Five Vital Skills to be The Thrifty Patient

From my upcoming book - The Thrifty Patient - Vital Insider Tips For Saving Money And Staying Healthy

Chapter 2 - The Thrifty Patient

Five Vital Skills to Staying Healthy and Saving Money

Throughout the book, we’ve covered various important aspects of getting the right care. It boils down to five separate but important areas you should be knowledgeable about: the doctor’s office visit, prescription medications, preventive screening tests and interventions, selecting the right doctors, and using the Internet. Each is also important to help save money. For example, learning how to communicate with doctors clearly about your concerns and needs as well as providing the doctor the information he needs can decrease the likelihood of unnecessary testing and medications. When seeing a doctor, the goal is to solve the problem you are having. It isn’t to get all of the imaging tests, lab work, or prescription medications available. When focused on the right goal, you get the right care and save money.

Sometimes, paradoxically, this may mean spending money to see the doctor to pick his brain and get his expertise. You may be tempted to ask for blood work or a MRI first and skip the office visit. Talking to a doctor seems so old-fashioned and out of date. Yet, as we will review, lab work and imaging tests are simply tools to help doctors. By themselves, without a good patient history, the test results have little meaning.

If your doctor recommends prescription medication, then there are ways to ensure that the medications you receive are effective and affordable. Many prescription medications are simply me-too or copycat drugs. Pharmaceutical companies market and promote these medications as aggressively as beer and soda. Don’t be fooled. When a medical condition is common, such as heartburn, seasonal allergies, high cholesterol, high blood pressure, and diabetes, save money by avoiding the latest advertised medication. There are often plenty of excellent and less expensive alternatives.

Focusing on prevention is extremely important. 

Getting screened for cancer and requesting vaccinations can keep you healthy. 

It isn’t particularly sexy, trendy, or even fun depending on these tests, but they can save your life. Periodically check out what the latest guidelines are, as the recommendations can change with continued medical research.

Identifying which doctor to go to is also important to getting the right care. 

It is extremely rare that any one doctor is the “best.” Don’t worry about finding the best, but rather focus on finding doctors who provide excellent quality care and who also listen to you. How do you determine if a doctor is good? How do you find one? Who is on your medical team? Should you always have a primary care doctor? If you need a specialist, how do you choose?

We also will review the use of the Internet and social media as a way to keep you informed. 

The ease of accessing information can both be a blessing and a curse. Used correctly, information from the Internet, whether from trusted health care organizations, patient or doctor blogs, or tweets, can improve decision making. It may help you determine if a symptom requires medical attention or can be safely treated and managed at home. Yet the access to this information can be equally as problematic.

The Internet, much like the lab tests and imaging studies doctors use, is still a tool. Like any tool, it can be helpful or harmful depending on how a person uses it. A simple rule of thumb—if an answer or solution sounds too good to be true, it often is.

Increasingly, you are being asked to pay more for medical care and be more responsible in making medical decisions. Knowledge is power. It isn’t that hard. Let me show you how.

Five simple skills can make you a thrifty patient who is staying healthy and saving money.

Finally, just a brief primer on what you should do outside of where I work regularly, the medical system. For most of us, life is not filled with doctor visits. That’s a good thing. Sometimes you or a loved one does, however, need our help. This is the first step to getting you the skills you need to stay healthy and choose wisely.

Let’s get started.

Update on The Thrifty Patient - Vital Insider Tips For Saving Money And Staying Healthy

New book is finally taking shape. A revised and streamlined version of my previous work with new content is nearly completed and will be available soon on Amazon and Kindle.



Here is a sneak peak of the first chapter!

Enjoy!

Introduction –

Why This Book Matters To You

After you finish this book, you will know what I know when it comes to medical care. I believe it can be boiled down into these short but important phrases.

• Newer isn’t necessarily better.
• More isn’t necessarily better.
• Common sense may not apply.
• Staying healthy and well means sometimes seeking medical care.
• You need to be informed and educated to get the best care.

Or I could burden you with statistics from the health care system

which you probably already know.

• Twenty-three seconds.
• Fifteen minutes.
• Forty percent.
• Medical costs.
• Increasing dissatisfaction.
• Worst among industrialized countries.

These are the questions to the previous answers.

• Twenty-three seconds: How much time do you have before your doctor interrupts you?
• Fifteen minutes: What is the average face-to-face time at a doctor’s office visit?
• Forty percent: What is the misdiagnosis rate based on autopsy?
• Medical costs: What is the leading cause of personal bankruptcy? Many had health insurance.
• Increasing dissatisfaction: How does the public feel about the American health care system?
• Worst among industrialized countries: How does the United States rank in terms of health care quality for prevention and treatment?

Staying healthy and well means sometimes seeking medical care. 

I could tell you that too many Americans die every year unnecessarily and too soon due to missed opportunities. Healthy patients forget to get screened for colon cancer or breast cancer. Heart attacks and strokes that could have been prevented occur. Grandfathers and grandmothers aren’t around to attend holidays, graduations, or spend time with their grandchildren. Parents leave their children alone because their cancer was caught too late. No one is the wiser to this.

Newer isn’t necessarily better. More isn’t necessarily better.

You may have noticed that increasingly doctors rush through office appointments and don’t listen. Too often blood work is done, medications prescribed, and x-rays ordered, and despite all of the additional treatments patients don’t feel healthier. Television, radio, magazines, and the Internet inundate you with the latest prescription medications or therapy promising you better health. The news warns you to check with your doctor about the latest therapy with quick, thirty-second sound bites. You are fearful that you might be missing something important that could save your life.

Common sense may not apply.

Increasingly more parents are not having their children immunized against preventable illnesses such as measles and pertussis (whooping cough). Now news reports note more cases. Some children die. Many have lost faith and look for alternative and more “natural” therapies. Doctors who are supposed to help guide you and distinguish truth from fiction are just too busy, so more people are relying on family, friends, and the Internet for medical advice.

You need to be informed and educated to get the best care.

To add even more stress, health insurance is becoming too expensive. Small and large companies are trying to control costs by offering health insurance with health savings accounts (HSAs). These plans have lower monthly premiums with high deductibles. Since 2004, these plans have become more common. Many patients are now asked to choose when to seek care and when to safely skip care based not only on their health needs but on their ability to pay, even as research consistently shows that they don’t want the financial responsibility to do so.

There is good news.

Despite all of these challenges, there is good news. You aren’t alone. When I took the Hippocratic oath to do no harm and help patients to the best of my ability, I didn’t realize that pledge included writing a book. I’ve always wanted to be a doctor. Never a writer. I hated English. I only took the class because I had to, not because I wanted to. 

Despite that, I am compelled to write because of what I know is occurring with alarming frequency in our country. Americans are skipping needed and recommended care that could save their lives and allow them to live to their fullest. Patients are more distracted, as life is more complicated and busier than ever. Households have both parents working, sometimes two jobs, just to make ends meet. They easily would make the right choice if someone would be willing to explain things in a simple, understandable manner. They would prefer a health care system that was so incredibly simple to use, convenient, and personalized that it would anticipate their needs so they could get the right care and get back to living life.

Instead, our health care system offers patients higher co-pays, deductibles, and out-of-pocket medical expenses. It shifts the burden of making the right choices to people who frankly are just getting by. It asks people to fend for themselves at a time when they need us, doctors, the most.

How do I know? Two things occurred that changed my life.

Is healthcare reform a win or a loss for Americans?

Although the media has been focused on repeating the same town hall meeting shouting matches, one should look carefully at other thoughtful pieces appearing in business magazines like Fortune and Money which claim to have the objective truth about healthcare reform.

Because they have it wrong as well.

Shawn Tulley, editor at large for Money, wrote "You'll lose 5 key freedoms under health care reform" specifically indicating that Americans will lose the ability to have high deductible insurance plans funded by health savings accounts (HSAs) as well as the ability to seek specialty care without first being evaluated by a primary care doctor.

My concern about HSAs is a philosophical one, but important. Do patients understand when they can safely skip and when they need to be seen by a doctor or get the preventive tests they need? Unlike auto insurance, having a dent in the car left unchecked is one thing, but what about one's body? Research shows those most likely enrolled in HSAs are doctors and accountants which makes complete sense. The former know when to seek care and when to safely skip. The latter understand the tax advantage of HSAs. Patients in high deductible insurance plans are generally less satisfied, would prefer to return to comprehensive health insurance if given the opportunity, and typically avoid getting necessary testing or treatment done due to cost.

I've heard the argument that consumer driven healthcare will make people better consumers. Please. We've tried this with retirement planning. Employers jettisoned their pension plans and moved workers to 401k plans where employees would have more responsibility and skin in the game to do the right thing and plan for retirement well.

Companies discovered that people don't do what is in their best interest. Many never enrolled. Others invested simply in cash unaware that they needed to make investment decisions. As a result, employers are requiring new employees to opt-out of the 401k program rather than opt-in and changing the default investment to a target date mutual fund. It isn't that people don't want to do the right thing. They do. But if they can't handle retirement planning, how well do you think they will do with healthcare planning?

Which leads to the next cherished freedom that supposedly will be given up. The freedom to choose your doctors. Certainly having a trusted primary care doctor who can help get you better and help you navigate the healthcare system is critically important much the same way a trusted financial adviser can help people avoid pitfalls and traps. Was it poorly done a decade ago? Yes. No one I know of goes to medical school to become a "gatekeeper". We all train to become doctors. Some of us become primary care doctors - family physicians, internists, pediatricians, obstetricians / gynecologists - while others become specialists.

Mr. Tulley makes the mistake that many patients do in believing that getting the best care means "freedom" to access all tests, hospitals, specialists, and imaging studies. Is that what people really want or do they simply want the right doctor, the right care at the right time?

The supposed freedoms given up would not as be terrible Mr. Tulley claims since they are responsible for allowing the US to have the worse healthcare outcomes of any industrialized country in the world, highest costs per capita, and shut out millions from accessing medical care by being uninsured.

It's this kind of misinformation that is troubling. The quiet thoughtful analysis which is dead wrong.

Are Health Savings Accounts - HSAs - Right for You? The Rules. The Truth.

Increasingly more Americans are being offered health savings accounts (HSAs) either from their employers or when choosing individual insurance plans.

What are they?

What are their advantages?

What are their disadvantages? (There is no free lunch after all).

Definition - Health Savings Accounts were enacted under President George W. Bush and allow individuals to save money tax-free for medical expenses. Unlike previous medical savings accounts, money not used within a particular year can be rolled over. In other words, the "use it or lose it" problem no longer applies.

HSA funds can be invested like retirement accounts into various mutual funds, bonds, savings accounts and those earnings are tax-free.

When the funds are spent on appropropiate medical expenses as defined by the IRS, the transaction is also tax-free.

In other words, HSAs are the only financial vehicle that essentially never gets taxed when done correctly. Set aside money tax-free (like your 401k), invest (if you want to) and earnings are tax-free, and finally spend money tax-free on medical expenses. You aren't obligated to use HSA funds to pay for medical expenses if you have other dollars available. In fact, after age 65, you can take out the money from the HSA, pay some taxes like your 401k, and voila use it like your other retirement accounts. There are NO income restrictions on who can get a HSA.

Sound too good to be true? Is it right for you? Depends.

The catch are at least a couple, not major, but you must know.

First to have a HSA it needs to be paired with a high deductible insurance plan. Unlike health insurance policies that you may have had in the past, you now have to pay a deductible before the insurance policy kicks in. Very similar to your auto insurance policy. Consequently, doctor office visits won't be the small copay, but potentially a hundred or two hundred dollars. The same may apply to prescription drug coverage.

Despite a higher cost when you use healthcare services, you still may have more take home pay. A high deductible insurance plan typically has lower monthly premiums. If you set aside money for your HSA you have less taxable income. Just be prepared for a little sticker shock. Of course, you can use the money you set aside in the HSA to pay for these expenses.

The second, which is far more important, is will you know when to seek medical care and when to safely skip? Unlike your car which many of us will defer repairs for damages in fender benders, will you know when you must spend money?

Research already shows that patients often skip important needed preventive care, medications, and doctor visits when copays go up. Should you pay for the colonoscopy, which is easily a few hundred dollars, to screen for colon cancer at age 50 even if you feel perfectly well and have no family history (Yes). Finding cancer early is far less expensive than waiting and needing abdominal surgery as well as chemotherapy, which costs tens of thousands of dollars and not only drains whatever other savings you have, but will be unlikely to extend your life. If only you had done the right thing.

HSAs favor those who will be proactive in taking care of themselves and knowing when to go seek medical care, when to invest money to stay healthy, and not "wing" it. Perhaps it isn't surprising then that doctors and accountants are people most commonly enrolled in HSAs. The former know when to get medical care and when to safely skip. The latter know all about the major tax savings as well as the ability to use a HSA as a retirement account.

For the rest of us, this is why I wrote my book - Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System - which gives you all the information you need to know to use the HSA wisely.

• How to make the most out of your office visit (after all each visit will cost more).
• The truth about prescription drugs (is the marketing really worth the hype?)
• What tests you must have to stay healthy and well (saving money by being uninformed will cost more in the end don't be ignorant).
• Assembling the right team of doctors.
• How to pick a health insurance plan and hospital.
• Websites that are free and excellent references (far better than simply Googling).
• Body scans, herbal dietary supplements (buyer beware).
• Much more and all for less than a price of a copay or a date to the movies! Your health is worth far more. What you don't know might kill you sooner!
  

Are HSAs good for you? As a doctor and someone who studied accounting at business school, I would have no problem enrolling. If I wasn't a doctor, I would always have some uncertainty about whether I was doing the right thing.

No need to worry, my book is written in an easy to read language that anyone can pick up. It's an insider guide just for you and your friends who will now have the knowledge I give my loved ones all the time.

So go ahead and save some money on healthcare, but make the right choices, be informed, be educated, and be empowered. Save money and stay healthy.