Two For One

OpenMedicine.ca is a brand-spanking-new "peer-reviewed, independent, open-access journal". Especially worth reading is the editorial Why Open Medicine? (The site is having some teething troubles, if it's down when you click just try again later)

The journal's mission: "... to facilitate the equitable, global dissemination of high-quality health research; to promote international dialogue and collaboration on health issues; to improve clinical practice; and to expand and deepen the understanding of health and health care."

Not only do we get to welcome an open access journal with this post, but we also get this article from the Toronto Star which reports "Health outcomes for patients in Canada are as good as or better than in the United States, even though per capita spending is higher south of the border, suggest Canadian and U.S. researchers who crunched data from 38 studies."

The cool part?

The study is in the inaugural edition of the afore-mentioned journal!

It's kind of like buy-one-get-one-free, except it's actually get-one-free-and-get-another-one-free. Gotta love open source.‎ Full story...

Tennessee Hospital Charges

The Tennessee Hospital Association today launched a Web site telling patients how much they'll pay.

Tennessee Hospitals Inform lists average prices for common procedures at the state's acute-care hospitals.
‎ Full story...

Dark Victory

Today's New York Post has a piece on hospital performance on the CMS measures.

I assume the reporter used the Hospital Profiles Web site.‎ Full story...

State Medicaid Programs P4P

In the first published nationwide survey of state Medicaid programs on "pay-for-performance" practices, more than half of all programs state that they provide financial incentives to health care providers for better quality care.

Almost 85 percent of states plan to have pay-for-performance programs within five years. Researchers also found that most current programs focus on women's, children's and adolescents' health issues. The study is published today by The Commonwealth Fund, a private foundation working toward a high-performance health system. Authors are from IPRO, a not-for-profit quality evaluation and improvement organization, and The Kuhmerker Consulting Group, LLC, a health care consulting firm.‎ Full story...

Miinor Hiatus

I lost Internet connectivity at my house a week ago, and apparently it's going to take Time Warner another week to fix it, so I'm Netless for the time being. Right now I'm sponging Internet in a hotel in DC, where I'll be until Wednesday, soI'm taking a sort of welcome forced break. In the meantime, see what Martina's writing about.

...‎ Full story...

PHRs: Certifiable?

There was a bit of buzz last week over the American Health Information Council's discussion around certification of Personal Health Records, with the Consumer Empowerment Workgroup not finding consensus on the issue. I've been waiting until the transcript of the CEW February 16 meeting was posted to comment on the workgroup's recommendations, however, the March 13th AHIC meeting which summarizes the CEW's February meeting has its transcript up already, so I'll work from that. When the Feb 16 transcript comes out I'll comment if necessary.

Quick recap on the Consumer Empowerment Workgroup:

Broad Charge for the Workgroup:

Make recommendations to the Community to gain wide spread adoption of a personal health record that is easy-to-use, portable, longitudinal, affordable, and consumer-centered.


Specific Charge for the Workgroup:

Make recommendations to the Community so that within one year, a pre-populated, consumer-directed and secure electronic registration summary is available to targeted populations. Make additional recommendations to the Community so that within one year, a widely available pre-populated medication history linked to the registration summary is deployed.

The February 16 meeting of the CEW attempted to find answers to the following questions:

• what is certification?
• how is certification actually going to be completed around a personal health record?
• what is the time involved for the certification process?
• what will the cost be for those innovators that are trying to get into the personal health record area?
• how will the certification help to protect consumers?
• what impact, in any, would certification have on innovation?

Notably, the question "what is a PHR?" is absent, although it's raised in the statement of dissent. While it may seem obvious, I think there should be a distinction between commercial PHR products and the general hazy notion of your PHI aggregated over a network.

In other words, it's one thing to make a platform for presenting your health record to you on a secure Web site, it's another to give me a report of all the data available to me from multiple sources using a clinical data exchange.

There are PHR products online I can go fill in myself, there are PHRs gaffer-taped onto EHR software products, there are PHRs auto populated by payors, there's a piece of paper in my wallet with my allergies on, there's various hospital records floating around...

Given a RHIO-like structure I could ostensibly aggregate my own data into my own PHR on my desktop by querying the exchange for myself.

I'll cut and paste the relevant sections of the transcript below, but in summary the split is over whether or not to recommend certification of PHRs against as-yet non-existing standards of privacy, security, interoperability and portability. The recommendation is for voluntary certification. Dr. Rose Marie Robertson, the Co-Chair of the group, led the charge for certification, David Lansky spoke for the five members who dissented.

In my estimation, the group is having a hard time defining what it is they're recommending. After Lansky speaks, Nancy Davenport-Ennis - the other Co-Chair - speaks to four different requirements the recommendation is trying to assure, i.e. privacy and security, transparency, affordability and interoperability.

Recommendation 1: HHS should support CCHIT and/or other certifying entities in identifying a pathway and timeline for voluntary certification of PHRs after adequate industry experience has been achieved in the market. Such certification should include: specifications for PHR privacy and security, interoperability between PHRs and personal health information data sources (including EHRs) consistent with HITSP-identified standards, and PHR portability. The certification criteria development process should take into account the best practices for security and privacy policies to be identified by the Consumer Empowerment Workgroup, the Confidentiality, Privacy, and Security Workgroup, and other relevant groups.

Recommendation 2: HHS, through the Centers for Medicare & Medicaid Services and the Indian Health Service, and in collaboration with the Office of the National Coordinator for Health IT, should develop plans to offer portable PHRs with adequate privacy protections to their beneficiaries, and HHS should report back to the Community about their plans as available. The plans should take into account the results of the studies and best practices recommended by the Consumer Empowerment Workgroup on January 23, 2007, as they become available, and should build upon work already underway at the agencies.

The dissenting statement was against Recommendation 1 only. The primary dissent was that instead of focussing on certifying a PHR's adherence to privacy and security standards, the workgroup should be formulating actual policy that PHR vendors could be held to, that PHRs are just too young an idea to even consider certifying them.

This is where my hacker side trumps my paranoid side.

PHRs barely exist. There are several Web sites that allow you to populate your own record, but they don't talk to any data sources. There are a few health plans that give you a sort of PHR, but they're not portable to other plans.

No-one has yet figured out what data is even available to populate a PHR, how to transport it across a network, how to audit it and the access to it, how to manage it once it's alive, the list is endless.

It seems almost obvious to me that PHRs must come to exist in exactly the same way personal credit data does now. Think about it:

• Credit data comes from providers; credit card issuers, lenders
• Credit data is aggregated by major clearinghouses; Equifax, Experian and TransUnion
• Consumers have access to their data, and the option to submit corrections
• Credit data is portable, no matter what bank issued the data remains usable
• Consumers have access to an audit trail of who asked for and who was given access to their credit data
• The information is heavily regulated and subject to proven policies

We can easily rewrite that and substitute clinical data:

• Personal health data comes from providers; hospitals, doctors
• Personal health data is aggregated by major clearinghouses; NHIN, RHIOs, clinical data exchanges
• Consumers (should) have access to their data, and the option to submit corrections
• Health data (must be) portable, no matter what health plan/provider is used the data must remain usable
• Consumers (*should) have access to an audit trail of who asked for and who was given access to their credit data
• The information should be heavily regulated and subject to proven policies

So asking providers of PHR technology to adhere to basic principles of security and privacy is great, but what policies will they be measured against?

It's kind of like the HON Code; a voluntary code of conduct that health content Web sites can claim adherence to. It's all well and good, and has certainly made inroads into consumer awareness, but there's nothing forcing me, as a health care Web site publisher, to neither (a) choose to adhere to the principles of the HON Code nor (b) remain accountable for my conduct if I choose to claim compliance.

This has led to billions of health care content pages on the Web that have little to no validity or governance.

The goal of PHRs should be consumer empowerment, and we can only get there by having real policy laid down for PHR producers to follow. We don't need to mandate specific technologies or functionalities, merely solid security and privacy requirements that can be upheld by the PHR hosts.

If the AHIC can't come up with adequate language, why not examine the banking industry and figure out what they use? Is our health information really so different? Is it really more sensitive?

AHIC has so far offered a tremendous amount of effort and work on our behalf, but as adoption becomes less of an issue we need actual governance and direction.

Let's certainly adopt a stance of having certification against standards and policies as a goal, but let's figure out the standards and policies first, yes? Frameworks are awesome, but without development they are useless ghosts of possibility. Man up and write it down. We need policy, not frameworks, and by all accounts we need it sooner not later.

--

[Excerpt from transcript follows]

Dr. Rose Marie Robertson, Co-Chair, Consumer Empowerment Workgroup:

This -- the majority of the Group was convinced that enhancing and assuring privacy and security, as well as interoperability, would lead to greater adoption of personal health records. That this was important to do, and that it was complicated. That we needed to have standards, and expectations and policies, that we needed to derive that from the appropriate bodies. That we needed to be certain that we would not stifle innovation, and in particular, that we would not stifle innovation and entry into the market of groups providing services to those who are disadvantaged, so that small vendors who might aim at a targeted population that we very much want to be involved in, and able to access personal health records, in particular, should not be disadvantaged. We were reassured that sliding scales or perhaps even government grants or other [inaudible] could be found, so that [inaudible] as well as an electronic health record, one could level the playing field.

And we ultimately came to the [inaudible] that health and [inaudible] should support certifying entities [inaudible] other certifying entities, and we carefully worded it. In identifying a pathway and a timeline, so not in certifying, now, but in identifying a way and process for doing this, for voluntary certification of personal health records. So again, not mandatory certification, but voluntary certification that would provide, if you will, the underwriters’ code, that sort of assurance for the public, after adequate industry experience has been achieved in the market to know best how to do that.

That certification would include, we think, most importantly, specifications for privacy and security, and we plan to, as you see there, work with the confidentiality Privacy and Security Workgroup. We have begun those discussions, and will have actually another meeting with them on -- a meeting to discuss that on Friday.

It should also include issues of interoperability between personal health records and sources, because otherwise, those records [inaudible] are ineffectual. And portability. We think it’s quite important for patients to be able to take this information from a tethered system [inaudible] or one employer, and be able to bring that to another system.

We think that this process should take into account practices for those policies, as identified by our Workgroup, DDS Workgroup, and other relevant groups, perhaps; including the Privacy and Security Solutions Group. Not functionalities, as you’ll notice, but privacy and security interoperability and portability.

Let me turn to David Lansky and let him present the views of the dissenting group, whose letter you have in your packet as well.

David Lansky, Markle Foundation

MR. LANSKY: Thank you, Rose Marie. I want to first thank both Rose Marie and Nancy for leading a very vigorous and open discussion about a complex area. It has been a very constructive discussion, and I think all the parties to our Workgroup have felt that we have learned a lot by going through this discussion, and I hope some of you will participate in that with us today.

I think a key point, as I come to you, is that we do not have consensus about this issue. There is, across the industry, across healthcare, across the consumer sector, not yet enough experience or understanding to achieve a unified recommendation regarding how to proceed.

The reason, I think, we don’t have a consensus about the industry at this time on this question is that it’s frankly too early. We simply have not done enough work in the policy development area, in developing, and marketing and using these products, and in testing the relationship between those policies and those products, to know exactly the best way to more toward implementing the policies to help more forward.

I’d also say there is no question, as Rose Marie has said, that we all share the same objective, building a trustworthy, reliable environment where people share their health information, is what we’re here for. And finding the appropriate mechanisms to develop the right policies and enforce those policies is the task we need to have in common.

In some of the ways, I think we are premature in moving the certification process forward. First, we don’t actually know what a PHR is. We can’t yet define the “it.” Secondly, the industry has felt it’s new and improved [inaudible]. Not really talked to each other [inaudible] enough experience to know what can be applied and enforced. Thirdly, frankly, this is one of the first steps most of us have taken, marketing to 300 million Americans with an enormous array of needs and requirements, in health situations, is new for all of us in this environment; and how to evaluate and validate product in the consumer stage is a new challenge that we have not yet done.

And lastly, in terms of the prematurity of the work, while we have all identified, I think, some of the areas of privacy, and other policies where we have a significant need to establish public trust, we haven’t yet developed a policy. We have identified the problem; we have not yet recommended solution. So we don’t have, even as Mark said earlier, the standards yet against which to certify. So we feel that discussion of certification is premature, until we understand what those standards and policies should be, and then determine whether certification is an appropriate tool.

In the letter that you received we’ve identified a number of [inaudible] whether the logic that has supported PHR certification as we’re seeing, does that apply equally to the consumer marketplace? Do we know that certification will enhance privacy and security and trust in the public minds? And what is the risk of impeding innovation in the consumer marketplace, which may be different than the risk in the [inaudible] or physician marketplace.

But the good news, I think -- I want to close with, is that there is tremendous areas of agreement across all the Workgroups, which are highlighted in both letters, and I hope we’ll take some time today, and see if we can move forward in areas of very strong agreement.

We all agree that we need to establish the standards and specifications for both private and [inaudible] PHRs. We all agree we need to gain more industry experiences in the real world with these products and services. And we all agree that we need to develop privacy and security policies that can be used as [inaudible].

So I hope you will undertake efforts to address those three objections that we all share, and defer the question of certification until we understand what are those policies which must be enforced in the environment we’re working in.

The last point I want to make, is really to distinguish this idea of enforcement and policy development, the way we, and those who are [unintelligible] here, have seen the question, certification is one tool among at least half a dozen by which we can implement or enforce good policies. The others include a wide range, health certifications, statutes to [unintelligible]. There are a number of tools available to implement good policies. Certification is one.

I would hope that we would first do the hard work of developing the policies [inaudible], and then determine which method of implementation or enforcement would be appropriate. If certification proves to be one that is helpful at that point, I think we will have a very strong consensus to support it, once we have done the work of developing the necessary policy.

Again, I want to thank both you, Mr. Secretary, and the Community here for letting us be part of this vigorous discussion.
‎ Full story...

Hospital Bill: Appendix Addendum

Well, my weekend got away from me, so I'll settle for blogging the hospital bill I just received regarding my recent day trip to the local Emergency Room, as chronicled in Appendix Addendum.

In case you missed the first post, I went to one ER, bailed, and went to a second one the next day. In all fairness, I haven't seen a claim made on my first, failed visit, which I'd be cool with if they billed for the labs they more than likely ordered before I left.

So, Hospital B.

In short summary, I had a blood and urine workup, one CAT scan, and was seen by an ER doc and a surgeon.

The bill goes like this:

Eight, count them, eight lab charges.

$101.00, $125.00, $28.20, $89.00, $89.00 again, $96.00, $50.00 and $62.00

Total lab charges: $640.20

Total amount covered by my insurance company? $62.41

All lab charges were covered to the tune of 9.75% exactly, each individual charge was paid at 9.75%.

Now, if this had been ten years ago and I was starting my little business and was scraping by uninsured - which is exactly the situation I used to be in - I would have been expected to pay $640.20, even though the hospital is perfectly willing to accept 9.75% of their bill as adequate payment.

Weird, huh?

So, what else. Ah yes. The CAT scan.

For some unfathomable reason I have two CAT scans listed. The first one was $1,022.00 and the second one was $1,043.00

I'm pretty sure I only had one CAT scan, I mean, I was there. Maybe one of these charges is a radiologist charge, which would explain the two items, but man, that's a nice paycheck for an hour's work.

Total bill for the CAT scan: $2065.00
Total covered? $201.29

There's that 9.75% again.

There's then a general Emergency Room charge of $516.00, covered at the increasingly-familiar rate of 9.75%, the hospital getting paid $50.30 of the bill.

Finally, the "service charge", $28.10, covered in its entirety. "Service Charge". It's labelled "State Claim Surcharge".

So, the entire bill was $3,249.30, the insurance company covers $342.10, of which $25.00 is apparently a copay I was supposed to cough up, which no-one asked for. Therefore, of the entire bill, the hospital received a check for $317.10, less than 10% of the billed amount.

Here's the rub. An uninsured person would be expected to pay ten times the accepted reimbursement. But of course, if an uninsured person could afford the bill, they could afford insurance.

According to various studies, medical bills account for up to half of all personal bankruptcies. These people have jobs, albeit low-paid and not offering health insurance.

29% of Brooklyn residents have no health insurance, and are not eligible for Medicaid. Those people without insurance have lower access to health care, and will put off seeing the doctor, get sicker, and end up in the Emergency Room, where they find themselves now with an unpayable bill of thousands of dollars, which the hospital has to write off, leading to higher prices etc etc.

I don't claim to have the answer, but market forces are certainly not working at this particular hospital, which filed for bankruptcy in 2006. I grew up in a single-payer society, and while we certainly don't have the best care in the world, we have better outcomes in many areas over the USA and no-one is scared to go see the doctor regularly simply because of cost.

The richest country in the world owes its citizens better than this. Whether it be government or private charity, somehow we should be providing for basic health care for all. The richest country in the world also has one of the widest wealth gaps, the haves are getting way ahead of the have-nots.

In the meantime, if you do get a hospital bill and can't afford to pay it, bear in mind that it's as negotiable as any other bill.









‎ Full story...

Spheroid Joy

Well, I've been extremely quiet this week as I've been travelling a little, doing a lot of research into retail pharmacy and medication reconciliation in the hospital, plus working on this year's Health Care Report Card. I'm in DRG heaven...

On top of that, I'm working on not one but two new Web sites, one for RHIOs and another for the NYS Department of Health, and then if that's not enough we're about to welcome three new collaboratives to the Jeny community site.

So yeh, I'm busy.

I intend to rectify my quietude this weekend as I have a Saturday all to myself for the first time in a long time which will be spent blogging and deciding which of my stack of unread books should be first; on a recommendation I just got a copy of Rosemary Gibson's Wall Of Silence, which I think will be the first to be opened.

If I have the energy, I'm also going to take Paul Levy up on his challenge to enable hospitals to post their infection rates voluntarily - myself and a mate are thinking of building it and seeing if they come.

But I wanted to take a moment to thank Shahid at the HITSphere for adding A Scanner Brightly to the HITSphere blog roll. Shahid runs a huge aggregator of HIT content, plus his own blog at healthcareguy.com, he's got a lot of cool stuff going on, go check him out.‎ Full story...

New Reports in KY, CA and IN

Martina at AboutHealthTransparency.org reports on three new public reporting initiatives around the country, one hospital level report and two, count them, two physician specific quality reports.‎ Full story...

Ad-supported, Free EMR System

I have absolutely no idea how I feel about this.

It's Google, it must be good.

It's advertising revenue from personal clinical data, it must be evil.

Good. Evil. Good. Evil.

(head explodes)

Check out the company's PatientFusion product too.


‎ Full story...

Appendix Addendum

This is a personal account of my recent brush with appendicitis and the fun I had getting hospital care...

I had appendicitis, but it took me a week and a half to figure it out. Couple that with my built-in fear of all things medicinal and by the time I had a CAT scan I'd actually beaten the inflammation back from whence it came.

As it turns out, I now know what that funny stomach ache that lasted a week back when I lived in France actually was. That's right. I've had appendicitis TWICE.

So seeing as how I'm this health care report card guy, I decided to put my money where my mouth is and chose a hospital based on the report card I built. Due to the nature of my work I have a better knowledge than most of the hospitals in my area, and I chose Hospital A, high scores for quality and surgical infection prevention, not to mention a nice middle-range $14,000 average charge for an appendectomy.

(Yes, I'm price sensitive. I grasp the fuzzy math that the more I spend on health care, the less my boss has to give me a raise next year.)

The Doctor is Out

I should back up a bit and mention that I called both of my doctors before going to the emergency room, I really didn't feel like I was in an emergency and I simply wanted a doctor to examine me. I'm on the books with two guys in Brooklyn, neither of whom could see me within a day and half of me calling.

I tried, damn it.

One was out for two days, the other had been paged three times in three hours with no reply. The girl at the office suggested his pager might be broken. I've only been to the guy once, in a recent effort to change from my DO to an MD. I like my DO, but no-one else does, the general theory being that DOs suck and MDs are gods. This particular MD was not at all helpful, and managed to lose my head X-rays for a week, but he has privileges at Hospital A so I figured I'd give it a whirl.

Hospital "A"

So off I trundled to Hospital A. It's a nice place, my son was born there, it's in trendy, upper-middle class Park Slope, so I anticipated good customer service also. It's a hike from Bay Ridge, but I felt the thirty minute drive and the potential three days to find a parking spot were worth it.

I got to the ER and wrote my name on a piece of paper and followed the instructions to post it through an anonymous slot. This later turned out to be the triage room.

The ER waiting room was pretty full, and no signs or clocks gave me any indication of how long I would be waiting or how many people were in front of me to see the doctor.

The deli where I buy my lunch can handle this simple task, and they only get five bucks from me. I'm in an ER waiting to spend $14,000 dollars. Come on people!

I waited about half an hour and was methodically seen by a triage person. I told him about my abdominal pain, other uncomfortable and unmentionable GI issues, the mentionable projectile vomiting, and I had my blood pressure taken. Blood was removed from my body with no indication as to why. I assume it was for tests, but still, a few words would be nice.

I was then given a plastic bracelet with a close approximation of my name handwritten on it, and was then directed to the *real* ER waiting room. Up until now I had been in the triage waiting room.

Gah.

The ER waiting room proper had many more people waiting, along with a TV. I toyed with the idea of turning it off using my universal off button, but felt that this was one audience who needed their network television.

I was registered and my billing details were taken. I then waited another three and a half hours or more until I became so uncomfortable sitting on the plastic chair I elected to leave so I could go home and lie down.

Strike one.

--

I didn't tell them I was leaving, I simply left; but here's the reason I didn't go whine about how long it was taking: health care is a service industry. My knowledge of service industries tells me that if I get seen out of order or in response to a complaint I make, my quality of service is likely to go down.

The hospital equivalent of the waiter spitting in your sandwich scares me.

If we're talking about sewing buttons on a coat I may make the value decision to be loud and demanding if I think my button sewing service is failing me, as I do not value buttons highly enough to care if the button sewer subconsciously does a crappy job because I'm annoying; however, I refuse to receive service from a health care professional who may be pissed at me.

I'm just not willing to risk it.

Hospital "B"

The next day I cheated and put my inside knowledge to work for me. I knew that Hospital B had recently filed for bankruptcy, had appeared in the infamous Berger Commission hospital closure list and was suffering a large decline in ambulance drop-offs. Plus, it's literally around the corner from me.

The down side was that, according to my report card, Hospital B scores very low on surgical infection, and had a surprisingly high average bill for appendectomies, a whopping $21,600!

However, I was still telling myself this was a bout of constipation and I really just wanted a trained medical professional to rule out appendicitis.

I trudged around the block to Hospital B and my cunning plan proved itself when I saw only one other person waiting in the ER.

Victory was mine!

I was triaged in about five minutes, and the only difference was that Hospital B also requested a urine sample, Hospital A had not done so. More surprisingly, unlike the scrawled, unreadable bracelet I received at Hospital A, I was given a computer-printed bracelet with my name, date of birth and other useful information on it.

I was begininng to be impressed.

A doctor came out within ten minutes, and guided me to the ER. I ran through the symptoms and professed my half-arsed fear that I had appendicitis, but the doctor pretty much ruled it out as I had no fever nor any other signs usually found with appendicitis. However, she recommended I get a CAT scan. I resigned myself to the three hours of Barium digestion and said yes. By now I was in a hospital gown on a wheeled bed.

Over the course of the next three hours I was successively removed further and further from the ER as people with real injuries and worse pain came in. By the time I was sent up for the CAT scan I was at the very end of the corridor. My gut feeling (pun intended) was that most of the staff figured I was fine, I obviously didn't have appendicitis as I looked perfectly fit and healthy apart from the searing stabbing pain I felt when I poked myself in the gut.

I overheard many conversations about the hospital's recent bankruptcy filing, people's holiday pay, new jobs, that sort of thing. I probably didn't help myself much by having brought a copy of Ian Morrison's "Health Care in the New Millennium" to read.

Undaunted, I got my CAT scan and was wheeled downstairs to await the radiology report. That took about another hour, at which time we found out that yes, of course it's appendicitis, here, have some antibiotics, please wait for the surgeon.

--

The best part was when they came up and just started hooking up fluids to an IV without telling me what they were doing. I had to stop them, get their attention, and have them tell me exactly what they were doing and why.

You can't just walk up to someone and start pumping stuff into them, can you?

Who do these people think they are, and who do they think *we* are? I'm sure the routine stuff gets boring after a while, but seriously, inform me.

By now I was actually down the corridor and around the corner, so I was practically outside the hospital. I sat and read and waited. And waited. And waited.

I was so invested by this point I was resigned to waiting for the surgeon to arrive. However, it turns out that I was by now parked outside the room where you put dangerous folk such as people with tuberculosis.

Of course, what are the odds of anyone turning up at a bankrupt hospital at 7 in the evening with tuberculosis?

Odds on, apparently.

A guy was brought in with full blown TB, a fact I only know because the nursing staff were discussing his dangerous-ness right around the corner from me, well out of earshot of the real patients.

Masks were handed out to the staff and the wife was briefed on her need to be tested. All of which was fine, until they left to go do other nursey things and this TB-ridden moron kept LEAVING HIS ISOLATION ROOM. RIGHT ACROSS FROM ME.

So, considering I had absolutely no intention of being operated on at Hospital B, and given the fact that a family of TB was walking past me asking how I felt, I decided to make a break for it. I wheeled myself down to the ER desk and asked to be discharged. Everyone seemed a little perturbed about that and convinced me to stay. I decided to give the surgeon a half hour, after which I would sign out against medical advice.

My antibiotics had finished a long time ago, and I was just in the middle of trying to figure out how to remove the IV from my arm without anyone noticing when magically, the surgeon arrived.

He was a bit flummoxed I think by the diagnosis, and was in no rush to whip the little bugger out. He wanted me to stay overnight but I could imagine nothing less inviting, so I sweet-talked him into letting me go home under the promise that if all hell broke loose in my abdomen I'd be back around the corner in two minutes flat.

He signed me out under "abdominal pains of unknown origin" or some such safety diagnosis, and I went home, whereupon I alternated between sleeping and eating toast for three days.

I feel gipped by this, I have appendicitis, I'm willing to sign out against medical advice, why stick me with a phony diagnosis?

Epilogue

I am now pretty much 100% better, although a bit gurgly. The pain's all gone, I have a huge new understanding of how medical care is delivered and how hospitals work from a patient's perspective, and best of all, I still own an appendix.

Now, I am not the kind of person who believes in vestigial appendages. It's in there, and it's in there for a reason. I do subscribe to the fact that it's great for digesting grass, and I also subscribe to the fact that I am evolutionally unfit to consume grass or other green leafage, being more genetically predisposed to large chunks of dripping red meat.

Therefore, I am now pronouncing that not only are appendices necessary, mine is different from most everybody else's which is why I want to throw up when I see cabbage or lettuce. Or spinach.

So there.

--

My next experiment in health care will be trying to schedule an appendectomy without a diagnosis of appendicitis, as I suppose it really should be removed at some point. It's obviously not happy in there, but without a valid reason for having it taken out as part of an emergency, I'm curious to see what my options are.

Seems to me that with my history I should be able to call up a hospital and just schedule an appendectomy, but I've a funny feeling nothing is that easy.

Common sense tells me it would be better to have it removed while it's in a vegetative state (har har) as opposed to inflamed and angry, as then it could be removed laparascopically. But hey, what do I know, I'm just the owner/operator of a human body.

Stay tuned.

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Generic Prescription Pricing: Where's My Discount?

Kaisernetwork.org has a review of a WSJ article that ran yesterday showing how generic prescription drugs are often not saving the consumer much over the brand name version.

The example given is Zocor, priced at $149.99 for thirty 20mg tablets, now competing with generic simvastatin which was being sold anywhere from $125 to $139.99. When called on it, Walgreens, CVS and drugstore.com dropped their prices.

Walgreens went down to $89.99, CVS to $79.99, and drugstore.com dropped to... get this... $27.99!

Amazing.

That's a cut from $4.17 to 93 cents per pill.

Even more amazing, all three of them claimed they dropped the price as part of their regular price reviews.

;o)

The New York State Attorney General's Web site has a prescription drug price compare tool that allows you to compare prices on a number of medications.

Just for fun, I punched in my ZIP code and reviewed the prices for the same thirty 20mg prescription.

For Zocor, at the pharmacies in and around my ZIP code, I have a range of $100.02 up to $199.28, which works out to $3.37 to $6.64 a pill.

I then went to pharmacychecker.com and found a range of prices for 20mg Zocor from $1.01 to $5.17 a pill.

Admittedly, some of those prices were for larger purchases, the $1.01 price was for 90, and most of the cheaper prices were from Canadian pharmacies, but still, come on. If pharmacy A can sell it for a buck then pharmacy B probably doesn't need to be selling it at $6 a pop.

To compare drug prices in your area, visit Consumer Health Ratings and see if they have a prescription drug price site in your state.

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The flip side.

I'm not 100% certain Zocor makes for a fair comparison. I'm sure I know a lot less than the Wall Street Journal about these things, but am I wrong in thinking that Merck slashed prices on Zocor in an effort to retain market share once the patent ran out?

If so, then there shouldn't be that huge of a gap between brand and generic pricing, in this instance. Right? If you know better, comment please.

However, according to this release from January 2006, at least one watchdog - the NY State Alliance for Retired Americans - has been watchdogging the issue for a while.‎ Full story...