Category Archives: healthcare

My 15 Minutes…on

I had my 15 minutes of internet fame recently, with a "My Take" essay on To say that made my month would be an understatement!

Social media played a part in bringing me this opportunity. If you're not a believer in the power of the Holy Trinity of SM (Twitter, LinkedIn, and Facebook)…you need to be.

That's my story, and I'm stickin' to it…


A Great Story On Healthcare IT

In today's Health Care Blog, David Kibbe MD and Brian Klepper PhD continue a discussion that they kicked off with an open letter to the incoming Obama administration in December about health care IT and electronic medical records (EMR/EHRs).

Patients think that EMR/EHRs are the answer to their prayers – no more forms to fill out, no referral slips to carry around, hey-presto, it's all on this flash drive. What Kibbe and Klepper point out is that's just the tip of the iceberg:

"…we are realistic about the problems that exist with health information technologies as they are currently constituted. As we described in our previous post (and contrary to some recent claims), most products are NOT interoperable, meaning licensees of different commercial systems – each using different proprietary formats – often find it difficult to exchange even basic health care information."

In other words, let's not create a tower of Babel just because IT tools exist that will let us. There's enough failure-to-launch across the medical-care sector now: forests of paper records that are a bear to manage, much less share; HIPAA standing like Colossus over every single one of those sheets of paper; and the rising tide of 'perfect EMR solutions' that have been developed in the last few years.

There is no 'perfect solution' – what's required is that healthcare realize that it's an IT business, just as every other commercial sector has come to realize over the last decade.

"…many health care professionals still think of health IT as a compartmentalized function within health care organizations. But health IT has increasingly become the glue between and across all health care supply chain, care delivery and financing enterprises. In the past, it was enough for health IT to facilitate information exchange inside organizations – in which case a proprietary system would do – but we now expect information to be sent and received seamlessly, independent of platform, including over the Internet. Most of the currently dominant EHR technologies don't even begin to get us there."

As someone who has recent experience as a patient managing cancer treatment, the idea of having my records securely available to any medical practitioner in the U.S. via the internet sounds like Utopia. An achievable Utopia, if the incoming administration listens to the rising chorus of voices asking for exactly that.

Add yours to the chorus.

That's my story, and I'm stickin' to it…

Cancer for Christmas – One Year Later


I had my annual mammogram this last Tuesday – remembering how last year’s formerly routine event wound up, to say I was a little nervous is a vast understatement.

Here’s the news: I’m now officially a survivor.

Looking back at the last 372 days, I have to say it’s been quite a ride. So many people have helped me, have lifted me up, have kept me from feeling that terrible aloneness that’s part of fighting a life-threatening disease.

‘Thank you’ sounds inadequate, but it comes from the deepest and most tender part of my heart.

I will finish the first draft of "Cancer for Christmas" by New Year’s Day. Then it’s on to finding an agent, a publisher, or – best of all possible worlds – both. I’ll be reaching out to Save the Tatas and the Susan G. Komen Foundation, offering them a piece of the cover price in exchange for helping promote the book once it’s published.

My goal is to help anyone in the fight – against cancer, or any other life-changing disease – navigate the medical car-wash and manage their medical care for their benefit.

Because if you don’t, no one else will.

2008 has been quite a journey. I’m in an incredibly wonderful place, which I don’t know that I would recognize had I not had my dance with the Cancer Troll.

2009 is already a mortal lock for my best year yet – I wish you the same!

Pay No Attention to the Man Behind the Curtain (If You’d Like to Stay Blissfully Ignorant)

I lost my health insurance the other day – and I'm not going to look for it.

I have reason to be very glad this didn't happen last year, given the cancer-for-Christmas gift I received at my mammogram last December.

Now that I'm in the self-pay column, I called the imaging practice where my next mammogram will take place to ask what the cost would be.

I have seen Explanation of Benefits (EOB) statements from my insurer – when I had one! – that listed the above-the-line cost as $600 to $1,000. Then there was the 'negotiated discount', and the other horse-trading hand signals that brought the cost down to around $350, which the insurer then paid the doctor.

Every EOB I've ever seen had this sort of dance on it – high initial cost, the insurer does a 'look what a great deal we got for you!' discount jig, and hey-presto, the final price is reduced by 50%-or-more.

So, when I called the imaging center, I was bracing myself for sticker shock.

I did get sticker shock, but in the other direction – a screening mammogram is $135, a diagnostic mammogram runs $120-$180, and ultrasound, if necessary, adds another $75.

Meaning the worst-case cost scenario is….$255.

Mention health care in any circle, and you'll hear cries about costs spiraling out of control, of doctors who lose money seeing HMO patients, of hospitals taking it in the shorts on equipment and supply costs, of patients paying $200 for an aspirin (I guess that's 'cause a nurse delivered it in a little paper cup?), of that last week of dad's life when his hospital bill hit $100K.

Here's a question – could it just be because of managed care that costs have managed to careen out of control?

I'm old enough to remember that, back inna day, you went to the doctor and paid for your visit on the way out. 

If you had a prescription, to went to the pharmacy and got it filled…and paid for it.

Needed lab work? You went to the lab, and paid the bill when it arrived.

You had insurance coverage against the day – which you hoped to avoid – when you'd have to go into the hospital.

Here's a suggestion for Tom Daschle, and the incoming Obama health care team: you don't need to invent a new system. Just go old-school, and add technology to it. Give consumers control not just over their care, but its cost.

When you're in the exam room with your doctor, thanks to managed care that's you, your doctor, and fifty people you can't see involved in decisions about your medical care.

That's fifty people who all want their 'taste', who add their cost – for administration, for oversight, for just taking up space in the transaction – to the cost of the actual visit.

That's the first way to attack cost – admit that the Great and Powerful Oz, the whole 'managed care' monolith, is really just a venal clerk behind a curtain who's inserted himself into the medical care system.

Putting patients back in control of their own medical care – really – would not just help control costs, but it might also drive actual patient ownership of their health. Now there's an idea.

So here's a suggestion – kill managed care. And don't have a funeral.

That's my story, and I'm stickin' to it…