Skin cancer screening guidelines

skin cancer“Insufficient evidence”

Many years ago I had a primary care doctor who used to perform a total body skin examination (TBSE) on me every year as part of my annual exam.

Of course, those all-inclusive physicals are a thing of the past. I haven’t had a physician perform a TBSE for a long time.

I often wondered about that. A TBSE seems like a relatively easy and harmless way to quickly screen for skin cancer. The goal, of course, is to find a melanoma, the deadly skin cancer, when it’s small and possibly curable.

Related post: A must-watch video about Continue reading

The high cost of healthcare in America

They say a picture is worth a thousand words, and the online news site Vox recently sought to open Americans’ eyes as to how much more we pay for healthcare compared to other countries.

America’s healthcare prices are out of control. These 11 charts prove it.

I can’t copy their charts, but basically they are bar graphs. The bar that shows how much patients in the US pay for similar drugs and services towers over the others like a skyscraper over a neighborhood of single-family homes. Like this:

healthcare costs graph

Vox got its information from the International Federation of Health Plans (IFHP)Continue reading

Prevent kidney stones

kidney stonesAnd save money!

If you’re interested in how much a kidney stone costs, read this blog post from the Costs of Care website. The author of the post gives an accounting of her physician visits, diagnostic tests and medications:

  • At least 5 sets of blood work, with CBC and chemical profiles, parathyroid studies
  • Several urine tests, including urinalysis and urine culture, and two 24 hour urine tests (a third 24 hour urine test was recommended but I declined)
  • 2 CT scans
  • 1 MRI
  • 4 specialist visits, 2 primary care visits, 2 ER visits (involving IVs, pain meds, lab studies)
  • Prescriptions
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What is RIP Medical Debt?

rip medical debtDebt forgiveness

I recently found out about an intriguing non-profit—RIP Medical Debt.

I’ve posted many times about the high cost of healthcare, even for those of us with health insurance. Medical debt is still a leading cause of personal bankruptcies in this country.

What if those debts could just disappear?

For a lucky few, they can.

RIP Medical Debt, Inc., was founded in mid-2014 by two former collections industry executives, Craig Antico and Jerry Ashton. Having worked for decades in the medical field, the two were acutely aware of the number of Americans who shoulder the burden

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Why are EpiPens so expensive?

epipensEpiPens – lifesaving but costly

I’m allergic to bee stings, so I keep an EpiPen handy when I’m working out in my garden this time of year.

But my EpiPens are more than 3 years old now, and it’s time to invest in a new set.

Why do I say invest? Because EpiPens are incredibly expensive!

Related post: First aid for bee stings

I didn’t know that three years ago when I bought them. At that time, my health insurance did not include coverage for prescription medications (all ACA-compliant plans must now), so I paid the full price out of … Continue reading

Obamacare premium increases for 2017

Up, up and away!

Does anyone’s income go up as fast as their health insurance premium? I wish.

11.6%. That’s how much more my current health insurance provider wants to charge for my bronze high-deductible health plan in 2017.

And although 11.6% seems like a lot to me, another company in my state is requesting a 19.9% average increase on all its plans, with a 28% increase on its gold plan!

So far, the rate increases that have been made public in other states are all pretty high, averaging well into the double digits. So at least I’m not … Continue reading

“End of the Line” for medical guidelines

Knowledge is king

That’s the take home message from Professor (of pharmacy) James McCormack’s latest parody video, End of the Line, which takes a whack at healthcare’s increasingly pervasive and rigid medical guidelines.

 

If followed to the letter, these guidelines (often based on research funded by drug companies) would have everyone diagnosed with a disease and taking one or more medications. Medical guidelines may be great for the drug business, but not so much for individualized, patient-centric care and shared decision-making.

Chronic disease state guidelines (blood pressure/lipids/glucose/bone density) do not provide clinicians with

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Be informed – Shared decision-making

Shared decision-making makes better informed patients, and better informed patients use less health care.

…as many as 20% of patients who participate in shared decision making choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids.

Which lowers health care costs.

…a 2012 study…showed that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over 6 months.

[It’s] estimated that implementing shared decision making for just 11 procedures would

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Harken Health – Betting on primary care

I just read about health insurance giant UnitedHealth’s bold but risky new insurance plan, Harken Health:

UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.

With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling is also provided, as are yoga, cooking and acupuncture classes.

At this time, Harken Health is only available in Chicago … Continue reading

The high cost of dying with dignity

I just read about another case where a pharmaceutical company bought the rights to an old, been-around-forever drug and then drastically increased the price. Argh.

A few months ago I posted about the drug Daraprim, which was bought by Turing Pharmaceuticals. Its CEO, the now infamous Martin Shkreli, raised the price from $13 a pill to over $700.

Last February, Valeant Pharmaceuticals bought the rights to Seconal (secobarbital), an 80-year-old sleeping pill. Ten years ago 90 Seconal tablets cost about 30 dollars. Now it’s closer to $3,000.

It’s believed Valeant did this in response to California’s new End Continue reading

Save money – When to call an ambulance

I recently read an article about a man who was taken to the ER in an ambulance for a sprained wrist.

And then he was astounded when the ambulance company charged him $250!

“If I wanted to go to the emergency room, I could have taken a cab costing less than $10,” he said.

Or Uber. Or a friend. He learned the expensive way that ambulances are costly—$250 is actually on the cheap end—and should not be used without good cause.

Ambulance costs can range anywhere from a couple hundred dollars to well over $2,000, depending on the length … Continue reading

Screening eye exams in older adults

Just yesterday I posted about the United States Preventive Services Task Force (USPSTF) and the fine line they walk between providing evidence-based recommendations for screening tests and making medical specialist groups happy.

Sometimes it just doesn’t happen.

The task force recently gave an “I” grade to vision screening in patients over 65. An I grade, or Insufficient evidence, means that the task force can’t definitively say that the benefits of vision screening in older adults outweigh the possible harms.

The American Academy of Ophthalmology (AAO) doesn’t agree.

Specifically, the task force reviewed the evidence for primary care doctors screening for … Continue reading

Are Health Care Loans a good idea?

Not in my humble opinion.

I just read about this idea proposed by health financing researchers out of MIT and Harvard: Financing health care with consumer loans.

They begin their article with what we all know—health care, specifically prescription drugs in this case, costs too much.

We propose a practical way to increase drug affordability through health care loans (HCLs)—the equivalent of mortgages for large health care expenses. HCLs allow patients in both multipayer and single-payer markets to access a broader set of therapeutics, including expensive short-duration treatments that are curative.

When they talk about “curative” drug treatments, they … Continue reading

5 tips to save money on prescription drugs

save money on prescription drugsOne of the driving forces behind rising health care costs is the increasingly high cost of prescription drugs.

And because 60% of Americans take at least one prescription drug, that adds up to a lot of money.

Insurance companies are trying to rein in costs by having tiered copayments (higher for brand names) or limiting the selection of drugs on their formularies (the list of drugs your insurance will cover).

This post gives you some suggestions to save money, and some resources that might be helpful.

But first, ask yourself and your physician if a prescription drug is really … Continue reading

Will Congress fight the high cost of prescription drugs?

Last November, with much media coverage, several members of Congress announced the formation of The Affordable Drug Pricing Task Force, promising to “take action to combat the skyrocketing costs of pharmaceuticals.”

Finally! I thought.

Related post: Prices continue to increase for generics

But I haven’t heard much since then.

There was a little noise earlier this month when the House Oversight Committee (of which the task force is a subcommittee, I believe) attempted to grill the now infamous Martin Shkreli about why he thought it was okay to jack up the price of Daraprim from $13 a pill to … Continue reading