TIME Healthcare

Planned Parenthood Appeals Ban on Telehealth Medication Abortions

Planned Parenthood patients, volunteers and supporters rally outside the office of Assembly Speaker-elect John Perez to oppose cuts to family planning funds by California Gov. Arnold Schwarzenegger on Jan. 12, 2010 in Los Angeles.
Planned Parenthood patients, volunteers and supporters rally outside the office of Assembly Speaker-elect John Perez to oppose cuts to family planning funds by California Gov. Arnold Schwarzenegger on Jan. 12, 2010 in Los Angeles. David McNew—Getty Images

Planned Parenthood is appealing a ban from the Iowa Board of Medicine over their telehealth medication abortion system for rural women

On Thursday, Planned Parenthood of the Heartland filed an appeal with the Iowa Supreme Court over a ban that outlaws a video-conferencing system Planned Parenthood provides for medication abortions.

The group launched the telemedicine abortion system in Iowa in 2008 so that women living in rural areas could get a medication abortion over video conferencing, a convenience that cuts down on wait time and the 500-mile round-trip drive some Iowa women must take to visit one of the state’s few abortion clinics. Planned Parenthood brought the system to several other states in the Midwest, but the majority of them banned the systems in a wave of abortion restrictions starting in 2011. Currently, 17 states have laws or regulations that specifically ban telemedicine for medication abortion, but both Iowa and North Dakota are appealing these bans. Iowa is now the only state where Planned Parenthood widely uses the system.

The procedure is very similar to an average medication abortion. Before making a decision, the woman speaks with a counselor at length about her options, including having the baby, adoption, and abortion. If the woman decides to terminate the pregnancy, she has a conversation with a physician over a secure videoconferencing system. A Planned Parenthood staff member is in the room to provide support, and the doctor reviews the woman’s medical history and answers her questions. The physician then administers the mifepristone (the first drug taken for medication abortion) by using a computer to remotely open a secure drawer within the health center and instructs the woman to take the medication while the staff member is in the room. The doctor then presents the woman with misoprostol (the second drug taken) and tells her to take it at home within 24 to 48 hours. That medication process is exactly the same as the procedure in the presence of a doctor.

The Iowa Board of Medicine investigated Planned Parenthood’s system in 2010 and deemed it safe. However, when Republican Governor Terry Branstad replaced the board in 2013, the new board reversed the decision, a move that Planned Parenthood and a former board member believe was entirely politically motivated and not based in scientific evidence.

On August 19, a judge ruled that the board was within its authority to ban the use of telehealth systems for medication abortions, and that the board cited concerns that a doctor needs to be present to perform an in-person checkup of the woman before she can take the abortion pills.

Dr. Daniel Grossman, vice president for research at Ibis Reproductive Health, disagrees with the argument that a doctor is needed for an in-person assessment.”[Our studies have shown] it’s safe, that the prevalence of adverse events and complications was low, and that statistics are not different compared to women at the same affiliate who went through the procedure in person,” he said. In 2012 Grossman and a team of researchers found that remote medication abortions did not increase the number of overall abortions in Iowa and that the number of abortions taking place in the second trimester, when the risk for complications is higher, dropped slightly.

“We also found that women were more likely to recommend it compared to women who underwent an in-person procedure,” said Grossman. “In some of the interviews, women decided to go to a telemedicine site because it meant they could have it done sooner. If they waited, they would have to have a surgical abortion.”

Telemedicine is growing, and it’s long been used in even more invasive procedures, from physical exams to surgeries. Major hospitals like the Cleveland Clinic are developing their own systems to cut costs and reduce readmission rates. In 2011, the Veterans Health Administration conducted more than 300,000 remote consultations using telemedicine, and companies like Doctor on Demand even allow doctors’ appointments over video chat and cell phone.

Recently, The New York Times Magazine highlighted a growing international push to find ways for women to take the abortion pills in the privacy of their own homes, specifically a program called Women on Web which helps women get access to safe abortion pills.

According to Planned Parenthood, if the ban takes effect, only three health centers in the state of Iowa will continue to offer safe and legal abortions. “This rule would jeopardize women’s health and target women who already have the least access to medical care–all in the name of politics,” Cecile Richards, president of Planned Parenthood Federation of America, wrote in an email to TIME. “What’s happening in Iowa is part of a dangerous national trend–politicians using underhanded tactics to impose their personal beliefs on women and restrict access to safe, legal abortion. It’s unacceptable and unconstitutional to deny safe care to women in need, which is why we are going directly to the state Supreme Court and fighting with everything we’ve got.”

TIME Healthcare

One Patient, Too Many Doctors: The Terrible Expense of Overspecialization

Doctored, by Sandeep Jauhar
Doctored, by Sandeep Jauhar Courtesy Farrar, Straus and Giroux

As physicians become more specialized, our health care system becomes increasingly costly, sloppy and disorganized

Not long ago, a primary-care physician called me about a patient with a right-lung “consolidation” — probably pneumonia, though a tumor could not be excluded — that a lung specialist had decided to biopsy. My colleague wanted me to provide “cardiac clearance” for the procedure.

“Sure, I’ll see him,” I said, sitting in my office. “How old is he?”

“Ninety-two.”

I stopped what I was doing. “Ninety-two? And they want to do a biopsy?”

My colleague, who is from Nigeria, started laughing. “What can I tell you? In my country we would leave him alone, but this is America, my friend.”

Though accurate data is lacking, the overuse of health care services in this country probably costs hundreds of billions of dollars each year out of the $3 trillion that Americans spend on health. This overuse is driven by many forces: “defensive” medicine by doctors trying to avoid lawsuits, a reluctance on the part of doctors and patients to accept diagnostic uncertainty (thus leading to more tests), lack of consensus about which treatments are effective, and the pervading belief that newer, more expensive drugs and technology are better. However, perhaps the most important factor is the overspecialization of the American physician workforce and the high frequency with which these specialists are called by primary-care physicians for help.

The past half-century has witnessed great changes in American medicine. One of the biggest shifts is the rise of specialists. In 1940, three-quarters of America’s physicians were general practitioners. By 1960 specialists outnumbered generalists, and by 1970 only a quarter of doctors counted themselves general practitioners. This increase paralleled an equally dramatic rise in medical expenses, from $3 billion in 1940 to $75 billion in 1970.

Specialist-driven care has now become a fact of medical practice. In the past decade, the probability that a visit to a physician resulted in a referral to a specialist has nearly doubled, from 5% to more than 9%. Referral rates to specialists are estimated to be at least twice as high in the U.S. as in Britain.

The consequences for patients are troubling. Besides high costs, having too many consultants leads to sloppiness and disorganization. As Drs. Donald Berwick and Allan Detsky recently wrote in the Journal of the American Medical Association, inpatient care at hospitals has become a relay race for physicians and consultants, and patients are the batons.

I remember a 50-year-old patient of my Nigerian colleague who was admitted to the hospital with shortness of breath. During his monthlong stay, which probably cost upward of $100,000, he was seen by a hematologist; an endocrinologist; a kidney specialist; a podiatrist; two cardiologists; a cardiac electrophysiologist; an infectious-disease specialist; a pulmonologist; an ear, nose and throat specialist; a urologist; a gastroenterologist; a neurologist; a nutritionist; a general surgeon; a thoracic surgeon; and a pain specialist. The man underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to investigate only mild anemia). Every day he was in the hospital, his insurance company probably got billed nearly $1,000 for doctor visits alone. When he was discharged (with only minimal improvement in his shortness of breath), follow-up visits were scheduled for him with seven specialists.

This case — in which expert consultations sprouted with little rhyme, reason or coordination — reinforced a lesson I learned many times in my first year as an attending physician: in our health care system, if you have a slew of specialists and a willing patient, almost any sort of terrible excess can occur.

What to do about this overspecialization? One option is accountable-care organizations, an idea put forward by the Affordable Care Act, in which teams of doctors would be responsible (and paid accordingly) for their patients’ clinical outcomes. This would force specialists to coordinate care. Unfortunately, most doctors, notoriously independent and already smothered in paperwork, have generally performed poorly in this regard.

Reforms will also have to focus on patient education. Medical specialty societies recently released lists of tests and procedures that are not beneficial to patients. By using these lists, cardiologists have been able to decrease their use of imaging tests by 20%. Better-informed patients might be the most potent restraint on overspecialized care. A large percentage of health care costs is a consequence of induced demand — that is, physicians persuading patients to consume services they would not have chosen had they been better educated. If patients were more involved in medical decisionmaking, there would be more constraints on doctors’ behavior, decreasing the possibility of unnecessary testing. This could serve as a potent check on what the doctor ordered.

Today roughly 1 of 6 dollars spent in America goes toward health care. If we do not succeed in controlling these costs, they will gradually crowd out other necessary societal expenditures. Improving health literacy will be critical to these efforts. Without a better understanding of what doctors are actually doing, one may end up like the patient who had 17 consultants and 12 procedures and who reinforced a further lesson I have learned many times since entering practice: when too many specialists are involved in a case, the result too often is waste, disorganization and overload.

Jauhar is a cardiologist and the author of Intern: A Doctor’s Initiation and the new memoir, out today, Doctored: The Disillusionment of an American Physician

MONEY

How to Keep Health Emergencies from Bankrupting You

Celine Dion takes a break from touring to care for her husband, who is battling cancer.
To help care for her ailing husband, Celine Dion has stepped out of the workforce for a while. Ryan Remiorz—AP

Céline Dion cancelled her tour to care for husband René Angélil, who's been fighting cancer. She doesn't have to worry about money, but most people in a similar situation do. Here's how to contain the financial damage.

Earlier today, singer Céline Dion announced that she would be canceling her tour to take care of her husband René Angélil—who has been battling cancer.

“It’s been a very difficult and stressful time for the couple as they deal with the day-to-day challenges of fighting [Angélil's] disease while trying to juggle a very active show business schedule, and raise their three young children,” a publicist was quoted as saying.

No amount of money can erase the worry and heartache associated with caring for a loved one who’s dealing with a critical illness. And of course Dion, with a net worth estimated at $500 million, doesn’t have to fret about how her family will cope financially at this difficult time. But for the average American, the economic consequences of a tough diagnosis can compound the stress. A study by Sun Life Financial found that even with health insurance, the average cancer patient faced $6,700 in out-of-pocket costs a year. Plus, a family illness can take you away from the office, potentially crimping your earnings.

Should something like this happen to you, a parent or a partner, follow these steps to keep the financial toll to a minimum:

First, maximize your insurance coverage

Dig into your health plan. “Find out if the treatments you need will be covered or if you’ll have to go out of network to see the best specialist,” says Donald Duncan, a Chicago financial planner. Check how much you could be on the hook for; note that your out-of-pocket max when you leave your network can be twice as high as for in-network care.

Appeal to your insurer. If you can successfully argue that no specialists in your network are experts in your care or that none have treated your condition frequently, your insurer may be willing to cover out-of-network care at in-network rates.

Negotiate with your doctor. Another cost-saving option is to see if an out-of-network practitioner will accept in-network rates. Get a sense of what prices doctors and insurers typically agree on at healthcarebluebook.com.

Next, Get Down to Business at Work

Make the most of open enrollment. Use the annual benefits election period to switch to better health coverage, fully fund a flexible spending account ($2,500 max), and see if you can sign up for extra life and disability insurance. For most large group plans, you don’t need a physical for life insurance during this annual event.

Protect your position. If your firm has 50 or more workers and you’ve been there a year, the Family Medical Leave Act lets you take 12 weeks of unpaid leave—for your care or a family member’s.

Work out a lighter load. Your company may very well pay all or part of your salary for a leave under the firm’s short-term disability policy. If all you want is to reduce your hours, most policies will allow for that too.

Last, Guard Against Greater Financial Damage

Get your shoebox in order. Assemble all your financial statements, insurance policies, property records, and estate plans now, not later, says Philadelphia financial planner Stephen Cohn. Add to that list online IDs and passwords.

Raise cash. Prepare for big medical bills and a potential reduction in earnings by deciding which funds you’d tap in a worst-case scenario. If you must raid your assets and you’re under 59½, tap taxable accounts first to avoid the penalties you’ll pay to cash out an IRA or 401(k) (unless you can get a hardship waiver). “Sell before you need cash so you won’t have to liquidate at a bad time,” says Cohn.

Pick a point person. Draft a durable power of attorney and health care proxy. And says Tampa financial planner Keith Amburgey, “identify who will be your trusted person through your illness.”

MONEY stocks

Here’s How to Make Money on Our Graying Population

With the fastest-growing segment of the global population aged 60 and over, biotech, medical devices, drugs and health care services all make for a durable investing strategy.

For health care, gray is the new black.

The fastest-growing segment of the global population is aged 60 and over, according to the United Nations Department of Economic and Social Affairs. That slice of humanity is expected to increase by 45% by 2050.

The surge in the older population has contributed to a wave of new product introductions in biotechnology, medical devices and pharmaceuticals, and expansion of health care services.

In addition, health care is a remarkably durable sector for investors, soldiering on despite periodic market downturns, like the one seen last week when the S&P 500 index had its worst week since 2012.

Overall, there’s a bounty of money being spent on healthcare that’s unlikely to be impacted by other economic trends.

One of the best ways to own the biggest players in the health care industry is through the Vanguard Health Care ETF, which holds global giants like Johnson & Johnson JOHNSON & JOHNSON JNJ 0.7576% , Pfizer PFIZER INC. PFE 0.034% , and Merck MERCK & CO. INC. MRK 0.1833% .

Charging 0.14% in annual management expenses, the Vanguard fund, which is almost entirely invested in U.S.-based stocks, gained 20% for the 12 months through Aug. 1, compared with 15% for the S&P 500 Total Return Index. Long-term, the Vanguard fund has been a solid performer, averaging 10.5% annually for the decade through Aug. 1. That compares with an average 7% return for the MSCI World NR stock index.

For more non-U.S. exposure, consider the iShares Global Healthcare ETF, which charges 0.48% for annual expenses.

The iShares fund has about 60% of its portfolio in North American stocks, with the remainder in European and Asian-based companies such as Novartis, Roche Holding, and GlaxoSmithKline GLAXOSMITHKLINE PLC GSK 0.4706% . The fund gained 19% over the 12 months through Aug. 1.

For a more focused play on leading-edge biotech and genomic companies, the First Trust NYSE Arca Biotech Index ETF samples some of the hottest companies in that sub-sector. Holdings include industry leaders Gilead Sciences GILEAD SCIENCES INC. GILD 0.0465% , Biogen Idec BIOGEN IDEC INC. BIIB 0.5275% , and InterMune INTERMUNE ITMN 0.3278% .

The First Trust fund was up nearly 25% for the 12 months through Aug. 1; it charges 0.60% in annual expenses.

Good Valuations Available

Since most institutional portfolio managers have seen the merits of health care stocks for years, there are probably few bargains available, although some sectors are pricier than others. Biotech stocks, in particular, are in high demand, although they experienced a sell-off earlier this year.

“On the other hand,” Fidelity Investments analyst Eddie Yoon said in a recent report, “some large-cap, stable growth companies across the [health care] sector continue to appear attractive, based on their stable underlying business fundamentals.”

Unlike other sectors such as consumer discretionary that are directly tied to overall economic conditions, health care is often insulated from broader economic trends. When the S&P 500 index dropped 37% in 2008, the Vanguard fund only lost 23%; the First Trust fund was off 18%. While biotech stocks tend to be volatile, the mainstream health care companies are seen as defensive holdings and more immune to broader market pressures and poised for bankable growth.

Long term, the more volatile biotech stocks of today may be tomorrow’s winners. The growing science of genomics will allow biotech companies to customize drugs to a patient’s genetic make-up. Just three years ago it cost $95 million to sequence a human genetic code. Now it costs about $4,000, with the price dropping every year. That will translate into more precise treatments with fewer side effects.

There are several concurrent waves of innovation in health information technology, diagnostics and delivery of services. More patients can be monitored and treated at home with the improvement in information technology. Diseases are being discovered and treated earlier, which means fewer hospitalizations.

In the United States alone, health care spending is buoyed by the $3 trillion spent annually on Medicare patients. While policymakers say this number is unsustainable and must be reined in, that does not change a key fact: Some 10,000 Baby Boomers are turning 65 every day. They will continue to demand the best drugs and treatments.

TIME Healthcare

10 Nervous Habits That Hurt Your Health

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Bad habits harm your health Marili Forastieri—Getty Images

Nervous habits are often more annoying to the people around you than to yourself, but some types of fidgeting and fussing can do real harm. Here, experts reveal the reasons why nail-biting, hair-twirling, and other seemingly harmless habits can be hazardous to your health.

You bite your nails

It’s one thing if you nervously bite your nails only during scary movies, but when it becomes a regular habit, it can damage both your nails and the skin around them, says Michael Shapiro, MD, a New York City-based dermatologist. Germs from the mouth get transferred to the skin, and vice versa. “Bacteria under the nails may also be transferred to mouth, causing infections of the gums and throat,” Dr. Shapiro says. Painting your nails may discourage you from chewing. No dice? Try tape to break the habit.

You twirl and pull your hair

Twisting and twirling a piece of hair around your finger can lead to damage to the root over time, says Ariel Ostad, MD, a dermatologist based in New York City. “This can result in temporary or permanent areas of hair loss as well as infection,” Dr. Ostad says. Obsessive hair pulling may be a sign of a psychiatric impulse control condition called trichotillomania, which requires psychotherapy and medication.

Health.com: 20 Reasons You’re Losing Your Hair

You crack your neck

Twisting your head forcibly to one side releases gases built up in the the joints between vertebrae and creates a popping sound. Although this may feel good, repeatedly cracking your neck can make the surrounding ligaments hypermobile and more susceptible to injury, says Michael Gleiber, MD, a board-certified orthopedic surgeon and affiliate assistant professor at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton. In addition, this excessive motion on the facet joints themselves can cause wear within the joints and may result in arthritis over time. In rare cases neck cracking may trigger a stroke, says Dr. Gleiber.

You touch your face

Repeatedly touching your face or picking at acne can damage the top very thin microscopic layers of the skin, says Jessica Krant, MD, board certified dermatologist and founder of Art of Dermatology and assistant clinical professor of dermatology at SUNY Downstate Medical Center in New York City. “If you bleed, you may have just created a permanent scar,” she says. “Do not pick at pimples or itchy areas. Treat them gently with topical creams and plenty of moisturizer.”

Health.com: 20 Things That Can Ruin Your Smile

You grind your teeth

Clenching and grinding your teeth (bruxism) when you’re under stress can wreak havoc with your oral health. Grinding can cause teeth to crack or break, which may require repair with crowns or root canals. It can also result in damage to the jaw joint in the form of temporomandibular joint disorder (TMJ), says Justin Philipp, who has a dental practice in Chandler, Ariz. “People clench or grind their teeth as a response to stress. However, most cases are a result of pathology such as misaligned or missing teeth and a ‘bad bite.'” Treatments include orthodontics to improve the bite and even Botox injections in the muscles, which can reduce the amount of force and, therefore, the potential damage.

You suck on hard candies

Sucking on hard candies bathes your teeth in sugar, which can lead to cavities, says Philipp. Bacteria feed off the sugar, which creates a perfect environment for tooth decay. Chomping down on hard candy can also risk damaging teeth or dental restorations, says Jack Ringer, president of the American Academy of Cosmetic Dentistry. “Sucking on candies in moderation is fine provided the candies are sugarless and low in acidity,” Dr. Ringer says.

Health.com: Best and Worst Foods for Your Teeth

You lick or bite your lip

Nervously licking your lips exposes them to your mouth’s digestive enzymes, says Whitney Bowe, MD, a New York board-certified dermatologist. “These enzymes chew away at the skin and can lead to dermatitis and cheilitis (inflammation), which make lips appear dry and cracked,” she says. Biting your lips when under stress can cause the development of fibromas, firm flesh colored growths, that may require surgical removal, says Coyle S. Connolly, MD, dermatologist and president of Connolly Dermatology in New Jersey. Relax in a healthier way with these expert-approved stress-busting solutions.

You gnaw on the inside of your cheek

Like biting your nails, cheek-chewing can also become a nervous habit. “Often the inside of the cheek gets swollen and it then becomes easier to continue biting the same spot,” says Ringer. “Even after it heals the habit continues.” Over time this can result in chronic inflammation, possible bleeding, and scarring of the area.

You chew gum

All that snapping and popping does more than annoy your coworkers. It may also put you at risk for TMJ from overuse of jaw muscles, says Philipp. Sugarless gum presents a different set of problems, mainly digestive ailments. Sorbitol, an artificial sweetener, produces an unpleasant laxative effect when eaten in excess (18 to 20 sticks a day). Swallowing excess air while chewing also increases risk of a gassy stomach, according to the National Digestive Diseases Information Clearinghouse (NDDIC). “It is usually easier to try to replace the habit with another one than it is to quit, so try something a healthier switch such as drinking water,” says Philipp.

Health.com: 27 Mistakes Healthy People Make

You nibble the ends of pencils and pens

Germs can lurk on the ends of pens so this habit can expose you to nasty pathogens including cold viruses, says Ted Myatt, director of research compliance at the University of Rhode Island. “An infected person likely has the virus on his or her fingers and spreads it through pens as well as computer keyboards and telephones.” And aside from the embarrassment of ink on your mouth from an exploding pen, chewing on writing instruments can damage teeth and dental work as well as injure the soft tissue and gums inside the mouth, says Ringer.

This article originally appeared on Health.com.

TIME Healthcare

We’re One Step Closer to Better Sunscreen

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Jeffrey Coolidge—Getty Images

A bill for better sunscreen is on its way to Congress

The approval process by the Food and Drug Administration (FDA) can be woefully slow, and for over a decade, new sunscreen ingredients—some of which are widely used in other countries—have been trapped in an FDA backlog. But on July 15, those ingredients got one step closer to market when the House Energy and Commerce’s Health Subcommittee approved a bill that would speed up the process.

As we reported in May, sunscreen innovation advocates are hopeful that the a bipartisan bill called the Sunscreen Innovation Act—which is currently under review—could pass this summer. There are eight ingredients currently waiting for FDA approval, and the majority have been used in European and Asian countries for years. Some of the ingredients appear to offer better protection from UVA rays than those currently used in U.S. products.

The House Energy and Commerce’s Health Subcommittee approved the bill, which means it’s one step closer to getting passed by the House, something advocates think could happen before Congress’ recess in August. After that the bill heads to Senate. If the bill passes, the FDA is will have to respond to the current pending ingredients within a year, and all new applications will have to be responded to within one and half years.

Since skin cancer is the most common cancer in the U.S., having the most up-to-date products is important to keep people safe. For now, here are some shopping tips.

Read our full coverage of the bill, here.

TIME Healthcare

20 Million Americans Get Insurance Under Obamacare, Report Says

A new report estimates millions of Americans have enrolled in health insurance as of this Spring

About 20 million Americans have gained health insurance or enrolled in new insurance under the health care reform law, according to a new report.

The report from the Commonwealth Fund, published Wednesday in the New England Journal of Medicine, credits President Barack Obama’s health reform law with an estimated 20 million enrollments as of May 1. The report looks at both people who gained coverage through insurance marketplaces, and people who gained coverage due to provisions in the Affordable Care Act (such as those qualifying for Medicaid and those now covered through the Children’s Health Insurance Program).

The authors estimate that 7.8 million people under 26—who are now allowed to be covered as dependents on their parents’ plans—have enrolled. They also report that 8 million people were enrolled in coverage via new health insurance marketplaces and five million purchased coverage directly from insurers.

The authors write that for ACA’s continued expansion to be sustainable, it will rely largely on the ability of the U.S. to control health care costs.

“Developing and spreading innovative approaches to health care delivery that provide greater quality at lower cost is the next great challenge facing the nation,” the report concludes.
The Commonwealth Fund
MONEY Health Care

The Mystery Behind Your Doctor’s Charges, Unveiled

Illustration of man unlocking filing cabinet of doctors
Medicare is providing consumers with a new way to research health care pricing. Paul Blow

A quick peek into some Medicare data can help you reduce your medical bills. Here's how to use the new tool.

Medicare has pulled back the veil on what doctors, physician assistants, physical therapists, and other health care providers charge, letting everyone see the rates for a wide variety of procedures in advance for the first time. “This is a big step forward and will be very enlightening,” says Jean Mitchell, a health economist at Georgetown University.

Health care researchers and fraud investigators are salivating over the data—already it’s revealed that some doctors favor the most expensive in-office intravenous drug treatments, likely because Medicare pays them a percentage of the cost, says ­Gerard Anderson, a professor at Johns Hopkins University.

As a patient, you can use the numbers, which are from 2012, to conduct your own research into prices and practices. Even if you’re under 65, you can glean valuable insights. Head to the Medicare Physician and Other Supplier Look-Up Tool to find your doctor. You’ll see how many times he or she did a particular service and the average charges. Then here’s what to make of the information:

If you’re facing surgery
See how often your doctor operates; for complicated procedures, frequency pays. “Research shows doctors who perform more than 50 hip replacements a year have fewer complications,” says Andrew Fitch of Nerdwallet Health. Yet about half of orthopedic surgeons did fewer than 20 a year on traditional Medicare patients, a Nerdwallet analysis of the data found.

The tally excludes operations on patients with private insurance or a Medicare Advantage Plan. Still, a low number compared to other MDs should prompt you to ask how often your doctor does the job, particularly for hip and knee replacements, says Fitch. If the figure is high, keep in mind that at times every physician in a group practice bills under one name.

If you’re on traditional Medicare
For a price preview, calculate the difference between the “average Medicare allowed amount” and the “average Medicare payment.” That’s your share of the bill before supplemental insurance kicks in. One caveat: What you see in the Medicare database are charges per service. So ask if you’ll face other bills or a facility fee if you’re cared for at a hospital or surgical center.

If you have private insurance
Check out the “average submitted charge,” which is the doctor’s full retail price. If you go outside your network, you’ll owe the difference between this amount and what your insurer deems a “customary and reasonable” rate (get that from your insurer), on top of your co-insurance.

You should negotiate with out-of-network docs, and the Medicare allowed amount is a good starting point. If the provider balks at that, go as high as 35% more, which is the national standard for a reasonable charge, says Anderson.

MONEY working in retirement

Three Retirement Trends to Be Happy About

Marketers are trying to reinvent retirement, but the best choices are the same ones we've always had. And they're getting better.

Just about anyone over the age of 50 has seen the barrage of new labels for today’s post-retirement lifestyle: Retirement 2.0. Encore Careers. Next Act. Third Age. Not Your Parent’s Retirement.

Forget the marketing hype. When it comes to figuring out your retirement plan, here’s the best strategy: take a good look in the mirror. What you’ll see, if you’re really paying attention, is the definition of retirement that matters to you. And the good news is there’s more opportunity today to design the kind of retirement you want than ever before.

The more research I read, and the more experts I talk to, the more I’m convinced that nearly every kind of retirement option has been heavily road-tested by those who came before. There have always been people who continued to work during retirement—the most powerful and successful people, in fact, tend to never retire. They are having too much fun. Bill Gates will never really leave Microsoft. He continues to work longer hours “in retirement” than the rest of us do at our office jobs. Warren Buffett? They will have to pry a can of cherry coke out of his cold, cold, cold hands before he stops working.

You don’t have to be Warren Buffett, either. Plenty of ordinary people have reinvented their lives in their later years. Older people have always made great entrepreneurs as well as creative artists and inspirational leaders. Often, having a lot of money has nothing to do with the levels of engagement and enjoyment that older people derive from being busy. Sunset years? Hardly.

Continued work in your later years will make your lifestyle during whatever-you-want-to-call-retirement easier to afford—and more comfortable and enjoyable as well. Here are three key trends that should put a smile on your face when you look in the mirror:

Living longer. Yes, you need to make realistic allowances for health problems. But most of us should assume we will live two or three decades past age 65. Take a look at this 2011 life expectancy data from the National Center for Vital Statistics. As you can see, someone age 70 can expect to live to nearly 86, on average:

Age Remaining Life Expectancy (Yrs.)
40 40.6
45 36
50 31.5
55 27.2
60 23.1
65 19.2
70 15.5
75 12.1
80 9.1
85 6.5
90 4.6
95 3.2
100 2.3

 

Of course, average numbers disguise a lot of differences. People with college educations, who tend to earn more money, will live a lot longer than average life expectancy. So run the numbers as if you plan on lasting to age 100, and update your will to bequeath what’s left over if you don’t.

Improved healthcare. The quality of your medical care will be better than ever. Once the wrenching transition to Obamacare has moved into our rearview mirror—and it eventually will—what we’ll see in front of us is a huge shift toward wellness. Not only will our lives be longer but we live more of that time in good health. Yes, there eventually will be a fall-off into frailty. But increasingly that period won’t occur until just before our death. The technical phrase for this doesn’t sound pretty: compressed morbidity. But the trend is terrific. Better healthcare, more effective drugs and physically active lifestyles are a ticket to a higher quality of life in our later years.

Market power. As our society ages, older people are becoming a new mainstream group. Companies are shaping new products and sales pitches for us—they know that older people control the lion’s share of the nation’s wealth. So we’re likely to see a new wave of positive attention to older Americans. Of course, that’s what companies do to sell stuff. What’s important here is the growing visibility of older Americans, which will encourage a celebration of the diverse and interesting paths they have decided to follow in old age. And in turn, more older Americans will be encouraged try and succeed at lots of different things in their later lives. That will benefit all generations.

Philip Moeller is an expert on retirement, aging and health. He is an award-winning business journalist and a research fellow at the Sloan Center on Aging & Work at Boston College. Reach him at moeller.philip@gmail.com or @PhilMoeller on Twitter.

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