From Labor and Delivery to LDL

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From Labor and Delivery to LDL Gender Issues in
Cost and Quality of Care Eric Bricker, MD
Dallas Association of Health Underwriters Novembe
r 16, 2011
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Background

• Compass Professional Health Services
• -Tools and Support for Healthcare Consumers
• General Internal Medicine Physician
• -Internist, PCP
• Johns Hopkins trained
• Hospital finance consultant with
• Stockamp Associates

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Labor and Delivery

• Cost Variance
• Ob/Gyn fee global billing
• Hospital fee local variation
• Anesthesia fee INN vs OON challenges

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Compare prices for Labor and Delivery
In Network Facility 1
6,450
3,350 wasted
In Network Facility 2
3,100
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Compare prices for C-section
In Network Facility 1
12,400
4,600 wasted
In Network Facility 2
7,800
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Compare prices for MRIs
In Network Facility 1
2,300
1,350 wasted
In Network Facility 2
950
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Why? How can this be?

• Hospital A
• I want good reimbursement for imaging
• Contracted Rate of 2,300
• I am willing to take lower reimbursement for
  deliveries
• Contracted Rate of 3,100

Hospital B I am willing to take lower
reimbursement for imaging Contracted Rate of
950 I want good reimbursement for
deliveries Contracted Rate of 6,450
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• Repeat that dynamic for
• Labor and Delivery
• Endoscopy
• Outpatient Surgery
• Implantablespacemakers, stents
• MRIs
• Med/Surg Day Rate
• Final Average Discount Rate

Hospital A 50
Hospital B 50
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Labor and Delivery--Quality Variance

• Despite the more than 4 million deliveries in
  the United States each year,1 there are currently
  no uniformly accepted measures of obstetric
  quality
• --Obstetrics and Gynecology May 2010
• Delivery Volumedoes NOT appear to correlate with
  better outcomes (unlike some other medical
  procedures)
• CMJ May 2002, J of Womens Health Oct 2010
• Highly VariablePersonal Diligence Communication
  breakdowns w/ handoffs
• Rushing

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Hysterectomies

• Cost Variance
• Ob/Gyn feenot much variation
• Facility fee
• Hospital Outpatient - Most
• ASC Outpatient - Middle
• Hospital Inpatient - Least

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HysterectomiesQuality Variance

• Frequency of Hysterectomies is highly
  variableshould it be done?
• 50 more hysterectomies performed in the South
  than in North East or West
• CDC 1994-1999
• Five-fold difference within one state
• Am J of Obstetrics and Gynecology
• Alternatives to Hysterectomysecond opinion
• Medication, uterine artery embolization,
  myomectomy, ablation

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Cardiovascular Disease

• 1 Cause of mortality for women
• Prevention is the best medicineABCs
• Mayo Clinical Proceedings Aug 2008
• A Anti-platelet therapy (aka Aspirin)
• Platelets form blood clots
• Body is constantly producing and dissolving
• clots in the blood stream
• Must be weighed against risk of stomach and
• intestinal bleeding

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Cardiovascular Disease

• B Blood pressure control
• 30 have high blood pressure
• 30 of those with high blood pressure are
  unaware of it
• 50 of those treated for high blood pressure
  are NOT adequately treated
• --usually requires 2 or more medications
• CDC Jan 2011

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Cardiovascular Disease

• C Cholesterol and Cigarettes
• Cholesterol
• LDL and HDL numbers are important
• ATP III Guidelines
• Cigarettes
• Tear up the blood vessels
• Must address cravings

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Cardiovascular Disease

• D Diabetes
• 1 in 12 adults have diabetes
• 30 of those with diabetes are unaware of it
• 40 of those treated for diabetes are not
  adequately treated
• CDC, American Diabetes Association
• E Exercise
• Goal of 10,000 steps per day (30 min of
  exercise)
• Buy a pedometer
• (F) - Fun

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Cardiovascular Disease

• (F) Fun
• Attitude, Stress and Coping Mechanisms count
• Cortisol, Epinephrine stress hormones
• Northridge Earthquake
• Tako-Tsubo Stress Cardiomyopathy
• aka Broken Heart Syndrome
• Type A personalities at increased risk
• Psychosomatic medicine Nov 2006

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Comments and Questions

• Eric Bricker, MD
• Compass Professional Health Services
• Tools and Support for Healthcare Consumers
• --Price Transparency
• --Quality Transparency
• --Consumer Advocacy
• ericb_at_compassphs.com