What do Snapchat, Vine, and foursquare have in common? It’s that damn “Press and Hold” - it’s so hot right...
A sweet chair:
A sweet exoskeleton Samurai (that isn’t Iron Man):
A sweet MRI machine:
2) An NPR piece about robot nannies that will save Japan’s economy.
I just read “When health insurance just isn’t worth it" in the NY Post and needed to respond.
This is the silliest line of reasoning I’ve ever seen. I’m sure Gabrielle is a lovely person, so while I am going to be a little sarcastic, this is not a personal attack. (Also, I’ve worked with NY Post editors in the past and they take many liberties, so her voice may have been lost in the revisions. But these are the words on the page and that’s all I can go on.)
First let me break down her logic:
Here are a few choice quotes:
Why pay into a system you probably won’t benefit from?
Answer: Because that’s how insurance works!
Hey, they’ll tell you, healthy people have to get insurance to cover the costs of the sick and elderly.
Who exactly is “they”? I’d love to meet the 24 year old who cites this reason when buying insurance. Also, again, this isn’t a reason to get insurance, that’s just how insurance works!
It was my choice.
Elective medicine is your choice. A broken bone is not. We’re talking about big ticket items that add up quickly and are not in your control.
But for anyone under 35 who can’t remember the last time they had a physical, why bother?
Yes… Because no one under 35 has ever gotten sick and needed more than some Tylenol and a band-aid.
Yes, I took a risk. If you want to be covered for surprise catastrophes, like a bad car crash, then go ahead and pay through the nose.
This is the most undermining point of this silly oped. Yes, you took a big risk. You risked a lot of other people’s money. You do understand when a catastrophe happens, someone pays through the nose, right? Also: ”If you want to be covered for catastrophes”? Why would anyone not want to be covered for catastrophes - unforeseen events that you cannot plan for, that take you and your loved ones by surprise, and that leave you with bills you won’t be able to pay in your lifetime.
Ok enough of this 3rd grade logic. I’ll take over from here:
Insurance is most important in catastrophes and unforeseen situations like, you know, cancer. My family learned about this the hard way when my older sister was diagnosed with a brain tumor at age 31. [In this blog post, I discuss in detail the ordeal with the insurance companies, the costs, and what Obamacare means to people who actually understand what insurance is and how it works.]
You’re upset about paying money into a system and not getting immediate value for that money. I get that. But this isn’t Amazon.com. You’re upset that you pay premiums and insurance companies then use that money to pay for hospitalizations of sick people who also pay premiums. Yes, many of those people are old. But then you turn around and say “you know what, I’ll just take my chances and not pay anything.” And your insane logic ends there… * Gabrielle, if I misrepresented your logic, please let me know.
So allow me to continue with your line of reasoning.
As you live your life, god forbid something bad might actually happen to you - a broken bone, a fever, an infection, cancer, a car crash, or a billion other things, many of which are indeed unlikely. But then you wake up one day and your vision is blurry and the side of your body is numb. Arguing that this is a one in a million chance event doesn’t do much for you.
In a catastrophic event, everyone will be in panic mode. Then if you have just a few minutes to squeeze in another thought, that one thought will be “who’s going to pay for all this?” Top quality cancer treatment doesn’t come cheap. It isn’t even remotely affordably priced. Remember, you don’t have insurance.
You’ll go to the ER. You’ll get hospitalized. Then you’ll wind up like a million other Americans: saddled in debt from astronomical hospital bills that are orders of magnitude more expensive than the puny $95 penalty or $3,000. You’ll realize very quickly that your NY Post salary won’t come close to paying your bills. A few days in the hospital, a few tests, a doctor - that’ll chew right through every penny of savings you have.
After that, you’ll just give up on paying those bills. Who pays anyway?, you’ll reason. Because we all know doctors, nurses and hospitals give you care for free and don’t expect to get paid.
You might wonder why your hospital bills are so high. Well, when people without insurance (you) get care but don’t pay, the rest of us (taxpayers, the insured) pay more.
Now, you may face a particularly horrific situation that might involve ongoing treatment like medication, physical therapy, chemotherapy, or radiation. You might encounter medications that cost $30,000 per dose. How do you intend to pay for that without insurance?
The answer is, of course, you won’t. You’ll allow all of us, the taxpayers and premium payers, to absorb the ever higher cost of healthcare.
But there’s this amazing new thing called “Obamacare” that can help you insure yourself in an affordable way so that, in case something happens, you won’t be totally screwed.
There is one sneaky way around all of this. In pre-Obamacare, you’d now have what’s called a “pre-existing condition”, and no insurer will take you because, duh, you’ll just join and then they’d immediately be stuck with all your ongoing treatment costs which could cost millions of dollars. So you’d basically be denied for meaningful coverage.
Lucky for you, we live in a world with Obamacare (that thing you hate), so now those insurers can’t deny you coverage even though you have a pre-existing condition. Congratulations! You gamed the system by never paying premiums and having insurance until you actually needed it. [Interesting discussion here.] The downside is that you’ll need to hold out for the “open enrollment period”, which fall on specific dates and during specific windows of time, and may not quite line up with when you need your life-saving drugs. So if you can just hold out for 3 months, you’ll be OK. Until then, all the bills will be on you.
A quick note about the backbone of Obamacare: high deductible insurance. High deductible plans combine precisely the best of both worlds. You pay a modest premium each month and if something drastic happens, insurance will pay all or most of the bill. At the same time, you are entirely responsible for the first $6300 or so (known as the deductible), so go wherever you want and get the Xray or see the doctor you want because that’s all on you. Obamacare steps in and just makes all of this a lot clearer for everyone and requires a few typical healthcare benefits to be covered by your insurance plans as well. This is a good thing for you.
Update: My friend Zak asked a few questions which I’ll try to answer here:
Recently, I’ve had to take a few more taxis than I normally do, so I tested a few interesting apps I’ve heard about.
Way2Ride: If you can look past the horrible name, the clunky design and the really lame taxi-rooftop ads that don’t really explain the value proposition at all, this is actually a pretty awesome little app. Way2Ride is an iOS app that lets you check in to a yellow cab and pay (automatically) via the app.
Most of us are pretty annoyed by the clunky dance you do at the end of the ride:
There’s a better way.
You see, the value of these taxi apps like Uber and Hailo is actually the last part of the trip where you get to your destination and get out. The least compelling part of these apps tend to be the actual hailing part. (And the part that, surprise, barely works at all - in June there were only 20,000 e-hail pickups, which is less than .25% of the daily number of yellow cab rides.)
The e-hail apps claim that walking outside and physically putting up your hand to summon a car is so barbaric and crazy in this tech-driven age. Yet most of the time in most places in NYC, that is a far more efficient way to do it. Wait a second: I can walk outside and put up my hand and in less than 15 seconds I can get a car to pick me up? That’s amazing! PS. In rush hour, (basically) no one gets a taxi - these apps fail (I’ve tried many times), my hands fail, and that sucks.
But most of the 500,000 taxi rides each day are hailed almost immediately, without having to pull out a clunky phone on a busy street, with just a hand. (So that’s what we’re all used to and most NY-ers know that’s pretty easy in most places when it’s not raining or snowing, and not during rush hour.
Which leaves the last part of the trip. That’s the real pain point, I have found. And this shitty little app actually does an incredible job of solving it.
You hop in the cab, open the app and hold it to the TV. It checks you into that cab by using an inaudible audio signal! That’s pretty neat for an old and crusty taxi POS company to pull off. You just hold up the app and it verifies which taxi you’re in. You connect your credit card with the app (just like every other taxi app) and then you’re ready to rock.
When the cabby presses the “end of ride” button, the app immediately pays (using whatever tip % you’ve set - which can be 0 if you feel like it! and can be set for each ride). It automatically charges your card, you get an emailed receipt plus the ride is saved in the app. It’s an incredibly seamless experience.
One downside is it only works with taxis that use the VeriFone point of sale system - this is the credit card and shitty touch screen in the back of the cab that was obsolete and shitty the day it came out and the iphone and capacitive touch screens were already mainstream. But that’s a different gripe.
The other major company in the back of cabs is the ironically named Creative Mobile Technologies, which I don’t think I have to mention… is anything but. So it’s annoying when you hail a cab and want to use Way2Ride but can’t because Creative Mobile Technologies - neither creative, nor mobile - has yet to build a mobile app. I think I mentioned this was ironic, but this is a really good example.
Go Green Ride: This is another really poorly named service that comes with the worst app you’ve ever seen. They’re basically a scheduled car service. That’s it. But the amazing thing is a) the cars are really nice (complete with iPads mounted in the back), b) the drivers are good and c) the prices are nearly identical or lower than yellow cabs! So it’s like a half-priced Uber.
I couldn’t believe this so when we had to go from our apartment on the Upper West Side to Westchester, I booked a Go Green Ride. It quoted me $53. To put that in perspective, an UberX would have cost at least $120, and I even used a yellow cab calculator to discover that a taxi would run us about $70.
The car showed up early and I could track him from the app (clunky but it worked). The ride was perfect, the driver was great, the car was a brand new hatchback hybrid (I think). We drove nearly 40 minutes and yes, they charged me what they quoted.
I highly recommend the app.
With Obamacare on everyone’s minds, not least of all because of the GOP’s government shutdown, I thought it would be instructive to share a personal story.
When congress was voting on the Affordable Care Act in March 2010, my older sister Jillana had just died from an inoperable brain tumor. The tumor was just horrible luck and something none of us could do much about - even today, the only therapy available is palliative.
But throughout the 15 month ordeal, my family and I had to cope not only with this awful disease and the hospitals, treatment and doctors, but also with insurance.
With the help of my mother and her sister, I wrote the following letter outlining our interactions with Jillana’s insurance company and their unconscionable labyrinth of policies. I faxed this letter to every senator and representative in congress, the white house and the Department of Health and Human Services.
Here’s the letter:
To whom it may concern:
Employer mandates and universal coverage are laudable goals for health care reform. But as the experience of our family shows, those goals must include minimum coverage requirements. At 31 years old, my older sister Jillana was a healthy young woman who completed the New York City Marathon in November 2008. Two weeks later, she was diagnosed with an inoperable Glioblastoma, a form of malignant brain tumor. Jillana had health insurance through her employer, Carlson Restaurants Worldwide, parent company of the TGI Fridays restaurant in Framingham, Massachusetts.
Jillana had purchased an employer provided health insurance policy with UnitedHealthcare. Like so many people in good health, she was mostly concerned with low copayments for routine services, such as annual exams and routine office visits. Not surprisingly, and like many people in her age group, she did not inquire about coverage for serious health conditions or catastrophic events. This policy suited her needs, and had anyone asked her about her insurance at the time, she, like so many others who are now being asked that same question, would have answered that she was satisfied with her current plan. Unfortunately, she soon discovered the outrageous limitations of her policy and the misleading nature of the information she was provided when she purchased this insurance.
Jillana’s $40 premium for “UnitedHealthcare Bronze” coverage was deducted from her paycheck every two weeks. Thus, her annual premium payments were $1,040. The employer contribution to her health care expenses, if any, is unknown to us.
The diagnosis of Glioblastoma was made at Brigham & Women’s Hospital in Boston. Within a few days she was notified by UnitedHealthcare that she had reached the Medical Bronze annual limit of just $1,500, and they would no longer pay for her treatment.
Jillana’s employer met the Massachusetts requirement that employers provide health insurance to employees. However, simple arithmetic is all that is needed to see the deception in this policy. Almost any contribution whatsoever by Jillana’s employer would have meant that the premiums UnitedHealthcare received exceeded the benefits available. That bears repeating: Jillana’s annual contributions nearly equaled the total amount her insurer was willing to pay in a year. That sounds more like a savings account than an insurance policy.
Jillana also learned that the policy’s “lifetime maximum benefit” was $1 million. The paltry annual limit of $1,500 means a customer must live past 600 years for UHC to ever pay out the million dollar amount, so what’s going on here? This amount would “follow her” if she switched to another plan under UHC, such as a high deductible plan that pays out a maximum of, say, $100,000 per year instead of $1,500. As an employee logs more years at the job, he or she become eligible for other insurance plans provided by UHC to Carlson Restaurants Worldwide. Those new plans have much higher annual benefits and therefore would make that $1 million achievable.
In other words, the lifetime benefit for Jillana’s existing insurance policy was merely a theoretical limit. The “UnitedHealthcare Silver” plan – the other option available to Jillana – had a more reasonable yearly limit of $100,000 but also a lifetime maximum of $1 million.
Within 5 weeks of the diagnosis, Jillana’s medical bills mounted to $655,000 as billed by the hospital. Of this, $284,000 were labeled “Patient Responsibility,” (reflecting the discount of $371,000 for the hospital’s “in-network” status), and of that, UHC paid their $1,500.
Now, imagine you have terminal brain cancer and you are a quarter million dollars in debt, and it’s only week five. This was just after a brain biopsy that left Jillana unable to speak or move and took nearly 6 weeks of intensive physical therapy to get her well enough to leave the rehab hospital and move back into her apartment. My mother had moved into Jillana’s apartment as she needed assistance and care. A plethora of other very expensive chemotherapy and radiation treatments as well as hospital and doctor visits would become standard procedure over the next 12 months.
When a family member is diagnosed with a catastrophic disease, the question furthest from your mind is: “will my insurance cover this?” The answer from UnitedHealthcare, Jillana’s primary provider at the time, was “no.” Fortunately, Jillana began a second job as a nursery school teacher at a new school that fall and changed her health care to Harvard Pilgrim, although she still had UHC as her primary until she canceled it.
Insurance companies must be taken to task for the aggravation they cause when something like this occurs. Harvard Pilgrim, however, is the gold standard to which all health insurance should be compared. They paid for everything and never put up a roadblock or hassle to cover hospital visits, ambulance trips and cancer treatments, even when they were not obligated to cover certain costs. In fact, they have been so helpful that my mother proclaimed, “Harvard Pilgrim is where God is hanging out.”
We are hopeful that out of our tragic experience, and out of my sister’s valiant struggle with a gruesome disease, we can offer some hope to other families who have to cope with similar problems. Our purpose in writing is to express our support for President Obama’s plan and to underscore that health care reform must include certain vital components.
- Minimum coverage requirements for all plans: No insurance plan should have the useless annual benefit maximums that Jillana’s UnitedHealthcare plan had. That is not insurance. Congress must set up basic minimum coverage requirements on a federal level so all insurance is at least guaranteed to provide basic coverage. No one should be deceived into thinking he or she is insured when the yearly benefits won’t even cover a single night in a hospital. Policies must provide meaningful coverage and insurers must be prohibited from unconscionably duping policyholders into paying premiums in excess of the benefits they are eligible to receive. This deception is undoubtedly unethical, and should also be illegal.
- Affordable, high deductible plans for all Americans: Every American must have a safety net that protects them against disaster. They have to be able to purchase a plan with affordable premiums (under $100 per month) with a high deductible ($5,000 - $15,000). Few Americans will go bankrupt with a $5,000 medical bill. A bill for $300,000 on the other hand, would destroy most families. This will also help curb unnecessarily tests and procedures that are done simply because they are free. When it is your $5,000, you will be more careful about how you spend it. Absolutely no one should be left with astronomical medical bills in the aftermath of catastrophe and certainly not a bereaved family.
- Patient advocates: When you become sick, the last thing you can focus on is the fine print in your insurance policy. There is no time to wait on the phone and try to learn about the intricacies of what’s covered or what’s not. That work must be left to an expert who works on your behalf for your best interest, not a bottom line. All plans must provide a patient advocate who answers his or her phone and is the first call you make when catastrophe strikes. This person will go to bat for you, navigate the insurance bureaucracy and denials and draw from his or her broad experience to obtain the best options for you.
- Insurance plans should emulate Harvard Pilgrim: Incentives for insurance companies are backwards. An insurance company’s goal is to increase its bottom line by denying claims or otherwise putting up administrative roadblocks to slow down how quickly it has to pay bills. Most people who have had significant medical bills have had to cope with this problem. My father and other doctors routinely experience this when they bill for visits. The industry does not have multi-billion dollar profits because it is generous. Harvard Pilgrim is a non-profit health plan covering 1 million people in 3 states and had $20 million in profit in 2009. In 2009 US News & World Report named it the best insurance plan in America for the fifth year in a row. (Compare this ranking to UnitedHealthcare of New England, #92, and all 23 other UHC plans ranked worse, down to #214 for UHC of Mississippi. This was out of 239 ranked plans.)
- COBRA Reimbursement: When Jillana became ill, she was immediately unable to go back to work and was therefore eligible for COBRA. But at $545 per month, the premium was simply unaffordable. Massachusetts has a reimbursement program and they paid for virtually all of those premiums month after month. This needs to be instituted on a national scale. This makes financial sense for a state because if Jillana couldn’t pay COBRA, she’d be stuck going to Medicaid which would end up costing the state far more in health care costs. While the unemployed have the COBRA option, the premiums are simply far too expensive for an average person to pay in addition to feeding a family, paying rent, and other living expenses. It is imperative that a long term reimbursement option be implemented so no one has to forego insurance or experience a lapse in coverage (which can lead to later denial of insurance due to a preexisting condition). This not only provides a safety net to the recently unemployed, but also makes financial sense to the state.
My father is an internist who has been in private practice in Westchester for 31 years. He knows the insurance industry inside and out and has a unique perspective on how we can reform medicine so it is fair to patients, less expensive for everyone and sets up incentives that are not geared towards maximizing insurance companies’ bottom lines or encouraging patients to demand, and doctors to prescribe, unnecessary tests and treatments.
As you continue your admirable effort at health care reform, I respectfully request that you set aside some time to have a brief discussion with my father. I am convinced that his perspective, as a veteran doctor and the grieving father of a daughter forced to fight against both cancer and this country’s health care system, would offer valuable insights.
Finally, we implore you to look realistically at the survey data - people report they are “satisfied” with their care primarily because they have never had to use their coverage. If you live in a climate where the weather is rarely cold, you are unlikely to be too concerned about the quality of your heating system. Not so, if you live in New England. The same is true of health insurance. The important question is what are people with chronic conditions, debilitating diseases and vicious tumors saying about their insurance? What is the cost to all of us when those people are left without appropriate coverage?
We received only a handful of generic responses from the White House, HHS, and possibly Chuck Schumer.
This was the insurance coverage card that Jillana had signed up for. It’s hard to see but you can make out the $100,000 and $1,500 annual maximum benefit.
When people talk about Obamacare and the affordability of insurance, no one ever seems to talk about how much it actually costs for an individual to buy real insurance on their own. The big boy insurance that actually pays for you when you get sick. I mean literally pick up the phone, call Aetna/Blue Cross/Oxford and say “hi, I’d like to buy insurance so I’m covered in case of catastrophe, what are my options and how much will it cost?” I’ve done this.
I was a freelancer for many years and back in 2007 I was just coming off of 18 months of Cobra (paying an insane $380/mo for the plan I had from Citigroup).
I called all of the typical NY insurers to find a high deductible plan. The reps on the phone would say casually “oh, this plan is $1,100 per month, that plan is $1,600 per month… we don’t have a high deductible plan”. More likely, they’d have to take down a lot of invasive information, then mail me a quote with what the premium would be.
Let that sink in for a second before you go bashing the healthcare exchanges. Insurance is not like Amazon or Kayak. It is nearly impossible to compare plans because they all have so many loopholes and moving parts (see my sister’s plan) and you can’t even get a straight price via the web or phone. At least this was my experience through 2009 when I had to make the same inquiries to NY insurance companies on behalf of my sister to see if they’d take someone with a pre-existing condition facing millions of dollars of medical bills. Obamacare is a step towards making plans more comparable in their benefits (bronze, gold, silver) and with transparent costs to consumers online.
After talking to 6 leading providers, I finally found a GHI high deductible plan for $230/month. For those who aren’t familiar with what a high deductible plan is, it means these guys don’t have to pay for squat - office visit, xray, hospital stay, ambulance, scripts, etc - until qualified expenses (that is, costs for all those things that they say are legit) hit the deductible threshold, in my case this was $5,000. So that means I’m going to pay out $230*12 + $5,000 = $7,760 for the year before I ever see a dime from the insurance company.
Here’s the crazy part: that’s not a terrible deal. Trouble is, when you get older, those premiums go well into the thousands of dollars. What would make sense (which we described in the letter) is to have a low-cost high deductible plan of maybe $100/mo (cable bill, cell phone bill) that came with a reasonable deductible of maybe $2,000. And ensure it actually comes to bat for you when you need it most! When you’re hospitalized or have cancer or get hit by a car or whatever, you expect your insurance to do the one thing you’ve been paying it diligently, month after month, to do: pay your goddamn bills!
When my sister got sick and we realized that “insurance” can just be a scam and not actually cover you over a certain amount or have confusing limitations (this is known as “under-insured”), I immediately called GHI and asked what would happen if I got cancer and needed $1 million in care from doctors, hospital stays, medications, chemotherapy, etc. Would they cover it?
Luckily, NY is pretty progressive so (as far as I could tell) plans here don’t have limitations when you get sick. You could still be very much in the hole for a lot since you could be responsible for, say, 20% of the cost, which is still $200,000. That amount would either bankrupt most people immediately, or give you a lifetime of debt to pay back.
Healthcare is a huge mess and the reasons why it’s so expensive are quite complex. I suspect most people have similarly horrific experiences when they have to actually use their insurance to get high quality care from hospitals and doctors. I know my family’s story is not unique. But I thought sharing theirs and mine would help illustrate just how valuable healthcare reform is and that the millions of people who are hitting the exchange websites have probably attempted to navigate the insurance system on their own and failed.
Feel free to leave comments or questions and I’ll do my best to address them.
Getting your or your child’s medical records (digitally) from a hospital should be automatic, part of the discharge process, and free. It’s none of these things.
Our baby was born at Mt Sinai, a pretty high tech hospital by most standards. They use Epic and are paperless… except for any transactions between the patient and the hospital, such as forms (filled out by hand on a clipboard), information (delivered via a folder and lots of pamphlets) and paper.
Obviously we wanted a copy of our baby’s medical records and a copy sent to our pediatrician. You might assume this is an easy task.
At the hospital, we asked the hospital pediatrician if we could get a digital copy of the records on the USB drive we brought.
"No. We don’t do that. If you want a copy, you can call the medical records department."
"Ok, but we’re already here, so wouldn’t the front desk just handle this with a simple signature or something? Where would I go to get this done?"
"No. The medical records people are in the basement."
She didn’t seem to have a clue.
Ok, so already this is incredibly inefficient and inconvenient. I’m already at the hospital, you guys already are using Epic and obviously everything is pretty damn secure because the patients (my wife and our son) are staying in the hospital!
We get home and I call. After several “hold please” and transfers, I talk to a woman about getting the records.
"Oh, you have to fill out a form and mail it to us."
I learned that I would have to fill out this insanely outdated and annoying form (yet another damn form!), either mail or fax it, then wait 5-7 business days for them to “process” it…
"Wait, you’re saying I can’t just do this online?"
"We don’t do it online."
Oh that’s right, because it’s 1983 and not 2013 and the dream of the EMR (electronic medical record) is still a twinkle.
… then comes the insult to injury. I gotta pay for my records:
If you are requesting copies of your medical records for yourself, yes, it is $0.75 per page based on NYS Public Health Law 18.
"Wait… you charge me to get a copy of my own medical records? 75 cents per page? That doesn’t sound fair at all. Fine. How many pages will it be?”
"We won’t know until after we process your request."
Ok, so I fill out this form, fax it, wait 5 days, then… wait for them to mail me a confirmation with the number of pages that the record is and the cost. Then I can accept and pay.
There’s all this talk about digitizing records and making things efficient, and the hospital legitimately was digital. We watched the nurses enter things into the computer. I saw Epic on the computer screens. But where health care actually starts to matter - where the patient is involved in the care, has visibility into his chart, can transfer information easily and seamlessly to other people digitally - all that feels like a bullshit pipe dream.
But the craziest part is that the concept of a “page” from your medical record, in the era of the EMR, is not only anachronistic but totally arbitrary.
Understand that when records go from paper to digital, there are a few big changes in the way records are even kept. Paper notes are manually entered by hand, data isn’t so easily added, pages make sense in a medium that is physically filed. But when things are digital, templates and cut-and-pasted notes begin to emerge with great frequency. What might have been a 10 page chart can now balloon to 100 with a few quick mouse clicks. My father sees this all the time in the hospital charts, where they also use Epic. He calls this the “tumbleweed effect”: a simple note from one doctor quickly gets appended into the next note by a new doctor, and each subsequent doctor simply excessively (and lazily) copies not just the previous summary or not, but literally the entire chart on every… single… entry.
This is not only completely unnecessary, but strikes a crucial blow against the whole point of electronic medical records, which promised to allow medical information to more easily be added, transferred, and reviewed. Crucially, though these tumbleweed charts can tick off the “comprehensive” checkbox that regulations ask for, they do so to the detriment of any doctors or patients who need to quickly read and absorb the gist of the chart. You see, with the EMR has come verbosity and a vast amount of irrelevant bullshit text and data one needs to wade through to discover a meaningful summary.
So what does this have to do with pages? Well, when you have inordinate amounts of data and text all stored in a database that doesn’t really care about what fits on a page, you tend to get arbitrary pages. That is, pages might contain a few lines, or many lines of text, or one small graph, or a paragraph. There is no reason for the EMR to worry about how its pages get exported or printed because, duh, the data isn’t supposed to be exported to dead trees!
I asked my father how many pages he thought my son’s chart might be, given that I’d be paying 75 cents per page. (Where they get this number is a mystery. Also a mystery: why people aren’t more pissed about paying for their medical information.)
He said that ours will probably be small. However, he says that patients are now beginning to face “prohibitively large” charts. If you’re in the hospital for 10 days, for example, doctors and nurses could easily interact with your chart and add 100 pages each day. Virtually unreadable, unnecessary, irrelevant bullshit with no succinct, up-to-date summary of facts.
Imagine how that conversation goes:
"Yeah, I’d like my medical record please."
"Sure. That’s 1,254 pages… which comes to … $954.50. Would you like to pay by credit or check?”
Let’s say you get past all of that. How does your medical chart actually get delivered to you? What is the ultra-secure, verified, HIPAA complaint method that the hospital uses to transfer this highly sensitive, confidential patient information?
Won’t do it online - that’s too futuristic. Seems the internet hasn’t been invented in the world that the medical records department inhabits.
Wait, so why didn’t you just give it to me on my USB drive while I was in the hospital? You remember when you were reading off numbers from a wristband that my son, my wife and I all had to wear? That seems like a reasonably safe way to verify my identity since it was how you identified we were the parents of our son. Why not just give us our data then?
I asked my father about that too. He said that even when the hospital attempts to export data from Epic, there is no chronology or order one could interpret from the files. It apparently just exports a shitload of PDF files - each one a bloated tumbleweed of notes where important timely info is mixed with outdated garbage info.
They use the mail. Because we all know a box of paper in a mailbox is totally safe and would never get stolen, misplaced, delivered to the wrong address…
I realize the CMS “Meaningful use Phase 2” objectives will:
Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital (for Eligible Hospitals/CAHs only) — CMS Stage 2 overview
So maybe this will make things better. Keep in mind, hospitals and doctors should be empowering patients but aren’t. So a government regulation had to wake them the F up and push them into the 21st century. If they don’t comply, they get fined. So hospitals aren’t doing this because they care. I don’t expect healthcare to be on the cutting edge but to drag their feet for this long is crazy. It feels like the DMV and our local post office are more progressive than a doctors office.
I guess I have no choice but to wait patiently for my records and pay, because it’s still 1983 at the medical records department in the basement at Mt. Sinai.
Last Friday my wife and I showed up at Mt. Sinai at about 10:30am, 4 days after her due date, and were holding our son Jack Reece by 3:10pm. We (er, Maddy) were very lucky with an easy, short delivery. This first week has been amazing. More on that in subsequent posts.
But anyone who knows me knows I can’t just go into a new experience without emerging with a ton of ideas on where things could be improved.
Don’t give paperwork (which could have been done a week before) to a woman in labor. We had already filled out paperwork for the hospital, called ahead, and took a tour. Yet when we arrived, we had to hand over our insurance card and drivers license and fill out several forms that asked for generic stuff like name and address. The anesthesiologist before administering the epidural gave a little instructional talk while Maddy was experiencing the most painful contractions. I can’t imagine any of these signatures meaning anything legally: what woman in labor could possibly read and understand some nonsense on a clipboard? Wouldn’t it make sense to do all of that prior to coming in and then maybe just sign in ONE place (not 12) that you’d like to proceed with everything you had prepared for?
Uber for Nurses. The nurses and everyone involved were really great. They all wore Vocera phone/walkie talkies around their necks that constantly chirped and squelched. When you’re in the hospital bed and call for a nurse, for example, it basically goes to an operator who then says “what do you need”. You then have to awkwardly explain out loud what you need. Then they say “someone will be there soon”, and you wait patiently. They should be using an app similar to uber but optimized for indoor locations, that can handle various input (audio, video, text) from the requester, and then gives an ETA. It doesn’t have to be perfect but the existing method seems wildly inefficient.
Shared rooms should have better noise dampening. Against the advice of many friends, we opted to not pay the additional (minimum!) $750/night for a private room. We figured the delivery was so good that even the worst roommate wouldn’t be a big deal. We’d just suck it up and use the money for more pressing things. Turns out that was the right choice. This was our view:
The first night we had a roommate who was quiet and fine. Visiting hours are 7am-10pm and Maddy and I were totally fine with parting ways to get some sleep. The roommate and her family moved to a private room the following day and no one took her place for the duration of our stay through the next afternoon. So we lucked out there too. Nevertheless, these shared rooms have the worst design imaginable. There is a paper thin curtain that slides between your bed and your roommate’s bed. This does absolutely nothing to the noise but makes it seem private. This causes people to have conversations at a regular loud level, but you’re just 2 feet away from their mouths. Nurses regularly are coming in to check on things, have extremely private conversations behind this paper curtain (obviously you can hear everything), and visitors are in and out. Even innocuous things are stupidly annoying. The TV is hooked up to a bedside speaker. So it might be a low volume but it’s still completely audible to the person sitting 2 feet from you. We lucked out but if this was a real problem, I might have run out to Home Depot to buy about $300 worth of egg crate foam and duct tape to put on the curtain. A curtain with at least an attempt to dampen the noise would go a long way.
Turns out, there are a lot of options already on the market, like Quiet Curtains, which makes hospital curtains that dampen sound by 20 decibels. I am betting they cost about as much as 2 nights in a private room.
Foodspotting for hospitals. Hospital food is literally the worst shit you could possibly eat. But I don’t look a gift horse in the mouth, so we just ate whatever they gave us and ordered several of each item. That may have been a mistake, but we saved some cash.
Apple juice from China? Yes please!
The cranberry “Juice cocktail” had 15% juice. The first two ingredients? Water and high fructose corn syrup.
These are the recommended guidelines for hospital food in NYC. The last page has “Sustainability Recommendations”:
Hospitals are encouraged to consider, when practicable and cost effective, sustainability criteria for the food they procure and serve. While New York City does not endorse any single criteria for sustainability, a number of food characteristics are associated with supporting the conservation of natural resources that are needed to sustain our food supply over the long term. For example, preferred products may include: (i) fruits and vegetables that are local, seasonal, or are grown by producers using low or no pesticides or an integrated pest management system, (ii) dairy products that are local or (iii) seafood that is sustainably raised or harvested.15 Hospitals may also request that their vendors offer fruit, vegetables, dairy products and seafood that is locally grown or produced. Hospitals are also encouraged to educate their patients, staff and visitors about these local and/or sustainably produced foods through labeling or other mechanisms.
The food we received seemed to be: industrial grade meat, pesticide laden vegetables, high arsenic rice, jello (which I’m assuming counted as “fruit”), ultra-high calorie desserts, etc etc. Was it Kosher? You bet! But that doesn’t mean the animals weren’t given antibiotics, hormones and inhumanely raised.
I would joke that the food was made by “acme industrial co” and other companies that you’d never actually find in a supermarket. I can’t remember the last time I saw a label that had anything from China.
The nurses were so sweet and gave us this cake. Trying to fatten us up. (It was gross and we didn’t eat it. I felt bad.)
This was a typical meal.
It felt like there were equal amounts of entree and dessert, by calories. That cookie monstrosity has to be pretty bad for you, but they would always ask “what would you like for dessert” for every meal, as if it were as important as the entree.
On demand instructional/how to videos covering all things post-pregnancy. There’s no instruction manual for a newborn, but with a little effort, youtube can cover everything. The hospital had a few “newborn” channels on TV with cheesy “talk show” style interviews about random topics that were often all over the place. Also, the graphics were hilariously dated.
Context is everything. The only people in these hospital beds are moms with newborns, so the only videos that make sense to them at this point are videos specifically about how to get through the first few weeks. To be fair, thenewbornchannelnow.com does have specific videos on things like changing a diaper, soothing, nursing, etc, but they are so cheesy and leave so many unanswered questions that a youtube search is often a million times more fruitful. On the hospital TV, though, these videos should be on-demand. This was part of the packet they gave us.
I’ve noticed a handful of startups that have recently closed up shop. Obviously this is nothing special in the startup world where failure happens 95% of the time. But these aren’t just any startups. I actually know these founders and remember hearing about these ideas in the very early stages and watched them hit milestones over the years. So it’s especially tough to see them fall.
Failure sucks. But I love when founders provide insights and context on what happened. Like my friend David Levy’s Tigerbow post-mortem.
There’s even some celebration about it with failcon and @foundersatfail.
Here are the 3 I just heard about in the last few weeks:
There are many more friends and acquaintances whose startups or side projects have come up short. I certainly know a thing or two about failure myself. Sharing and introspection helps. I would encourage everyone with a failed idea in which they poured lots of time, money and heart into, to post about the experience and what they learned.
Alexandra Jordan and Super Fun Kid Time finally got me to put some thoughts down re coding and its impact on youth culture. Who is Alex Jordan? She’s the nine year old fourth grader that dreamed up, designed, and pitched her playdate app at Techcrunch Disrupt the other day. Her (adorable) presentation and an interview are here. According to Techcrunch, she’s learning to code in Ruby and HTML with help from her father and Codeacademy.
The bigger takeaway here is, as Mashable put it:
"Coding is 21st century literacy."
And it is permeating youth culture in a profound way. It is mainstream. It is cool. It is hip. And it is a really big deal.