My friend, Mobisante CEO Sailesh Chutani tells this story:

“I recently had my annual physical (which I missed the last 4 years).

The doctor looked at my age and came up with a list of tests. So I asked what these tests cost.

Like 16 million Americans, I am on a Health Savings Account plan with the first $5,000 coming out of pocket so I have started to care about costs. (That was not the case 6 years ago when I had a gold-plated employer-offered plan where I had zero deductible!)

I asked if specific test results would change any treatment and whether cheaper but comparable alternatives exist.

We shrank the list of tests needed from six to two.”

Today’s questions for the group:

• As patients, have you ever refused a medical test due to cost?

• As manufacturers, have you seen a correlation between higher deductibles and lower procedure volumes? If so, what have you done about it?

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Discussions Worth Catching

Should We Focus on the Biggest Killers? (78 comments)
http://bit.ly/biggest-killers

The next revision of ISO:13485
http://bit.ly/new-13845

When does a subassembly become a part or vice versa?
http://bit.ly/subassmbly

Solutions for Medical Device Software?
http://bit.ly/meddev-software

How do you submit a combination product for 510k?
http://bit.ly/meddev-combo

Bicycle as Med Device?
http://bit.ly/meddev-bike
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Make it a great week.

Joe Hage
Medical Devices Group Leader

P.S. Have you visited http://MedicalDevicesGroup.net for our library of webinars, resources, events, and more?

Julie Omohundro
Principal Consultant at Class Three, LLC
If you are going to teach them to live “properly,” which is to say, in a way that you think will minimize their chances of developing one of the chronic conditions that are currently the biggest killers, then you are at the same time actively increasing their chances of dying of something else. You aren’t leaving it to God, you are actively encouraging them to live in a way that will increase their likelihood of dying from one or more specific causes. I think this is rather different than worrying about dollar costs.

At the very least, I think you should be prepared to inform anyone you are going to encourage to live “properly” of all the likely consequences of that behavior. To do otherwise would be like enrolling a subject into a clinical trial of a product that is expected to have a particular benefit, and informing them only of the benefit, but not of any anticipated side effects. No…more like enrolling them into a clinical trial without having even tried to determine potential side effects.

Burrell (Bo) Clawson
I research patents & design products to get a patented competitive position: Over 30 patents.
Julie that is a question God should answer. But I will say that we need to concentrate on minimizing known chronic conditions with the idea of letting people live a healthier and more productive life even if the lifespan itself doesn’t materially increase very much.

Jus minimizing chronic illnesses will cause a dramatic reduction in healthcare spending. I recall a hospital CEO from Boston saying ‘I go to sleep at night worrying about the 50% of my hospital’s costs going to take care of just the 5% of the worst chronic illness cases.’

Julie Omohundro
Principal Consultant at Class Three, LLC
So, Bo…what would you prefer to see as the biggest killers instead of the diseases that currently are, and how would you recommend that people live so they can be assured of dying of those causes instead? Bigger picture, what do you think makes one cause of death preferable to another?

Jerry Robinson
Consulting Designer: mHealth, IoT, Embedded Products, Wireless Commun, Consumer, and Disruptive Innovation Tech.
good approach…. I went and looked.. really good idea…

I stand in awe of the very high web site quality of goodrx.com.. the comparison approach is awesome..

I think the searching part – and threading down into the service is complex to do…

Vish Banthia
Chief Medical Officer, CEO
As a practicing physician, I see patients who have high deductibles who do not do indicated scans given their high cost…so basically, they ‘refuse’ the treatment as they cannot afford it for whatever reason. There are lots of cost-comparison apps out there — and I do agree with the above comments re: technologies finding solutions for this high-deductible phenomenon which is likely going to get worse over time. ZendyHealth.com is a more direct approach to getting care at affordable costs – as patients who have high deductibles tend to get their CT or MRI scans thru ZendyHealth now as it saves several hundreds (if not thousands) of $$ for them. Disclosure: I’m the founder — but this is exactly the problem what we are trying to solve…and it looks as if we are making patients and providers happy based upon feedback.

Irene Haimovich
ANZ Project Manager Marketing at GSK
Tough situation, I’m in Australia and most of the tests are under Medicare meaning bulk billing for us or minimum costs, therefore no, never refused a test. Working in medical device industry, we knew that if the device will not be reimbursed by the insurance companies than it will have minimum chance for success in U.S.

Jerry Robinson
Consulting Designer: mHealth, IoT, Embedded Products, Wireless Commun, Consumer, and Disruptive Innovation Tech.
“deductibles” will eat you alive.. you quickly realize that Obamacare is really aimed at “guaranteed money” for high end medical services.. big bill protection for hospitals and such… When you paying out $12K in deductibles.. then what you pay MATTERS….

Jerry Robinson
Consulting Designer: mHealth, IoT, Embedded Products, Wireless Commun, Consumer, and Disruptive Innovation Tech.
Take the approach that GOODRX is using.. start looking at equivalent cost – and consider Pharma.. and also flu shots.. “doc in the box” cost… and a whole lot more…

If you need an operation – then COMPARE LOCAL HOSPITALs… what is their success and failure rate?

The number of “comparison” apps is pretty vast…..

Already -there are two “teledoc” companies I know of.. $40 for a visit.. instead of “sometime next month – $90 to $160″… Teledocs deal in NOW – not LATER.. and that matters too…

Dominik Hoffmann
Principal Research Scientist at SAIC
This is the mechanism that will drive down health care costs. Not a government mandate!

Julie Omohundro
Principal Consultant at Class Three, LLC
Keith, I’ve nothing to sell only observations to make, and what you buy or don’t buy has zero impact on the reality of the situation. I see everywhere people arguing like whoever wins the argument will determine the truth of the matter. But the truth rolls on unaffected by arguments, bought or sold.

Keith Ensminger
Principal at Kramer Translation
I don’t buy your police analogies, Julie. First responders at the Boston Marathon or 9/11 came to protect and serve victims. Finding the perpetrators came next, same as the NYC police who helped us. Insurance is designed to pool participants, so by definition, we rely on others. Always been that way. My wife transitioned to Medicare this year, and the difference between the socialist program and private insurance is night and day, especially paying premiums as a percentage of income as the fairest way to protect our our nation’s health. We’re not commodities like a house, car, or washing machine where we’d expect to pay premiums based on the value of our property. The Legionnaires Disease that struck NYC recently wafted through the air and struck the health of rich and poor. We still have time to get it right.

Burrell (Bo) Clawson
I research patents & design products to get a patented competitive position: Over 30 patents.
John Eckberg has it right in more ways than most people might think: “Let’s fix what is broken.”

The most recent national articles on Alzheimer’s research noted the reduction in symptoms when people with Alzheimers ride a bicycle.

When we look at the percentage of overweight and particularly obese people in the population, what it does is implicate the whole US education system as being seriously deficient in teaching our entire nation about how to live properly.

Failure to educate citizens seems to be behind a large number of issues in the US.

Is there a clue here?

Julie Omohundro
Principal Consultant at Class Three, LLC
Keith, two good examples.

The police didn’t actually come to protect you and your friends; they came to apprehend a criminal. That is how they protect the community, and why the community pays for police protection with tax dollars. If you wanted someone to protect you and your friends, you would need to hire private security and pay for it yourself.

Communicable diseases do affect the community, but that’s a public health issue, not a healthcare issue. That is why the community supports public health agencies with tax dollars. Their mission is to protect the community, not individuals, from the impact of communicable diseases. Having worked in the public health sector, I can tell you that it is not that uncommon for the interests of the public health to conflict with the interests of the individual.

If you want to be protected from financial ruin in the event that you wind up in the ICU, you need to have health insurance to pay for your healthcare, and you need to pay for it yourself. If you rely on someone else to pay for it, then you can rely on it to protect someone else’s interests, not yours.

John Eckberg
Media Relations
ACA is a noble but flawed effort. Let’s fix what is broken.

Burrell (Bo) Clawson
I research patents & design products to get a patented competitive position: Over 30 patents.
Keith, you make a good point. Unfortunately, for decades, people have been used to the idea that “everything” will be covered by insurance and not just catastrophies. People are going to start to pay more attention to avoiding things that lead to medical care with “attitude adjustment.”

Keith Ensminger
Principal at Kramer Translation
I slept through an armed robbery in NYC, Julie, and I was glad the police came to protect my friends and me. Flu, Valley Fever, and other communicable diseases affect the community, and insurance is supposed to spread risk so people are protected from financial ruin if communicable disease lands them in ICU for weeks.

Julie Omohundro
Principal Consultant at Class Three, LLC
Josh, but it is the organizing that is the root cause of the problem. The sole purpose of organizing is to consolidate power, and it’s true what they say about power. To “corrupt” is to change from what it once was. All organizations rapidly devolve to the same bad end…whatever mission the organization was founded to serve is corrupted and their mission becomes the organization itself.

As for doctors organizing to “come up with something that really works to promote health within individual people and provide efficient and meaningful care when that health falters,” it’s been done already, with predictable results:

http://www.ama-assn.org/ama/pub/about-ama.page

Julie Omohundro
Principal Consultant at Class Three, LLC
I have never declined a test or treatment because of dollar cost. I have instead turned my back on healthcare altogether, because the value offered is not worth the time cost.

The system is not competent even at the level of scheduling appointments. If I do manage to make an appointment, I will then be given the healthcare that providers want to give me, rather than the healthcare that I want. Because only the latter has any value to me, all healthcare has become “too expensive” for me.

I have also turned my back on health, which has become The National Neurosis, and very unhealthy in its own right.

Julie Omohundro
Principal Consultant at Class Three, LLC
Keith, I would prefer to insure my health like I insure my home and auto, which is to say, to insure it only for actual crises, rather than for minor repairs and maintenance, and paying for it myself.

Police and fire protection are intended to protect the community more than to protect you, which is why the community pays for them. How that works with the police should be obvious. Fire protection is as much or more about saving the entire neighborhood as it is about saving the one building in which the fire started.

Julie Omohundro
Principal Consultant at Class Three, LLC
Jane, my instincts are that we have never been able to afford it, and that ACA has just revealed that awful truth. I think most likely the previously “affordable” care was more like the “affordable” housing made available through sub-prime mortgages, or the stuff we can “afford” to buy by charging it and not worrying about whether we can afford to pay it off later. The other side of this is when people say they “can’t afford” something, often they could in fact scrape together the money somehow if they really wanted to, and what they are really saying is that they don’t think it is worth the cost, not when they have to pay instead of someone else paying.