to Frank Hone at the Why Healtcare Matter Blog for taking the time to check out change:healthcare, the Healthcare Consumerism Index and giving My Healthcare Is Killing Me a shout out!

Last but not least, to JenMcCabeGorman for Twittering about MHIKM. I think she may have started something

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.

So it would appear that I’m not the only one less than thrilled about the balance billing practices of some hospitals:

Here’s what the WSJ had to say.

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.

Ran across this blog entitled medical bills suck. Have to say we empathized with their situation. This is a young couple with a new baby and lacking insurance. That’s a tough spot. They are getting hit with medical bills for the birth of their child now, and the mom despairs about not being able to realize the rest of her dreams of owning a home, etc. because of the medical bills that keep holding them back.

But like the comment I posted says, they probably won’t have to pay the whole bill amount. If they just pick up the phone and call and ask for a discount or failing that, ask to make monthly payments, the hospital will probably negotiate. Some rediculous percentage of people (I think around 60% or more. If I find the source, I will come back and add it) who called and asked for a discount got one.

Making that call can be hard for someone with high moral standards and a strong sense of responsibility. After all, if you incurred the bill, you should pay it. The problem is, the docs and hospitals are not burdened by those same standards. Yes, they are healers and are bound by the hypocratic oath, but that oath says nothing about fair payment between patients. It really would not hurt to add something to that end.

Providers (docs and hospitals) generally charge everyone the same for services. However, what they get paid varies drastically between the uninsured and the insured. It also can vary widely between insured. Uninsured usually wind up with the biggest payments made to providers. Then the privately insured. And then the low cost payors - Medicare and Medicaid.

So. All of that to say that chances are she’s looking at paying the equivalent of MSRP (Manufacturer’s Suggested List Price) or the sticker price for the healthcare. Nobody pays MSRP for a car. You should not for medical bills either.

So pick up the phone and negotiate. You’ll be talking to someone in the back office, not the doc. And there’s little need to be worried that the doc won’t take your appoinment next time. Hell, the doc probably won’t even know what you paid.

Even though providers don’t have to charge fairly, if you need them in the future, the hypocratic oath does require them to provide you with care whether you paid the full amount for your previous bill or not.

Interesting article popped up today on how the healthy population may cost more in terms of healthcare than the obese or smokers. The premise is that the healthy person lives longer and therefore has more opportunity to run up costs in part because they have a longer window to work in.

Let me add a little personal perspective to that. I have been fortunate in my life in that I have lost relatively few people in my immediate family (partially the result of parents who were both late children, and many of my relatives were gone before I was 6). However, lately, the odds have been catching up to me. My parents, my in-laws and many other people close to me are getting older and facing increasingly greater health challenges. One in particular comes to mind.

This friend is a former coach, world champion in sports and just flat out all around great athlete. Never smoked or drank. He is in his 80’s - well into his 80’s. Healthy as a horse. His healthcare costs are piling up - slowly and consistently. Some had written him off at one point. He had a leg amputated due to complications and many saw that as the beginning of the end. For someone less healthy, it probably was. That was nearly two years ago. But well into his 80’s, he is going strong. I actually carried his mother’s casket at her funeral when she was well into her 90’s. I suspect that he will live to a similar age. Ironically, I wrote a piece on him in grade school about how I admired him, and here I find myself over 30 years later writing about him again.

Another friend is much the same way. Never smoked, never drank. Kept her figure. She has had a number of near misses lately. Much to our pleasant surprise, she continues to move forward and recover. A less healthy person would not fare so well. I interviewed her for a high school history project where we taped the conversation to capture some of the pieces of history locked inside of the average person and that might otherwise be lost. She continues to this day to be a wonderful source of history.

 I can point to many others I have known - less healthy, far younger and far shorter illnesses took them. It’s all anecdotal, but it’s hard to ignore. I think this underscores the mission of what we are doing at change:healthcare. It’s easy to think that it’s only the less-than-healthy who need to keep up with their healthcare and the associated costs. But it’s not. It’s all of us.