Tag Archives: mammogram

Health Alerts

Paying For Mammograms: We’re Thinking About It All Wrong

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(A version of this Health Alert was published by Forbes.)

The third rail of American health policy is women’s health care.  The U.S. Department of Labor states that women make 80 percent of health care decisions for their families, although this appears to be derived from folklore rather than scholarly research. Nevertheless, any politician knows that the way to drive up polling numbers among women is to dial up the rhetoric on health care.

Back in 1996, Hillary Clinton, bitter after the defeat of HillaryCare, campaigned against “drive-by deliveries,” demanding that a federal law should be passed mandating that health insurers pay for mothers to stay in hospital for at least 48 hours after delivery. The campaign succeeded quickly: The Newborns’ and Mothers’ Health Protection Act passed that year, and took effect in 1998. It mandated a 48-hour stay (or 96 hours for Caesarian section). Although, doctors are free to discharge their patients earlier.

More recently, controversy arose when the Affordable Care Act was being debated, because it was being jammed through Congress just as women were struggling with a 2009 decision by the US Preventive Services Task Force to change its guidelines recommending annual mammograms. The new guidelines recommended screening starting at 50 years, not 40 (as previously recommended).

Needless to say, this upset many people. The American Cancer Society maintained its recommendation that preventive screening start at 40, as did the Mayo Clinic. Politicians took note, and made an exception in Obamacare for mammograms, such that the 2009 USPSTF revision was ignored when it came to Obamacare’s “free” preventive care.

The USPSTF looks ready to re-issue its guideline, which means “free” mammograms for women in their 40s will not be mandated by Obamacare. Avalere Health has published a study estimating that this could “eliminate guaranteed coverage” for 17 million women. Continue reading Paying For Mammograms: We’re Thinking About It All Wrong →

Health Care Costs

Breast Cancer Screening Update

Women joggingYou may recall controversy circa 2009 and 2010, when the Affordable Care Act was passed, about whether women in their 40s would get “free” mammograms every year. In 2009, the US Preventive Services Task Force issued guidelines recommending annual mammograms starting at 50 years, not 40 (as previously recommended).

Needless to say, this upset many people. The American Cancer Society maintained its recommendation that preventive screening start at 40, as did the Mayo Clinic. Politicians took note, and made an exception in Obamacare for mammograms, such that the 2009 USPSTF revision was ignored when it came to Obamacare’s “free” preventive care.

The USPSTF looks ready to re-issue its guideline, which means “free” mammograms for women in their 40s will not be mandated by Obamacare. Avalere Health has published a study estimating that this could “eliminate guaranteed coverage” for 17 million women.

Health Insurance

Clinic with Two Doors: Those Who Pay Up Front Get Better Care than Those with Insurance

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This gives a whole new meaning to “two-tier” health care:

On Manhattan’s fashionable Upper East Side, the door on 77th Street says Lenox Hill Radiology. It’s a busy place, with 20 or 30 people typically waiting in chairs. It takes insurance.

But if you walk a few steps down the block to Madison Avenue, and one block up to 78th Street, you’ll walk through the door of New York Private Medical Imaging. The waiting room has only four chairs, usually empty. It takes cash, checks and credit cards. You can try to recoup some of your money later if you have insurance.

httpv://www.youtube.com/watch?v=iyoPaVxMyWY

Behind Closed Doors

 

Continue reading Clinic with Two Doors: Those Who Pay Up Front Get Better Care than Those with Insurance →

New Health Care Law

Who Will Determine Who Gets a Mammogram and How Often Under ObamaCare?

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Not you and your doctor. Unless you can pay out-of-pocket. Ever since the U.S. Preventive Services Task Force called for fewer mammograms and fewer Pap smears, the Obama Administration has been trying to distance itself from the organization — referring to its recommendations as “nonbinding.”

Yet the National Center for Policy Analysis has discovered that the Reid health care bill refers to the task force no less than 26 times. And, yes, the task force will determine what screenings will and will not be included in the minimum coverage that everyone will be required to buy.

Health Insurance

New Mammogram Standard: How Much is Your Life Worth?

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In recommending “against routine screening mammography in women aged 40 to 49 years,” the U.S. Preventive Services Task Force is clearly weighing potential lives saved against the money needed to save them.

The task force recommended against screening because it concluded that there was “moderate evidence that the net benefit [of screening mammograms] is small for women aged 40 to 49 years.” The documents supporting its decision review selected literature on mammography and breast cancer survival. They show that mammography reduces the risk that women aged 40 to 49 will die from breast cancer about as much as it reduces the risk that women aged 50 to 59 will die from breast cancer. According to one of the supporting papers, screening produces a 15% reduction in breast cancer mortality in both groups.

Continue reading New Mammogram Standard: How Much is Your Life Worth? →

Health Alerts

Americans Get More Mammograms, Colonoscopies, etc. than Europeans

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We don’t get a little bit more. We get a whole lot more. But first things first.

If you are like me you probably have noticed a claim being repeated over and over again, like a steady drumbeat: that Americans spend more, but get less care. The latest, from the Commonwealth Fund (CWF), is published in Health Affairs. According to the journal’s press release:

American doctors are significantly behind many of their counterparts elsewhere in providing access to high-quality care and use of health information technology.

According to CWF, U.S. physicians are worse than those other developed countries at providing after-hours care — leaving no choice but the emergency room. Far more than in other countries, U.S. patients have difficulty paying for medications and care and U.S. doctors are more likely to be hampered by insurance coverage restrictions.

“Our weak primary care system puts patients at risk and results in poor health outcomes and higher costs,” CWF president Karen Davis told Reuters. Other countries have solved problems the United States is still struggling to conquer, she said. “U.S. primary care lags behind care in other countries on key measures,” said a Health Affairs press announcement.

All this had me in a real funk until I discovered through my own prying — and without the aid of any press release — an article in THE VERY SAME JOURNAL that reported on the care actual patients actually receive. You can’t imagine how surprised I was.

Continue reading Americans Get More Mammograms, Colonoscopies, etc. than Europeans →

Health Care Costs

Are We Getting Our Money’s Worth in Health Care?

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This is Gary Becker, writing at his blog:

A study by Samuel Preston and Jessica Ho of the University of Pennsylvania shows that the fraction of men receiving a PSA test, which is a test developed about 25 years ago to detect the presence of prostate cancer, is far higher in the US than in Sweden, France, and other countries that are usually said to have better health delivery systems. Similarly, the fraction of women receiving a mammogram, a test developed about 30 years ago to detect breast cancer, is also much higher in the US. The US also more aggressively treats both these (and other) cancers with surgery, radiation, and chemotherapy than do other countries. Continue reading Are We Getting Our Money’s Worth in Health Care? →

Health Care Costs

The Patient as a Billing Opportunity

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Imagine going in for a free medical screening and then being hit with a big bill. It's happening a lot these days.

Company health plans increasingly are offering to pay the full cost of preventive services such as physicals, colonoscopies and mammograms to help employees stay healthy. But some patients then find they owe money for such screenings, sometimes hundreds or thousands of dollars.

So, what can go wrong? (1) The doctor's office miscodes the service. (2) Something happens, say, during a preventive exam which allows the doctor to code the episode as another service. For example, the patient mentions he has allergies or some other problem and the session gets coded as a treatment rather than a physical. (3) Or, during the exams:

Doctors sometimes order more views of suspicious masses they spot as they are doing a screening mammogram. This then gets billed as a diagnostic mammogram, which deals with existing symptoms, rather than a screening, which is for people without any specific signs of risk. For patients, that shift could mean new fees.

Warning: Once it gets coded wrong, it's like pulling teeth to get it fixed.