I Don’t Understand This

[UPDATE]:

10/27/15

I said all along this was hinky.

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Can one of my readers in the healthcare field please explain to me what “consumer-based lab testing” is? AHIP (America’s Health Insurance Plans) is holding its annual convention in Nashville right now and one of our local biz rags gave a brief rundown of what they’re discussing. “Consumer-based lab testing” came up and it sounds all shiny-sparkly-free-markety-“let’s all shop for our healthcare”-y. And I’m just trying to understand who this is for:

“Without consumer engagement, there is no pressure for prices to go down,” said Elizabeth Holmes, founder and CEO of Theranos.

Theranos, which Holmes founded in 2003 and has former Sen. Bill Frist as a board member, offers accessible and affordable lab testing, with transparent prices available on the company’s website. Holmes likened consumer-based lab testing to at-home pregnancy tests, and said by making lab testing more accessible, early detection becomes possible for patients who are not a part of the existing health care system.

“When prices are transparent and consumers are informed, competition flourishes,” Holmes said.

What the fuck does this mean? If you’re not part of the existing health care system, it’s because you’re either too poor (but not so poor as to qualify for Medicaid), or else you’re one of those young fools who thinks they’re invincible. So you’re gonna, what, get a blood test or a PAP smear or funny lump biopsied by “shopping around” for your labwork? Without a doctor’s referral? I don’t get it. Who’s taking the sample? If it’s a PAP or a biopsy, you need to see a doctor. So I’m just confused who would be “shopping around” for their labwork.

And is cost really the only issue when it comes to who is analyzing your lab work? Or even the most important issue? Isn’t accuracy kind of important, too? Even more important than cost? I mean, I can divine your labwork by gazing into a crystal ball and I’ll do it for $5. Don’t think I’d get many takers.

Or is she saying this is for people who are in the healthcare system? So that when I get my annual PAP smear or have a funny lump biopsied, I’m going to have to shop around and tell my doctor which lab I want processing my test sample? Like I have time for this? Like “consumer choice” is something I have time to deal with in my life? (And yes, I’ve already been down this road with Bill Frist and his infatuation with “shopping” for healthcare). Because again, cost is the only thing I’m supposed to care about?

Please tell me what I’m missing here. I swear to Goddess, Republican infatuation with “shopping” is so far removed from the way most of us navigate our daily lives. I do not want to shop for this shit. Who would? What consumers want, and deserve, is the absolute best healthcare, when they need it, without having to go bankrupt. Always and forever. That’s not shopping, that’s fixing our fucked up system.

38 Comments

Filed under health insurance, healthcare

38 responses to “I Don’t Understand This

  1. Eykis

    Beale,

    You win the innertubes today. Great rant. Agree 100%!

    BillionaireBill and WillieF running healthcare into the ground for profit. As sickening as Insure Tennessee is for those in need, it is something and that Rabid Ron Ramsey will not pass it. Ron and Beth, denying healthcare for their very own constituents, the EvangeliBaggers!

  2. Joseph Stans

    Ms Beale,

    This is just a way to craete a buzz phrase as center peace for later marketing. If the sleazy Frist is in on it is not a good idea for consumers.

  3. Chris T.

    When I’ve accidentally chainsawed off a finger, I always shop around for the best emergency room, and wait for “reattach thumb” to go on sale, myself.

    That’s why I’m typing this with my nose.

    (/sarcasm)

  4. CB

    I have no idea, either.

    Lab work, for some reason, seems to be one of those things that goes through 52 pick-up with the insurance companies every couple of years. For example, I have BCBS’s HMO policy. My primary doctors have their own lab facilities, and for a few happy years, I was able to have them do my labs when I went in for my routine check-ups. Then it changed again, and now (again!) I have to get up at the crack of dawn, fasting, and go to a lab facility, where I will sit for approximately an hour before I’m called back to pee in a cup and have my blood drawn. It’s a good day when my blood sugar doesn’t tank before I can get out of there and get something to eat. I’m supposed to have this done 3-4 times a year. Sometimes I fall behind. I have an insulin pump with a glucose monitor built into its controller. If my endocrinologist, or my primary, want to see how my blood sugar is running, they can download the readings, and they do this, but there’s still a requirement for independent lab analyses.

    A cynic might surmise that this rant about consumer choice is simply another way of saying, “My Cousin Al just set himself up in a medical lab, and I’d like to be able to funnel some cash his way.” It sounds too simple, but could that be it? That’s kind of the way things work in Georgia, anyway.

  5. S. Miller

    I took this to mean that they are talking about the big chain labs like Quest Diagnostics and LabCorp. Often times, doctors were not doing their own tests, and I had to go to one of the two labs above for annual blood tests. This meant that I put them off for a long time.

    Sometimes, insurance will have a contract with one lab but not the other, and you have to go to their preferred lab. But there may be loopholes for particular tests that a particular lab cannot do. For example, LabCorp either could not do a particular type of allergy test so that type of test would get farmed out to Quest. Here are some people discussing that test.

    • But then there’s no “shopping around” for lab tests and no need for “transparency” on a website about pricing, right? I’ve had to get bloodwork done directly by Quest and there was no debate about where I would go, the only place I COULD go was Quest. They were the only ones who did that test.

      So I still don’t get who this is for.

      • Years ago, I asked the doctor’s office how much it would cost to get just the lipids profile (all the PCP was interested in knowing, at the time) and they gave me a price of around $30. The bill came in at about $140 and when I asked them about it, they said, “Oh, well, they ONLY do the whole thing.”. I moved on to another practice.

        I will say that the VA does labs that are as exhaustive as any I’ve seen. I guess that they figure blood and piss will tell them more than “self-reports” from their patients (and they’re prolly right).

  6. Jim in Memphis

    Since a lot of heath insurance plans are going to high deductible types then it makes sense that people will want pricing information on things like lab testing that they are likely going to pay for out of pocket as part of meeting their deductible. So yes, I can see where someone that is looking at paying $200-$300 for some lab tests may want to spend a few minutes surfing the net to look for the best deal.

    • Jimbo(b):

      I understand that there are numerous “labs” that are more than happy to do work for a lower price than better known concerns. The fact that they may not do them correctly won’t be a problem, I’m sure.

    • Lab work is covered thanks to Obamacare, though. For example, every insurance plan MUST cover PAP smears and mammograms. If they don’t, even a high-deductible plan doesn’t meet the Obamacare standard and basically those plans got dumped by insurance companies (that’s what all of that hullaballoo was about when insurance companies stopped offering certain plans and Republicans pretended Obama was a liar for saying “if you like your plan you can keep it.” Those were crappy plans that no longer met the minimum standard because they didn’t cover a bunch of basic stuff. And if you liked that plan you were a fucking moron.)

      So I still don’t get what this is about.

      • Jim in Memphis

        That would only cover lab work done at your annual check up that is free. Any other time you go to the doctor you are paying out of pocket until you reach your deductible.

      • But if you read the link, it’s the regular stuff that this Theranos woman seems to be talking about. She’s not talking about “any other time,” some kind of diagnostic labwork that is outside the minimum care and is prescribed by a doctor (and which is often part of your regular insurance plan, too — I’ve had diagnostic mammograms and they are always covered, I never pay out of pocket).

        No, she’s talking about lab tests that do “early detection” and it’s “for patients who are not a part of the existing health care system.” That’s the regular blood work, biopsies, mammograms, PAPs, etc.

        So I still don’t understand who would avail themselves of this.

  7. Randy

    This:
    “This is just a way to craete a buzz phrase as center peace for later marketing.” -Joseph

    Rich people that don’t golf got to Caribbean Resorts on business trips and ooh and ah over spreadsheets while they eat their West Indies salads. They can afford the high deductible plans Jim references above. Ergo they’re shopping around. The HIV+ homeless guy in the ER …Not so much.

    • Jim in Memphis

      Randy – Most of the exchange policies being sold are high deductible plans. They have deductibles that are in the thousands.

      http://www.healthpocket.com/healthcare-research/infostat/2014-obamacare-deductible-out-of-pocket-costs#.VXUM2c9Viko

      The silver plan average deductible is almost $3,000 for an individual and $6,000 for family coverage. That is the plan that is covered by the subsidies in the law.

      • Gosh, whillikers, Jimbo(b); I would think that you would LIKE that feature. It will keep allathem TAKERZ from squandering alla YOUR hard earned privileged healthcare dollaz!

        Oh, there is that little detail about several-to-a-fuckton of people now having coverage of some sort that is BETTER than what they had before or way better than nothing.

      • Jim in Memphis

        DC – my comment was in response to Randy’s assertion that only the “rich” could afford high deductible insurance plans. I am not sure what your response to me was supposed to mean.

      • I appreciate the clarification Jim. This blog business serves an educational function for me as well. Having said that I don’t know that it follows that the poor can “afford” high deductibles. Apparently if one falls in the subsidy demographic that’s the choice available.

  8. Ginny Welsch

    Theranos can do blood tests with just a few drops of blood, taken from what is essentially a pin prick. They can do testing for about a tenth of what a hospital charges. Lab work is a major part of health care costs – it’s a multi-billion dollar industry. Medicare pays more than $10 billion a year for lab work alone. Theranos wants to bring that down, and make access faster and cheaper. Think about cancer patients or others who have to get blood drawn all the time. Theranos offers a way to get the testing done without being ridiculously expensive. The company’s prices are set to never exceed half the Medicare reimbursement rate for each procedure. I believe the plan is to eventually have labs set Walgreen’s all over the country.

    • Ok, so I know some people on certain meds have to get bloodwork done regularly, but does insurance not typically pay for that? And again, aren’t those people already IN the healthcare system? If they’ve got a condition that needs regular monitoring, I would assume that means they’re already under a doctor’s care. I don’t get the part where Holmes says thanks to Theranos, “early detection becomes possible for patients who are not a part of the existing health care system.”

      I can see where getting bloodwork, etc. done at a Walgreen’s or CVS would be a huge convenience to people who require regular testing for whatever reason, but I don’t get the pricing benefit. If it’s already covered by insurance, then that’s not a direct benefit to the consumer, that’s a direct benefit to the insurance company. And I don’t get where this is supposed to benefit people not in the healthcare system because suddenly they can go to Theranos’ website to price a test of some kind.

      It’s still not entirely clear to me.

      BTW speaking of pharmacies, there’s a new law in California that allows pharmacists to do bloodwork and directly prescribe some medications like hormonal birth control. Again, a huge convenience, and I like the idea of anything that makes it easier for women to access birth control. It might be something we’d want to look at here in TN, if we’re all so interested in free markets and competition and all that. But it would be directly in competition with companies like Theranos so I bet it wouldn’t go anywhere. Also, I do have a problem with the people prescribing your meds being the same people SELLING them. Seems to be potentially problematic, and patient care could be compromised.

  9. The New Yorker profiled Elizabeth Holmes last December, and she didn’t seem sleazy, just very driven and (a bit suspiciously) well-connected. As Ginny Welsch points out, the aim seems to be to wrestle blood testing away from the big lab racketeers who own it now, but there is always the potential that the replacement is a bigger crook: http://www.newyorker.com/magazine/2014/12/15/blood-simpler

    • From the link, “If you show the pharmacist your I.D., your insurance card, and a doctor’s note, you can have your blood drawn right there.” So people already in the HC system. Interesting she’s in Silicon Valley, and the state that just passed the Pharmacy Act I mentioned below. So I guess if Walgreens and CVS and the like are sending their blood samples to a Theranos lab, the new law is actually a big boost to companies like Theranos. I don’t have a problem with it, but I do see some potential problem areas. The “regulatory gray area” in which they operate, for one … (“ince Theranos manufactures its own testing equipment, the F.D.A. doesn’t need to approve it, as long as the company doesn’t sell it or move it out of its labs. Holmes said that the company has long resisted discussing how its technology works or how it makes money in order to avoid tipping off potential competitors.”)

      And this:
      “The board of her company is stocked with prominent former government officials, including George P. Shultz, Henry Kissinger, Sam Nunn, and William H. Foege, the former director of the Centers for Disease Control and Prevention.”

      Just seems fishy to me.

  10. Seeker

    I’ve had a similar problem to CB’s; I’m not on an insulin pump, but I do need quarterly bloodwork done, and both LabCorp an Quest are absolutely abysmal. It doesn’t matter if you make an appointment for a specific time; I’ve made appointments for 7 am, shown up at 6:55 am, and not been seen until 9 am, at which point I’m dizzy and sick from not having eaten anything. Additionally, when my son was on Accutane, he needed monthly bloodwork to check for potentially serious side-effects. Since we all have lives, the monthly appointment meant taking time off from work/school and standing around in the LabCorp lobby from 6 am until they opened at 7 (and we were not the first people in line at 6 am). The dermatologist kept faxing over standing orders for bloodwork; every month, the inept and sullen LabCorp would deny they had the request, and naturally the dermatologist didn’t open until 10 am. It’s quite a racket these labs have going on.

    • I can definitely see how being able to pop into Walgreen’s to get those tests done would make many peoples’ lives easier.

    • CB

      I would never even suggest that the medical lab “industry” doesn’t need a lot of work. It does, for sure, a big ol’ overhaul. I’m just skeptical of the new and shiny being all that much better. Yes, it might be far easier to just go to Walgreen’s to get your blood work done, but I’m having a hard time wrapping my head around that one. If you’re seeing your doctor on a regular basis, and his/her office has qualified technicians on staff anyway, what’s so wrong with killing two birds with one stone? That’s what makes me suspicious.

      Seeker, I hear you loud and clear. I’ve had blood taken by every vampire you can think of — one of the very, very worst being a phlebotomist in a hospital; wouldn’t you think that’s where you get the very best? But no, I went home with a hematoma on my hand the size of a jelly bean, and a bruise inside my elbow the size of a tennis ball. This was part of a week-long stay for my initial diagnosis of diabetes, years ago, so I was being stuck all the time. Arterial blood gasses are still the worst. Thank God and all his angels, I haven’t had to have that done in years.

      • Seeker

        CB, when I was on Accutane in the early 1990s, my regular-old, nothing-special dermatologist office drew bloodwork right in the office (I recall it was a nurse who drew it, but that could be mis-remembered). In the late 1990s, my standard-issue, nothing-fancy GP’s office drew bloodwork right in the office. It seems to me that in the 1980s and 1990s, if a doctor wanted blood taken, s/he had a paid staffmember qualified to do it. Now? They’ve outsourced it to make a buck, and it’s LabCorp or Quest for the patients to waste their time. I quit going to an endocrinologist because she demanded monthly bloodwork but had nobody on staff to draw blood. Spending hours a month sitting in a chair at LabCorp next to coughing, sneezing people, screaming babies, and blaring Fox news on the tv? Ain’t nobody got time for THAT.

        However, like you, I’m a bit suspicious about a drug store pharmacist drawing blood. It was a drug store pharmacist who refused to give Accutane to my (cisgender) son without my son providing a negative pregnancy test first. He told me that with my son standing right there in front of him.

        Like you, I also have had absolutely horrible results from hospital phlebotomists. I’m now seeing a nurse practitioner whose office has several people on staff who draw blood…who are actually quite good at it. I can’t explain it, but I am grateful for it.

      • Ginny Welsch

        Actually the labs in Walgreens have Theranos trained technicians doing the draws, and the amount needed if miniscule – 1/1,000 of a typical draw – and can run 30 tests off one drop of blood. And prices for tests are clearly listed. As an example, this is a bit from the Theranos site:

        panel ABO/RhD Blood Typing $4.10
        82003 Acetaminophen $13.91
        82024 ACTH (Adrenocorticotropic Hormone) $26.55
        87799 Adenovirus DNA, Quantitative $29.44
        84460 Alanine Aminotransferase (ALT/SGPT) $3.64
        82040 Albumin $3.40

        While it may seem like I am advocating for Theranos, I have never been to one of their labs, which I understand are only in Arizona and california right now, and have limited knowledge of the company. But I read several articles in the past couple years about the company founder, who dropped out of Stanford at 19 when she developed this new way of testing blood. I found it all pretty amazing.

      • Yeah Chris Clarke posted a link here to a profile they did on her in the New Yorker last year. I have a slightly better understanding of “who this is for,” which was my original question, but I’m still not 100% sold. I get the convenience aspect, especially if you’re required to get regular bloodwork. The more I looked into it, however, the more other issues popped up. Their technology is proprietary and so doesn’t require FDA approval, for instance. And in general having the same person testing you as who is selling you drugs might need some kind of oversight (per CA’s new pharmacy law…)

      • CB

        That’s what bugs me. I can’t have a technician in my doctor’s office do a blood draw, but I can go to a pharmacy, which is in the business of selling drugs, not providing medical care, to have blood drawn? Glad to see that I’m not the only one who has a problem with that.

  11. Since you can now get injections for both the flu and shingles at my local Walmedimart (or for that matter, the local chain grocer) I can see where it’s easy for them to make the jump from using real phlebotomists to having someone with whatever the state’s minimum for training is in that profession*.

    * I don’t know if it’s still the case, but a few years ago the state of NY required something like 200 hours of training for someone to do weaves and extensions in a salon and somewhat less (not quite zero) for dermographic artisans. Just sayin.

  12. Seeker

    Re: insurance paying for bloodwork; it depends on the insurance. Thanks to my former company switching insurance mid-year, my spouse’s company having better insurance, and then me getting a job with pretty good insurance, I’ve dealt with five plans in the past 14 months. The worst plan cost $1200/month (with a $5k deductible) for a family of 3, $100 office co-pays, $100 blood draw co-pays, and about 70% of the actual bloodwork at the lab….and prescription drugs were practically actual-cost. It was so bad that my Costco pharmacist took me aside to speak to me about going on the ACA because he’d never seen a plan as bad as the one I was on. The next plan I was on was also about $1200/month for the family, but with a $60 doctor’s office copay and a $60 copay for blood draws. The spouse’s insurance was about $800/month with a $4,000 deductible, but actually covered prescription drugs (mostly) without having to meet the deductible. It also charged office co-pays and for blood draws.

    My current insurance is about $800/month, $4k deductible (paid by the company), no doctor co-pays, no blood draw co-pays, and covers probably half of the prescription drug cost.

    TL:dr; employer-provided insurance plans vary wildly in what they will and won’t cover. When employers switch insurance plans mid-year (or even open season), there is literally no way for an employee to plan ahead or shop around, because the field is always shifting.

    • “I’ve dealt with five plans in the past 14 months.”

      You have my sympathies!

      • Seeker

        Thanks! It’s not by choice! What I can say is that there are absolutely no standardization in plans; 3 out of the 5 health plans were BC/BS, and no two covered the same things for the same price. There is no way a consumer can make a rational choice on any care based on cost, because the cost is always shifting.

      • Definitely true of insurance plans. It’s why I’ve always said the mantra of “shopping for your insurance plan” sounds like some dystopian horror show. Who the fuck wants to wade through that toxic waste dump? Just give me my damn healthcare without all the drama. Just let me see the doctor of my choice, when I need to, without causing me to file bankruptcy. Why is that so hard?

      • CB

        Well, it’s very hard for congresscritters who never supported the ACA, because SOSHALIZUM! And, that attitude just naturally filters down, like dandruff, to their supporters in medical laboratory companies, especially, as well as hospitals, doctors’ offices and pharmacies. Yes, I know, very conspiracy-theory of me, but at some point, it all clicks together.

  13. When social services of all sorts are delivered to ALL recipients at exactly te same level, then those useless fuckbags in Congress will sit up and take notice. So long as they get a better deal, they simply won’t give a fuck.