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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Simplify.

I recently came across an article Simplifying your life from a fellow blogger Doctor John Halamka, Chief Information Officer at BIDMC. 

Unfortunately simplifying it self is a complex procedure. You would require a paradigm shift and shed some of the load we carry. As we grow old our culture promotes complexity. At least this article provides us with something to ponder.

It is very inspirational and I have already shared it with few friends of mine. Please take a look at this article and tell me what you think. 

About the picture: Picture taken at Chicago Art Museum.

My Teachers.

I have been blessed with great teachers. They showed me horizons which I thought did not exist. They had an array of personalities and professions. Not all of them were strictly in the academic settings. They varied in age and things they had to offer, at different stages of my life. Like my high school teacher Ms. S, who taught me time management and brought out the best in me. My father, who showed me being a doctor, is more than billing a patient.

My little 6 year old daughter, who taught me what is more important in life, when she asked me to donate money to the hospital I work at, I asked why. She said “so that you can spend more time with me”. My teacher at Beth Israel Hospital/Harvard Dr. Ferris Hall, who taught me that you can not ask for respect, you earn it.

My “singing heart” patient who taught me that you have the power to brighten someone’s day. My supervisor at the carpet cleaner company where I worked in Chicago during my first year in America, who taught never to treat anyone the way you don’t want to be treated.

Our janitor Julie, who spent decades at University of Massachusetts, taught me never to ignore people who help you, with what you do. She said "I feel invisible, people pass by me all day long but never seem to notice my presence". Indeed, she was right when I saw her next day working, she was….invisible to everyone.

I cannot forget my senior resident Kirk MacNaught, who told me once during my intern days when I was in a hurry to make a decision about a patient, “You should never treat a patient like you would not treat your own family member”. Then he continued in his soft voice “can you please stop running around the hospital like a chicken with its head cut off and get back to work”.  

I sometimes still run like that. I never claimed that I was the best pupil, I was just lucky to have great teachers. Most of all my patients are the best teachers, who teach me things I could have never learned in any school.


About the picture: I think this does not require any explanation.