Medicine Follow The Money

While I believe in trust but verify, I've always been a skeptic of conspiracy theories, I guess because I beliebpve in the inmate goodness of the human species.

I watched a movie on Netflix last night titled "The Widowmaker". Documentary about the CT Heart Scan, it's ability to detect very accurately plaque in the arteries, and stratify risk to an individual as a result. And medical profession and insurance industry's efforts to stop it from become accepted mainstream.
I've been talking to a guy on another (not PC) forum who funded the movie, as a philanthropic venture, and he pointed me to it.

The movie really shook my faith in the system. Not that it's different than some of the Drs who recommend one PC treatment or another because it's what they do. But this was just different. It wasn't that they believed what they were saying, being against heart scans. It was totally money motivated, at least as it seemed to me.

Since the Ct Heart Scan was developed, till the time it became accepted mainsyptream screening, the movie claims that over 4,000,000 people have died very suddenly, mostly prematurely, and so many of those deaths were preventable.

Worth watching. And the test is worth getting, I wish I had done it sooner. It only runs about $250, and most insurance companies will pay for it.

In software development, we talk about the triad of time, quality and money. You can't improve in one of the areas without affecting at least one of the others. If you want to spend less money, quality or the schedule will take a hit. To improve quality, expect to spend more time or money. To do things faster, you need more money or compromises in quality, and even then, timelines cannot always be compressed.

I think this is essentially what Halbert is saying. We want the best, we want it now, and we want it to be free. Something obviously has to give.

I'm reminded of a dilbert cartoon that surfaced a few years ago on numerous bulletin boards in my workplace--particularly among the engineering staff.

Boss to Dilbert: "I need your project's scope and cost"
Dilbert to Boss: "The project uncertainty principle states that if you know the scope you cannot know the cost, and vice versa"
Boss: "You just made that up"
Dilbert: "That doesn't make it wrong"

>rimshot<

Tread carefully. I see politics coming, and that will have the predictable end.

The hospitals want to continue stenting. Because they get paid 30-50,000 per procedure. Its better for them, than a patient having a $250 scan, that scares them enough to follow lifestyle modifications in the extreme that will just as easily save their lives.

alephnull said...
I know this is pie in the sky, but maybe clinics should be forced to lower their costs once their expensive machines are paid for.

My 34 RTs cost $196K
I'm betting the machine was between 5 and 15 million.
That's 100 patients at most, that is using my insurance billing as a measure. 19.6 million.
I saw the ROnc 9 times, worth $196K. ...

That is a pretty impressive payback !!! Paying for a 20 million dollar machine in 6 1/2 weeks !

BTW, i've mentioned before that i have not been able to find a website for Heart issues anywhere near as robust as this, in fact none that are robust at all. Well, this website where i am finding all this info, is exactly what i was looking for. Its more than a forum, its a program. Its not free, i'm paying $8.99 a month, but worth it. I need to be able to validate this Drs concepts though. Seeing a cardiologist tomorrow that was recommended to me by one of these guys, he is not only board certified cardiology, but also board certified Integrative (not alternative) Medicine.

I had a conversation yesterday evening with my sister-in-law about this very thing. Her husband has survived leukemia and has significant kidney problems. A recent hospital round left them with a bill for $250K and an insurer who is refusing to pay more than like $50K because he's out of network, so the hospital is going after them. Their policy states that their out of pocket max for out of network is $5200, which they paid. The hospital still wants another $195K, and has turned them over for collection.

Yeah, it's the same thing. Follow the money.

We all have to remember that paying for medical services is like buying a new car......everything is negotiable and no one pays the sticker price. Read your explanation of benefits page that comes with every claim payment and you will see the hospital and most all providers gets paid much less than what is billed. When my wife had breast cancer and reconstruction surgery the reconstruction surgeon billed $50,000 per Ta......ended up getting about $4,000 for the surgery....4% of the amount billed per her agreement with the insurance company. I have never understood why providers bill such outrageous amounts when they know they won't get close to the amount they bill.

My rad onc billed the insurance company exactly what the contract called for. I had 25 IMRT fractions and two HDR Brachytherapy procedures and the total was just over $29,000. The rad onc insurance person explained all this to me before I signed on for the procedures and showed me the agreement with the insurance company and the billing method. On the other hand, the hospital I went to for the HDR catheter placements billed over $15,000 per time (about two hours each time) and accepted about $750 each time from the insurance company, which is what they knew they would get from the start. So why exaggerate the bill so much?

So when we talk about costs of health care are we using the inflated bills that no one pays or the actual payments the providers receive as the real cost of delivering health care? A very substantial difference.

Michael_T said...
So I can stream the Widowmaker on Netflix? (Kinda scary title, I must say.) FWIW, I'm having an echocardiogram later this afternoon...

Hope the echocardiogram goes well. If possible, you might want to have the same physician order a "Coronary Artery Calcium Score." Mine cost $100 out of pocket.

I believe this is the same or similar as to what Prato is talking about,

Good point about employer sponsored coverage. I believe we will see some significant changes in the coming years.

One of the main objectives of the ACA was to reduce the problems people had getting individual health insurance. In the next few years we should see to what extent health insurance decouples from employers as the employer mandate finally comes into force. Some companies will probably end their plans while many will increase deductibles and co-pays and tighten provider networks to match those in the individual marketplace. This will negate much of the advantage of employer sponsored plans.

While this will result in more even coverage levels it will mean more people will be paying for more of their healthcare (through higher deductibles and co-pays and more limited networks) than before.

Best wishes for their fight....hope they prevail very quickly with limited interruptions to their lives.

Remember why employers first offered health insurance. In the great depression the government froze wages. In response, large companies and unions got approval to offer non-wage benefits to attract and keep employees. That is basically when employer sponsored health insurance and pensions were introduced to the American workers.

I think changes are coming based on the dynamics of the ACA that remove many of the old coverage obstacles of the individual marketplace. Remembering back to 1974 and ERISA. This is the law that exerted greater regulations on pensions and gave us the IRA and basis for the 401(k) plans. From that point forward essentially no company has started a pension plan in the US, many have stopped plans, but most all have 401(k) plans and most of us also have IRAs.

Look at all the huge companies started in the last 30 years, Apple, Microsoft, Home Depot, WalMart, etc.....not a one has a pension plan. Look at many companies like IBM that stopped their pension plan. Now we are gradually seeing the same approach to retiree health insurance plans. Many of the companies listed above do not have such plans and many more have gotten away from them. Thus the trend has been for employers to get out of the business of providing income and benefits after a person stops working and to make the employer sponsored plans more portable through IRA rollovers, COBRA provisions and individual health insurance. Basically this reduces the employer cost over a long period and does not negatively affect the individual because of the individual based plans that have been made available.

Many expect that the ACA will do much the same with employer sponsored health insurance over the coming years. When employer sponsored insurance is neither a better benefit nor an expected benefit more employers will transition out of providing the benefit. I wouldn't expect it to be sudden, but more over the coming generation.

Prat,

I was going to ask specifically what scan you're referring to...above Ken mentions the "Coronary Calcium Artery Score"--is that the one? (Sorry for my ignorance here.) If so, my PCP recommended against it since he had it had high doses of radiation. That said, I also found myself wondering if that was because he had a way of making money off the echo, which was done in his office, as opposed the calcium test.

FYI, my wife had the Calcium test last year (she scored a "1," which I believe is considered a very good score) and when I asked him about for myself, that was when he recommended the echo.