Lab Soft News

Large Hospital Chains Developing More Specialized Standalone Centers

We are moving toward a future where inpatient admissions are becoming less common with more specialized, remote centers becoming more numerous. More hospitals are also being designed as "bedless" facilities  (see: The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology; The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals; Some Additional Ideas About the Bedless Hospitals of the Future). A recent article discussed how large hospital chains seems to be moving in this direction (see: Warding Off Decline, Hospitals Invest in Outpatient Clinics). Below is an excerpt from it:

Some of the hospital industry's most active investing these days is happening outside the hospital. Giant U.S. hospital operators, including Tenet Healthcare Corp., Dignity Health and HCA Healthcare Inc., are investing heavily in surgery centers, emergency rooms and urgent care clinics located outside hospitals, chasing after patients who increasingly want cheaper and more convenient care. Insurers and employers that pay for health care are helping drive the change as they shift more Americans to high-deductible insurance plans, which require patients to pay more of their medical bills before insurance kicks in. That has pushed more patients to seek lower-cost options....Hospital demand slumped during the last recession, a trend that has continued even as the economy recovers....Admissions growth at HCA hospitals has slowed in recent quarters to 1% to 2%, as a boost from the Affordable Care Act faded, while Tenet's admissions have been flat or down 1% to 3% most quarters since late 2015. In an effort to strengthen their hold on their markets and prevent rivals from siphoning off patients, hospitals are investing outside their own walls. They are "following the patient,"....The strategy also places hospital satellites closer to where patients live and work, which executives say they hope will win over new, loyal customers....

Trevor Fetter, Tenet's outgoing chief executive, says company executives have pursued rapid outpatient expansion partially out of necessity.....Non-hospital operations typically generate lower revenue than hospitals but produce higher profit and require less capital to build and run.....Prices for common surgical care can be sharply lower outside of hospitals, which generally have higher overhead related to round-the-clock operations and the technology and specialists needed to treat more complex cases. Cataract surgery and knee arthroscopy prices at ambulatory surgery centers were $5,000 to $2,500 less than at hospitals for employees and retirees with health insurance provided by the California Public Employees' Retirement System....Tenet said it would spend an additional $100 million to $150 million annually on other free-standing surgery centers, emergency rooms and satellite locations. 

In a previous note, I discussed the tug-of-war between free-standing surgicenters, often owned by orthopedic surgeons and hospitals that are vying for the same knee replacement patients. The surgicenters offer lower cost procedures because of their specialized approach (see: Tug of War between Hospitals and Surgicenters for Knee Replacements). The same pressures are occurring in radiology. Here's the latest about Anthem refusal to pay for MRIs and CT scans performed in hospitals (see: Anthem's new outpatient imaging policy likely to hit hospitals' bottom line):

In what may be the first strike in a battle over what healthcare services should be provided in a hospital, Blues giant Anthem will no longer pay for MRIs and CT scans performed on an outpatient basis in hospitals across the country.

To summarize, hospital inpatient admissions are trending downward nationally and, in response, large health systems like Tenet are building new surgicenters, emergency rooms and urgent care clinics located outside their hospitals. At least one health insurance company will now only reimburse for MRIs and CT scans performed in imaging centers because of their lower costs. All of this is going to result in a major clinical data "dis-integration" challenge. 

An Algorithm Using Medical Record Data Predicts Risk for Parkinson's Disease

We are entering an era when algorithms will be used to analyze data in the LIS and EHR databases and predict the risk of a patient developing various disease(s) in the future. This field is often referred to as predictive healthcare analytics. A recent article discussed this process in terms of predicting the onset of Parkinson's disease (see: Algorithm scans medical records for higher Parkinson’s risk), Below is an excerpt from it:

Researchers have developed an algorithm that could check patients’ medical histories to find signs of increased risk for developing Parkinson’s disease and alert doctors to evaluate patients at greater risk. Before symptoms become pronounced, there is no reliable way to identify who is on track to develop Parkinson’s disease....The algorithm relies on information in patients’ medical records, such as tests and diagnoses of various medical conditions....One of the most interesting findings is that people who are going to develop Parkinson’s have medical histories that are notably different from those who don’t develop the disease.....[The authors of a paper on this topic] analyzed de-identified medical claims data for Medicare beneficiaries nationwide, ages 66 to 90. They found 89,790 people who had been diagnosed with Parkinson’s in 2009, and matched them with 118,095 people in the same age range who had not been diagnosed with Parkinson’s in 2009 or prior years. Then, the researchers sifted through each person’s claims history to draw up a list of all diagnoses received and medical procedures undergone from 2004 to 2009...[They] developed an algorithm using medical history—combined with age, sex, race or ethnicity, and history of tobacco smoking—that correctly identified 73 percent of the people who would be diagnosed with the disease in 2009, and 83 percent of the people who would not. Specifically, many of the claims codes that helped predict the disease referred to problems already known to be associated with Parkinson’s such as tremors, posture abnormalities, psychiatric or cognitive dysfunction, gastrointestinal problems, sleep disturbances, fatigue and trauma, including falls. Other factors associated with the disease included weight loss and multiple forms of chronic kidney disease.

Part of the challenge of predictive healthcare analytics is that much of the relevant clinical data is locked in the EHR in the sense the it's recorded in natural language and not easily searchable. I blogged about this problem previously (see: Assessing Drugs Using "Real World Evidence" in Addition to Clinical Trials). Along these same lines, I encountered a company on web called Linguamatics Health that describes itself on its home page as "the world’s leading NLP text mining platform for health science." On its home page is the following claim:

Quickly develop new predictive models using unstructured data such as clinical notes: Identify high risk patients based on living conditions or life style choices like alcohol or drug use. Using NLP reduces the manual chart review needed to build data sets for machine learning models.

So the brave new world that we are facing in healthcare is that a patient will be admitted for the treatment of X disease. Algorithms will scan his medical record and then predict that he will probably develop Y and Z diseases in the near future. I have posted previous notes about some of the challenges relating to pre-diseases (see: The Challenge of Diagnosing Predisease in Our Healthcare Delivery System; Predisposition to Disease and Pre-Disease on the Health Continuum). We are also facing the challenge of patients not necessarily wanting to learn what diseases they are facing in the future (see: CASSANDRA’S REGRET: THE PSYCHOLOGY OF NOT WANTING TO KNOW).

Some Specific Areas Where Hospitals Are Investing in Innovations

Innovation is all the rage these days and hospitals are developing innovation centers to promote  changes in the healthcare industry. A recent article listed the specific areas where hospital executives believe innovation will drive improvements in care (see: Here's where hospitals are investing in innovation today). I list the five specific areas listed in the article below with a short commentary following the list:

Patient-generated data and customized services. With more and more patients wearing smartwatches, wristbands and other fitness trackers, hospitals are “eager to understand how to securely integrate these data,” to improve patient experience as well as managing high-cost populations under risk-based contracts, the report explained.

Network utilization and management. Hospitals are looking to maintain network integrity for tracking and managing patient populations in the transition to value-based care. That involved analyzing patient utilization data, profitability, demand management, scheduling and patient readiness.

Referral management and in-network retention. In the case of aligning patients with appropriate clinicians, hospitals are turning to new technologies for decision support, logic-based provider screening and referral tools. 

Social community support. Providers are looking to surrounding communities, including underserved populations, to both control costs and improve outcomes....

Convenient patient access — including telemedicine. Tools like telemedicine and virtual consults can help make care more convenient and efficient, thereby enhancing patient experience, satisfaction and retention. Despite the innovation in these areas, obstacles persist.

Not surprisingly, the middle three of these innovation items involve recruiting and retaining patients. This is what I would call "soft" technology and I won't dwell on it further here. The exception under the "Referral Management" category was one item that stood out for me: new technologies for decision support, logic-based provider screening and referral tools. This idea presumably involves computer analysis of patients' medical records with a determination with algorithms which providers within a particular health system would provide the best and most relevant services for a patient. Makes perfect sense and presumably results in better care.

The first and last categories were of the greatest interest to me: patient generated data and telemedicine. I have blogged on many occasions about the latter topic (see, for example: Telemedicine as a Tool for Physician Visits in Senior and Assisted Living Facilities; A New Perspective on Telemedicine: Patient Visits with Multiple Providers; Surgeons Extol the Advantage of Telemedicine in Rural British Columbia). I personally believe that telemedicine will drive major changes in healthcare delivery and will be one of the major ways in which our healthcare system can expand without extensive further investment in bricks-and-mortar. 

A recent article referred to three of the major obstacles to telemedicine (see: Telemedicine: The top 3 obstacles facing clinicians today). They are: (1) Complex telemedicine equipment; (2) System downtime: (3) Security and privacy. I personally believe that the biggest challenge facing telemedicine programs and virtual visits is that they will change the nature of the relationship between patients and providers that has been established over many decades and that it will take time and great effort to establish new processes and norms.

Graham-Cassidy Could Be an Additional Financial Blow to Smaller and Rural Hospitals

I have blogged previously about the shaky financial status of small and rural hospitals (see: Rural Hospitals Fighting for Survival; How Can Care in Them Be Improved?) and similar stories are common on the web (see: A Hospital Crisis Is Killing Rural Communities. This State Is ‘Ground Zero.’) A recent article suggested that the Graham-Cassidy bill will increase the financial pressure on rural and small hospitals (see: Rural hospitals see Graham-Cassidy as latest threat to survival). Below is an excerpt from it:

Leaders of cash-strapped rural hospitals worry that the latest proposal to repeal and replace the Affordable Care Act could destroy them. With higher rates of Medicaid patients than their urban counterparts, rural hospitals would be disproportionately hurt by an end of the Medicaid expansion proposed in the so-called Graham-Cassidy Senate bill....The legislation would repeal the employer and individual mandates, while doling out nearly $1.2 trillion in ACA subsidies to the states through block grants. The bill is silent on the current crisis affecting the individual market. In fact, the push to hold a vote on the bill next week thwarted bipartisan discussions aimed at crafting legislation to address cost-sharing reduction payments. Those payments help insurers offset the costs of offering low-income people more affordable plan options. Today, 41% of marketplace enrollees in rural areas have just one option for insurance, representing 70% of all rural counties across America....Of the nation's 1,160 rural hospitals, 41% are operating at a financial loss; 82 have closed since 2010. And 1 in 3 of the survivors is considered at risk of closing....Medicare payment cuts should stop since 60% of patients at small, rural hospitals are elderly. The Medicare Payment Advisory Commission noted that urban hospitals make a 7% margin on their Medicare business while rural hospitals have a negative 6% margin.

I suggested in a previous blog note that Congress would never allow rural hospitals to fade away because they are one of major financial pillars of small towns (see: Rural Hospitals Fighting for Survival; How Can Care in Them Be Improved?). Here is a quote from that note: 

Small hospitals are not going to disappear because they are the major employers in many smaller towns. Perhaps Congress will come up with some new subsidy programs to offset the decreased reimbursement from Medicare and Medicaid.

Unfortunately, I made the naive assumption in this note that members of Congress would not intentionally harm their constituents in rural areas with additional cuts to our healthcare system, thus menacing small and rural hospitals. This actually seems to be the goal of the vast majority of Republicans senators who are voting in favor of Graham-Cassidy at the time of this writing. It seems that their major goal is to eliminate the Affordable Care Act (that is, Obamacare) rather than act as responsible legislators. It is notable that almost all of organized medicine opposes this bill (see: Doctor, hospital, and insurance groups are blasting the Republican healthcare bill). Hopefully, cooler heads will prevail.

The Science and Technology of Liquid Biopsies Improving Rapidly

I have blogged about liquid biopsies over the course of seven years (see, for example: Does the New Term "Liquid Biopsy" Make Any Sense?; Rapid Adoption of the Term "Liquid Biopsy" on the Web; "Liquid Biopsy" Used to Refer to Detection of Any Serum Cancer DNA). The procedure has the potential to revolutionize both the diagnosis and monitoring of malignant lessons. A recent article discussed the technology in detail (see: Going With the Flow: The Promise and Challenge of Liquid Biopsies). I offer below only a short excerpt from the article. Be sure to read the whole thing if you are interested.

A more promising alternative [than cancer biomarkers] that is gaining traction [in cancer diagnosis] is to evaluate tumor products such as circulating cell-free tumor DNA (ctDNA) and circulating tumor cells (CTCs) that are shed into the blood—or other bodily fluids, such as urine or saliva....One reason it took the liquid biopsy so long to catch on is that CTCs and ctDNA are found in low concentrations in the bloodstream. However, the technology has now developed to the point of sufficient sensitivity and specificity to accurately detect these tumor products. A recent large-scale study reported that ctDNA analysis identified cancer mutations in 85% of all advanced tumors, and the genomic profiles obtained correlated highly with those from solid tumor biopsies.

A big advantage of the liquid biopsy is that it can be carried out in a simple, noninvasive way that can allow the tumor to be sampled in serial fashion, providing a more comprehensive view of a patient’s cancer than can be obtained through traditional methods....[U]nlike tumor samples, liquid biopsies can capture how a tumor’s molecular profile evolves over time in response to various pressures, including cancer therapies....Liquid biopsies are currently limited to only 2 validated uses: identifying targetable genetic mutations or fusions to match patients to a first-line therapy and detecting emerging resistance to treatment to justify switching to a different therapy, particularly when a tissue biopsy isn’t feasible. To date, the only liquid biopsy with US Food and Drug Administration (FDA) approval is the cobas EGFR Mutation Test v2 [from Roche], a blood-based assay that identifies epidermal growth factor receptor (EGFR) gene mutations...in ctDNA from patients with non–small cell lung cancer (NSCLC)....

A number of studies involving patients with metastatic cancer—including breast, colon, and prostate—have shown that CTCs in the blood are a prognostic factor for survival, with higher CTC levels being associated with a poorer prognosis. Liquid biopsies are also being investigated to assess a patient’s response to therapy. Two recent studies investigating metastatic cancer—1 in breast and 1 in prostate—demonstrated that changes in CTC counts measured with a standardized assay can contribute to the early assessment of therapeutic efficacy....The next goal...is to show that CTC count can be used to guide treatment in patients with metastatic cancer....Research is also focused on developing liquid biopsies that could be used to determine which patients are at increased risk for developing metastatic cancers. 

To briefly summarize, the term liquid biopsy refers to the isolation and analysis of cell-free tumor DNA (ctDNA) and circulating tumor cells (CTCs). Obviously, either can be shed by primary tumors and metastases. The technology can be used to diagnose a lesson, to assess the stage of disease, to assess the efficacy of treatment, to learn how a tumor’s molecular profile evolves over time in response to various pressures, and finally to assess a patient's risk of developing metastatic lessons from a primary cancer. More potential uses will certainly evolve over time.

For decades, I and other pathologists have suggested that tumors could eventually be assessed by "test tube analysis," replacing the current standard of formalin fixed, paraffin embedded tumor samples. The latter constitutes the current gold standard for tumor diagnosis which will certainly continue for a number of years. Liquid biopsies, however, offer an alternative to tumor assessment using "test tube" methodologies. Given the explosion of molecular testing and cancer genomics within pathology departments, pathologists are not going to "loose" these cases to other departments. However, much more information in the future will be extracted by examining circulating tumor cells and cell-free tumor DNA than from tissue biopsies.

Chikungunya Outbreak Halts Blood Collection in Parts of Rome

As a former blood banker, I often take notice of the relationship between blood donation and infectious disease, a sensitivity that harks back to the AIDS era. A recent article noted that blood donations were being halted in parts of Rome because of an outbreak of Chikungunya (see: Outbreak of disease carried by mosquitoes halts blood donation in Rome), Below is an excerpt from it:

Italian health officials have banned residents across half of Rome from donating blood because of an outbreak of the painful, mosquito-borne illness Chikungunya. At least 17 people in southeastern Rome have been diagnosed with the virus since the end of August, and the local health authority decided to suspend blood donations in the affected areas to prevent accidental transmission.The ban covers some 1.2 million residents. Anyone who has visited the affected area of the capital since Aug. 25 should not give blood for 28 days. Chikungunya symptoms include high fever, joint and muscular pain, severe headaches, nausea and a rash. They normally surface within three to seven days after a bite from an infected mosquito and typically dissipate within a week. The virus is not deadly, but there is no vaccine.The disease is typically found in tropical areas and used to be entirely absent from Italy. However, a mosquito which transmits Chikungunya, the Tiger Mosquito, first appeared in the country in the 1990s and is now commonplace, and there was an outbreak of the virus around the city of Ravenna in 2007.

Here are some additional facts about Chikungunya (see: Chikungunya: Symptoms):

• Most people infected with Chikungunya virus will develop some symptoms.
• Symptoms usually begin 3–7 days after being bitten by an infected mosquito.
• The most common symptoms are fever and joint pain.
• Other symptoms may include headache, muscle pain, joint swelling, or rash.
• Chikungunya disease does not often result in death, but the symptoms can be severe and disabling.
• Most patients feel better within a week. In some people, the joint pain may persist for months.
• People at risk for more severe disease include newborns infected around the time of birth, older adults (≥65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease.
• Once a person has been infected, he or she is likely to be protected from future infections.

When I first read this article, I assumed that the outbreak in Rome was due to travelers or immigrants to Rome from areas where Chikungunya is endemic (see image below). However, Italy and Spain are already endemic areas as is the U.S., Mexico, and all of South America (see: Chikungunya virus in the United States).`

 

 

 

Lab Outreach: Forge Ahead or Accept Purchase Bid; Upcoming Free Webinar

Beginning in the Fall of 2013, the Association for Pathology Informatics (API) and Sunquest Information Systems have co-sponsored a webinar series focusing on pathology and the clinical lab industry with emphasis on informatics. The fifth annual webinar series will launch on Wednesday, Sep. 20, at 1:00 p.m. ET, with a lecture by Khosrow R. Shotorbani, President and Chief Executive Officer, and Richard VanNess, Diagnostic Optimization Product Manager, TriCore Reference Laboratories. Tricore is located in Albuquerque, New Mexico. The title of their lecture is: Outreach: Forge Ahead or Accept Purchase Bid. Here's the link the registration page. Registration is free of charge.

Khosrow recently authored an article on this same topic that was published in CAP Today (see: Outreach: Forge ahead or accept purchase bid?). I am sure that he will extend the points that he made in the article in this webinar and will also be able to answer questions. Here's a quote from this latter article:

In some ways, hospital lab outreach programs are ripe for the plucking, says Stan Schofield, president of NorDx, the core laboratory of MaineHealth in Scarborough, Me. Laboratories are being sold off for three main reasons, in his view. “First, they can’t compete at the much lower reimbursement that’s in store” when PAMA kicks in. Second, many insurers have narrowed their networks for testing providers to just Quest and LabCorp, hindering hospital labs from making a profit on their services.“ And third, hospitals have much higher service and technology demands than revenue coming in, and they may have to have a garage sale somehow. They can’t sell off janitorial or easily outsource imaging and radiology, so the lab is one of the first things to get served up.”

My own feeling on this topic is that having a successful outreach lab is a very important intellectual and strategic asset for many health systems that hospital executives may not adequately appreciate. They may thus reach for quick capital gains by selling such a program rather than focusing on the strategic advantage of owning a sophisticated lab. If any of this discussion catches your interest, be sure to register for the event. It's sure to be provocative.

Hospitals Obstructing Medical Record Exchange; Here Are the Reasons Why

I recently came across an article by Bruce Fryer discussing the problems he encountered when a relative of his was hospitalized at St. Josephs Hospital in Atlanta which is part of Emory Healthcare. He was trying to get access to the patient's electronic records in a hospital across the street and was encountering an interoperability problem, a topic that I have blogged about repeatedly (see, for example: NYT Op-Ed on EHR Interoperability Blames Vendors and Greedy Hospitals; Integration and Interoperability Are Essential for Growth of Digital Pathology; Hospitals Need to Pressure Their EHR Vendors to Improve Software Functionality). Here is the link to an article by him (see: How Hospital Administrators Are Obstructing Medical Record Exchange APIs) and below is an excerpt from it:

A survey of 60 Healthcare Information Exchange leaders was done by the University of Michigan Schools of Information and Public Health in March 2017 on information blocking (see: Information Blocking: Is It Occurring and What Policy Strategies Can Address It?). 22% responded that hospitals/health systems routinely or often control patient flow by selectively sharing patient information and 42% reported that vendors routinely or often make third-party access to standardized data difficult. Why would hospitals/health systems do this?  It’s a combination of multiple factors. Revenue is a factor. The reason that patient portals are available is driven by reimbursement dollars from the federal government for meaningful use compliance. By complying, the hospitals/health systems receive money. Across the four portals I used, some of them did just the bare minimum to qualify, while others embraced it.....Secondly, training is an issue.....Finally, there is an attitude problem. Institutions and vendors believe they know what is best for the patient and that limits their vision on what patient enabled data could do (see: Do Patients Really Need Access to Their Access to Their Health Records?)....Although Cerner, Epic, and other vendors support APIs based on the FHIR data standard [Fast Healthcare Interoperability Resources Specification, a standard for exchanging healthcare information electronically], it is up to the hospitals/health systems to make them available and interoperable. Imagine the innovation that would occur if you could easily receive information from all your providers.Not everyone holds information hostage. Utah UHIN operates a Clinical Health Information Exchange, allowing doctors and patients to work together for safer, better-coordinated care by making crucial information available to doctors at the point of care. 

Bruce Fryer is correct that hospital executives are dragging their feet in terms of clinical data exchange with other hospitals for reasons of protecting revenue, training, and attitude. This in spite of the fact that the EHR vendors and non-profit IT standards groups are often providing the means for such data exchange. I think that the issue of "hospital revenue" needs additional elaboration. Hospitals may be slow to exchange data for competitive reasons. They want to hinder patients' ability to take their business to the "hospital across the street" and this ability is enabled by portability of medical records. Here's a quote from one of my notes about this topic more than eight years ago (see: Do Hospitals Really Want Interoperable E-Health Records?):

What about interoperability across competing hospitals in a city or region? I have been involved with LISs and EMRs for decades. I have never seen a request for interoperability with information systems in competing hospitals in an RFP. This is quite simply a matter of market competition. Hospitals don't want portability of patient information with their competitors. If hospitals never asks for the expensive and complex interoperabilty of systems, given today's architecture of EMRs and LISs, how many vendors will try to force it down their throats?

Alcoholic Beverages Cause Cancer; Industry Groups Advocate "Responsible" Drinking

Clear patterns have emerged relating alcoholic beverage consumption to the development of head and neck cancer, esophageal cancer, liver cancer, breast cancer, and colorectal cancer (see: Alcohol and Cancer Risk). Hence, when countries experience high consumption of alcoholic beverages, public health officials worry that their populations may experience a surge in the incidence of such lesions in the future. A recent article discussed this possibility in Europe, particularly GI cancers (see: Love Affair With Alcohol Is Driving GI Cancers). Below is an excerpt from the article:

Europe could be headed for sharp increases in rates of alcohol-related digestive cancers unless strategic political and clinical efforts reshape the cultural status quo in a region where the per capita daily drinking rates are the highest in the world....With an average alcohol consumption of two drinks per day, adults in all 28 member states of the European Union (EU) face a 21% increased risk for colorectal and esophageal cancer....More than one fifth of the European population aged 15 years and older are drinking heavily at least once a week, and not one state within the EU has "light" per capita alcohol consumption, defined as an average of one or fewer alcoholic drinks per day. Moderate alcohol consumption was defined at one to four drinks per day. "Heavy" drinking, defined as consuming five or more drinks each day, is associated with a significantly increased risk for pancreatic, liver, and gastric cancer. This is particularly true for those living in Eastern Europe, where the risk of dying from an alcohol-related cancer is seven times higher than in the Mediterranean region of the EU. According to the World Health Organization, in 2016, annual per capita consumption of pure alcohol in the EU was estimated to be 27 liters, compared to 22 liters in the United States....The five most common digestive cancers in the world — colorectal, esophageal, pancreatic, liver, and gastric — are responsible for more than three million deaths annually and more than a third of cancer deaths globally....

Recognizing the existence of a public health problem and taking constructive actions to ameliorate the problem are two different matters. A recent article in the Guardian makes the point that the alcoholic industry with its "drink responsibly" campaigns and industry funded groups avoid discussing the relationship between alcohol consumption and cancer (see: Drinks industry downplaying alcohol-cancer link – report). Below is an excerpt from this article:

Alcohol firms and “responsible drinking” bodies they fund are denying that drink causes cancer and distorting the overwhelming evidence to the contrary, in information they provide to consumers....Despite portraying themselves as socially responsible, many drinks producers are also trying to distract attention from alcohol’s well-established role as a key cause of cancer, confuse consumers and blame other factors, it is claimed. Their “denial, distortion, distraction” tactics closely resemble those cigarette companies used to limit exposure of tobacco’s role as a main cause of cancer....The Portman Group and Drinkaware, two UK bodies financed by the alcohol industry, are among those accused of being involved in what the researchers say is systematic “denialism” of the heightened risks of cancer from drinking.

Although it's difficult to change drinking behavior, the liquor industry obviously is doing little to significantly change the amount of alcohol consumed. Because most people dread cancer, it's possible that vigorous publicity campaigns by governments that stress this relationship might be more effective in changing habits. It's no accident that the alcohol industry has chosen tactics similar to those of the tobacco industry. However, smoking habits have changed significantly over time, partly the result of hard-hitting consumer education programs (see: Trends in Current Cigarette Smoking Among High School Students and Adults, United States, 1965–2014).

Healthcare Cost Estimator Tools Evolving; Consumers Can Compare Prices

I have posted multiple notes about the opacity of healthcare pricing, particularly that of hospital bills (see, for example: Maryland Controls Hospital Prices; Now Wants to Cap Overall Hospital Spending; Coding for Hospital Services; One Reason for the High Cost of Healthcare). There has been some progress in making prices more transparent and a recent article went into great detail about this topic (see: Is the price right? Solving healthcare’s transparency problem). In today's note, I will only address healthcare cost-estimator tools but read this whole article if you are interested. Below is an excerpt from it:

The amount of price information available for consumers is growing. Nearly all major health plans offer a cost-estimator tool or contract with a third-party vendor to provide one so that commercially insured patients can search for a common clinical service and obtain a cost estimate. The vast majority of self-insured employers—85%—offer such tools to employees. They contract with vendors such as Castlight or Truven Health Analytics. Of the health plans with cost-estimator tools, less than half use negotiated rates with providers to produce the estimate....Still, insurers say their tools can save members big bucks. Since it launched its tool in 2015, Grand Rapids, Mich.-based health plan Priority Health estimates that its members have saved an average of $1,000 each to date, while a total of $6.3 million has been avoided in total healthcare costs. Priority’s tool offers out-of-pocket estimates based on a member’s specific benefits, a characteristic that’s unique in the market....National insurer UnitedHealthcare, which has offered its members a price-estimator tool for a decade, in July launched a website to help spread price transparency to the general public, though the estimates are not as tailored. But evidence suggests that few patients are actually taking advantage of health plans’ tools. Just 10%, or 38,000 commercial members, use Priority’s tool.....A 2014 JAMA study found that Castlight’s price tool resulted in strong savings for customers shopping for the best deal in imaging—but not in clinician office visits or lab results. 

The healthcare price estimator tools available on the web make various assumptions when providing price information. For example, Blue Cross, Blue Shield of North Carolina (BCBSNC) describes its approach in the following way (see: Estimate Health Care Costs).

Cost estimates are averages based on historical BCBSNC claims data. Amounts listed typically include physician fees, facility fees and costs for things like anesthesia, drugs, medical supplies – as well as customer responsibility (deductible, co-pay and co-insurance). Your actual costs may be different based on variations in these factors as well as your health plan design, deductibles/co-insurance and out-of-pocket limits.

UnitedHealthcare says that its cost estimator can provide the following information (see: Cost Estimator):

• Look up the care you need, like back pain or scratchy throat.
• Get an average health care estimate for that kind of care in your area.
• Search through all network providers so you can compare quality of care and cost ratings before you choose where to go for your appointment.
• Get a personalized health care cost estimate based on your specific doctor, clinic, hospital and health plan.

To reinforce the point made in the article cited at the beginning of this note, healthcare consumers  first need to know about the availability of cost estimators and then use them to have any effect on prices. However, this will be a slow process and I am also sure that the tools will grow more useful in the future.