Cost Share Program by Blue Cross Blue Shield.

Aspirin for headache.... 30 cents, medication for cough……. $3, antibiotics for flu…… $40. Being treated at some of the top notch hospitals.... an extra $1000. They say all good things in life are free, as long as you are not going to a hospital.

Recently Blue Cross Blue shield of Massachusetts introduced Hospital Choice Cost-Share Program. It is based on a system of High Cost hospitals and High Value hospitals. This year it was determined by CMS that all hospitals met the quality bar in Massachusetts. 

So these hospitals were than classified on the basis of cost meaning High Cost versus High Value hospitals. If you choose this program and if you decide to go to “high cost hospital”, you will end up with a higher co pay after their deductible. So far I hope this is not too confusing.

OK here goes, various hospitals charge different amount for the same services. So let’s say for a certain test one hospital charges you $1000 and another hospital charges to $600 for the same service. If you choose a Higher Cost Hospital you will pay your standard deductible + $450 co pay, for a lower cost hospital you pay only your co pay. However, if you go for the same test again within a year, for a Higher Cost Hospital you will pay $450 co pay, for a lower cost hospital you pay zero dollars. If you choose this program your premiums would not hike as much for next year.

Now if you decide to see the top 15  providers in Massachusetts, you would have to pay a higher out of pocket expense almost $1000, including hospitals like Brigham and Women’s Hospital, Harvard and University of Massachusetts Hospital (UMASS). Not so for Beth Israel Deaconess Hospital, Harvard (BIDMC) which was considered to be a low cost institute. I can relate to these issues as I saw it first hand when I was working at BIDMC and also at UMASS.

What impact this would have nationwide is still yet to be determined. I think if this becomes a trend with other insurance agencies and Medicare too, it may result in a paradigm shift in the way some hospitals do their billing. As we all know hospitals bills are not an easy thing to deal with regardless of what insurance you have. I wrote about this issue here (Bankruptcy, You Could Be Next).

Blog You Later.

About the picture: My very first day at UMASS many many many years ago.
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Human Factor. Sepsis

 I recently received this email from a follower regarding sepsis,

I read your blog regarding the necessity of urging hospitals to develop a protocol as a preventable measure in the early detection of sepsis in a patient. 

You blog rings very true to my family and as we buried our mother last month.  A victim of sepsis.  She was scheduled to be released from the hospital within the next two days, when the hospital realized at that point that her overall condition had started to rapidly deteriorate.

We are at a loss as to the hospital's late discovery about the severe infection our Mom had detected and the hospital's seemingly either misguided or complete misunderstanding of the early signals for sepsis”.

I think this is occurring more than we anticipate. One way to prevent this from happening is to have a good screening system in place. Patients should be screened for SIRS (Severe Inflammatory response syndrome) not only in the ER but also on the floor with the change of shift. As we know, SIRS is the initial phase of sepsis followed by Sepsis, Severe sepsis, Septic shock and finally multi-organ failure.

SIRS consists of

1.      Heart Rate more than 90/min.

2.      Respiratory rate more than 20/min.

3.      White blood cell count more than 12000 or less than 4000.

4.      Temperature less than 36 degrees or greater than 38 degrees.

A number of hospitals are implementing this screening protocol. I hope we should be able to do that too. I will keep you posted as we move along.

Blog you later.

About the picture:  Big Island while I was lava hopping. Temperature around 1,200 °C. 

Sepsis. Hospitals, Mind Your $$$.

As we are talking about sepsis here. 


In a recent study published at Archives of Internal Medicine, it was concluded that just because your institution can throw more money for sepsis protocols does not mean that it will result in decrease mortality.

Considering some of the bigger institutes has spent millions of dollars in creating these protocols. This means from hiring full time nurses who only responds to sepsis codes to hiring big consulting firms to establish and run these programs.

It was unclear from the study that why some institutions do better even without higher expenditure but with lower mortality rate.

Something to think about.

Blog you later.


Round Rainbow by Olafur Eliasson at Hirshorn Collection. Did you get it?

Sepsis Protocol.

 Sepsis is a condition which causes derangement in cardiovascular compartments, problems with inflammatory and hematological processes, which is due to an infection or injury resulting in severe morbidity or even mortality.

There is a “Surviving Sepsis Campaign” led by European Society of Intensive Care Medicine, international Sepsis Forum and Society of Critical Care Medicine. The goal is to decrease the mortality associated with sepsis syndrome.

We are taking an initiative to decrease the mortality associated with sepsis and I am part of this team to create a protocol for our hospital. Unfortunately sepsis has not been recognized as we have other conditions like cancer, strokes and cancers. It is imperative to identify this problem early  and manage properly.

These are some facts which everyone should know about sepsis.

-          Sepsis is the leading cause of death in non cardiac ICUs.

-          Severe sepsis causes more deaths than deaths due to colon, breast, prostate and pancreatic caner….. all combined.

-          Mortality due to sepsis almost matches that of a heart attack (Myocardial infarction).

There are several great treatment protocols based on Rivers ET AL study, which basically concludes that early goal directed therapy decrease mortality in septic patients.

We are in the process of creating a protocol based on this study which can suit our needs. However, I feel the problem is not finding the right protocol; the problem is correct and consistent implementation. You can have the greatest of protocols but it would be of no use if the implementation is based on unrealistic expectations or lack of resources.

In the next 15 days we will work on these issues

-          Creation of time line to work on these schedules.

-          Screening procedure to identify sepsis.

-          Procedure to create time zero.

-          Creating code sepsis protocol.

-          Creating a “one click” order for sepsis protocol.

-          Education for medical staff.

-          Evaluation of resources available to reach these goals.

Well it is a good start. Let’s see when we reach there.

Blog you later.

About the picture: During FCCS course.