Lack of transparency keeps medical costs high

Profits stay high, too

On Monday, the New York Times published another brilliant piece by Elisabeth Rosenthal in her series “Paying Till it Hurts.”

Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue.

And American doctors, clinics and hospitals tend to order lots of tests. “It’s one of the most lucrative revenue streams they

Continue reading

Harvoni, Solvadi and hepatitis C screening

harvoni hepatitis c treatmentNew treatments for hepatitis C

I read an article online the other day in which the author practically shouted at her readers to “Run as fast as you can to your doctor’s office and get screened for hepatitis C!”

OK, what she actually wrote was:

Overall, the outlook for patients with hepatitis C is much better than it was just a couple of years ago. So if you’re a baby boomer who hasn’t been screened for hepatitis C yet, don’t wait. 

Still, let’s step back and look at the big picture.

Hepatitis C screening has been in the news a … Continue reading

Be informed – Number Needed to Treat

number needed to treatHow many are helped; how many are hurt

My son sent me a great link to an article in Wired magazine about a physician and his colleagues who have started a website called TheNNT.com.

What is the NNT? It stands for “the number needed to treat” and it’s a pretty common measurement talked about in health care. Simply put, it quantifies how many people need to be treated for one person to be helped.

The best therapies have a low NNT:

If your kid is throwing up and you take her to the hospital, she might get a drug

Continue reading

Avoid unnecessary medical tests

This is a guest post from a dear friend. As a cancer survivor, she has a lot of experience dealing with doctors, hospitals and insurance companies. She does not work in the health care industry, but is very savvy and not afraid to ask questions. She has been a huge supporter of Frugal Nurse as she, too, sees a need for patients to be more aware and wary of the health care they receive.

After a recent trip to her doctor’s office, she called me with the following story and asked if I would be interested in sharing it with

Continue reading

Researching health care costs

It’s not that simple

Last night on the local news I watched a story about health care costs. The reporter, a consumer affairs specialist, talked about the expanding trend in health care of high-deductible medical insurance plans. Under the ACA, family annual deductibles can reach up to $12,700 (increasing to $12,900 for 2015); whatever your deductible, you pay your medical bills out of pocket until that deductible is met.

The uninsured, of course, just pay out of pocket.

Related post: Health insurance basics, part 1

The reporter encouraged us to

…take some time to research, and see what the

Continue reading

Do you need an annual pelvic exam?

annual pelvic exams unnecessaryYet another screening exam found unhelpful

Earlier this month, the American College of Physicians (ACP) published its recommendation in the Annals of Internal Medicine that routine annual pelvic exams are unnecessary for healthy, non-pregnant women with no gynecologic symptoms (bleeding, discharge, pain, etc.).

The ACP looked at evidence on pelvic examinations dating back almost 70 years and concluded:

… no data support the use of routine pelvic examination (excluding cervical cytologic [Pap] examination) for reducing the morbidity [disease] or mortality [death] of any condition. Furthermore, limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety,

Continue reading

“Dreamland: Adventures in the Strange Science of Sleep”

dreamlandThe big business of sleep

As someone who has always had trouble sleeping, I find solace in the fact that I am far from alone. The last statistic I saw was that about 60 million Americans complain of some form of sleep trouble. And I suspect that number is under reported.

Sleep experts recommend we get 7-9 hours of sleep every night, and popular media are quick to point out all the ill health effects due to lack of sleep that will kill you.

It’s scary enough to give you nightmares—if you could get to sleep.

Insomnia and fatigue are … Continue reading

Save money by Choosing Wisely

save money choosing wiselyUnnecessary care = unnecessary expense

Every day I see a new article about the high costs of health care.

A new study suggests that in a single year, up to 42 percent of Medicare patients got at least one medical procedure they didn’t need — overtreatment that cost as much as $8 billion.

Use of [Mohs] surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its

Continue reading

Concussion assessment apps

There’s no such thing as a “mild” concussion

Last week I posted about first aid for concussions, which is important because head injuries in kids are a growing concern in the medical and public health communities.

Of particular importance is avoiding the potentially fatal “second impact syndrome”; if a young athlete suffers a “mild” concussion and then sustains another within a few weeks, “diffuse cerebral swelling, brain herniation, and death can occur.” Luckily, it’s rare.

But even minor concussions need to be recognized and treated, and it can be difficult because symptoms are often subtle and most parents … Continue reading

Choosing Wisely for kids

choosing wisely for kidsEducating patients and doctors

I’m a big fan of the Choosing Wisely® campaign sponsored by the ABIM Foundation, a non-profit group established by the American Board of Internal Medicine.

Why? Because the campaign’s objective is to reduce the number of unnecessary and potentially harmful (not to mention expensive) medical procedures being done in the US.

Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

In response to this challenge, national organizations representing medical specialists

Continue reading

Screening for Alzheimer’s and dementia

Will there soon be a blood test?

My father-in-law recently passed away after suffering with Alzheimer’s for several years. I also have an aunt who is currently living with some form of dementia, probably vascular.

Few diseases strike more fear into those over the age of 50 than Alzheimer’s. Needless to say, both my husband and I worry when we find ourselves saying:

“Oh, what’s the word I want?”

or “Where did I put it?”

or “Why did I come in here?”

So when I read the prevailing health headlines this week about a blood test to predict Alzheimer’s, … Continue reading

Do you need an annual mammogram?

mammogramThe latest report

Most of my nursing career was in breast cancer, so I like to stay current on the most recent research on screening, diagnosis and treatment.

Earlier this week, the British Medical Journal released a pretty stunning report:

In conclusion, our data show that annual mammography does not result in a reduction in breast cancer specific mortality for women aged 40-59.

In normal language that translates to “annual mammograms don’t save lives.”

Aaron Carroll, MD, writes on his blog:

This study is going to make a whole lot of people upset. It’s a large, well designed

Continue reading

Parents: Don’t insist on CT scans!

ct scans on childrenToo many CT scans ordered on children

This morning I read a post by a pediatric intensive care (PICU) doctor who admitted too many CT scans are still being given to children, despite recent evidence that radiation exposure from the scans carries a not insignificant future risk of cancer.

I posted about the results of this study a couple of months ago: Children are more “radiosensitive” than adults; CT scanners can vary dramatically in the amount of radiation exposure; and radiation exposure is cumulative–more CT scans relate to a higher risk.

This doctor focused on the overuse of … Continue reading

Pushing back against too much medicine

As someone who advocates for less medical care, I’m always thrilled to see physicians and others in the health care industry step forward to protest over-testing, over-screening, over-diagnosing, over-treating and over-charging.

Here are some of my favorite health care blog posts and news articles from the last week.

“Testing Wisely” by Dr. Rob Lamberts 

Dr. Lamberts is embracing the newest trend in primary care: the direct-pay model. He does not accept health insurance, but rather charges a modest (age-based) monthly fee per patient. Booting the insurance companies not only lowers his overhead costs considerably, but frees him from so many … Continue reading

What parents should know: Protecting children from unnecessary CT radiation exposure

ct radiation exposureCT scans increase a child’s risk of developing cancer

A year ago the British medical journal, The Lancet, published a study looking at the potential cancer risk to children from using CT scans.

CT scans use ionizing radiation, and children are considered more “radiosensitive” than adults.

The Lancet study concluded there was “… a positive association between radiation dose from CT scans and leukaemia” and recommended “…although clinical benefits should outweigh the small absolute risks, radiation doses from CT scans ought to be kept as low as possible and alternative procedures, which do not involve ionising radiation, should be Continue reading