Written by Tony Payne
As consumers, our knowledge about the all-in cost of health care procedures is abysmal — and hospitals aren't much better. Of course, there's a perfectly good reason; most all of the cost is paid by an insurance company. A hip replacement, for example, costs anywhere from $11,100 to $125,000 so wouldn't you expect people to go shopping? Because patients pay only a fraction of the cost, why should they care? Besides, it is difficult to get a total price for elective surgery.
It's not as if prices are a mystery or can't be obtained. There simply isn't an incentive for providers to publish their costs which leaves consumers, employers and taxpayers paying higher monthly insurance premiums that are eating up our paychecks, profits and Medicare funding. Meanwhile, the cost of health care absorbs nearly $18 of every $100 in the U.S. economy, the highest per capita cost in the industrialized world.
Most hospitals don't know the all-in costs, according to a 2013 study published in the Journal of the American Medical Association for Internal Medicine. Hospitals and surgeons charge separately so determining an all-in cost takes some diligence.
The study, conducted by a team from the University of Iowa, surveyed two hospitals in each of the fifty states as well as two in Washington D.C. They also polled the top twenty hospitals for orthopedic surgery as ranked by U.S. News and World Report. When asked for the all-in cost for a total hip replacement, 45 percent of the top-ranked hospitals were capable of providing a package price. Only 10 percent of the non-ranked hospitals could meet the all-in cost challenge.
Those top-ranked hospitals that could offer a complete-package cost ranged from $37,489 to $68,791 with a mean of $53,140. The mean cost for non-ranked hospitals with an all-in price was $41,666.
The aggregated data in the study showed that surgeons' charges for doing this procedure at top-ranked hospitals ranged from $6,450 to $17,500 with a mean of $11,117. Surgeons at non-ranked hospitals charged about $9,203.
Not knowing or caring about prices carries a high cost. When consumers have very little skin in the game, the beneficial forces of competition don't come into play. Imagine buying a car knowing that your out-of-pocket cost is only going to be $3,000 yet you can choose any car on the lot. What's your incentive to buy anything but the vehicle that has all the bells and whistles you want? That reminds me of an abject lesson is in dissociative behavior. A friend driving his dad's car was abusing the transmission. When I said "take it easy," his response was "Hey, it's not my car." In health care, it seems we all say "Hey, it's not my money." But, of course, it is.
The intermediary in our current delivery model is the insurance carrier which picks up the rest of the tab. It has an incentive to control costs in order to price its insurance products competitively. But its negotiated rates with hospitals and physicians is so far removed from the consumer that we simply take for granted that insurance premiums must be fair and competitively priced.
That begs the question: How can we inject consumer incentives into the health care system as well as create transparency in pricing? Education and persistence.
One of the best available solutions to changing consumer behavior that lowers cost is the health savings account. By design, a health savings account (HSA) plan has a high deductible for which the consumer is responsible. For example, if a consumer has to pay the first $3,000 of annual health costs (with the exception of preventive care that is paid by insurance), studies indicate that utilization and costs decline. According to a 2011 study published by the National Center for Biotechnology, people having an HSA-eligible plan had:
17.4 percent lower total expenditures
13.6 percent fewer office visits
20.3 percent savings for those office visits
20.1 percent fewer emergency room visits
29.2 percent lower costs for pharmacy expenditures
27.9 percent lower expenses per drug
Until health consumers have skin in the game and clear, concise, all-in data becomes available for common elective medical procedures, it is unlikely that we will be able to bend the cost curve. You can change your own behavior and cost of health care, though, by enrolling in your company's HSA plan or request that your employer offer this cost-saving opportunity.
Last Updated on Tuesday, 04 March 2014 23:38
Written by Timothy Gillis
Rosa Noreen's first car was a rowboat. The local dance instructor and owner of Bright Star World Dance grew up in a boatyard in Jonesport, where she hit the waves on the family craft and fell in love with the water.
Her family is a big influence in her life. She learned her business skills from her mother, Twig, who was also a dancer and a dance teacher in Machias. Her father, Sune, built Twig a barre, which Noreen has in her studio today. When Noreen began dancing at age seven, it was a natural progression from the ocean to the ballet studio.
"There's a connection between feeling good dancing and being on the water. You become one with the music," she said. "The goal is to ride the music like a wave. Don't anticipate too much; let it carry you along."
Noreen continued to take dance seriously, and was pre-professional, until age 16 when Achilles tendonitis made her reconsider her future plans.
"I thought dance was over for me," she said.
That was until a fortuitous day in Portland, while pausing at a traffic light. She saw through a window women belly dancing at Full Circle Synergy, which was a t'ai chi studio at the time.
"The women were all having a wonderful time together dancing," Noreen said. "It didn't look competitive. It looked like a fun, positive time and I wanted to be a part of that."
She had been teaching belly dance classes in Bath, Yarmouth, and most recently Portland, and decided it was time to take the plunge and start a studio.
She was talking with her friend and fellow dancer, Jan Hanseth, who also wanted her own space, and they decided to write a business plan together.
"We lucked out," Noreen said. "We found a space quickly. Our rent was cheap, and we were able to get off the ground right away."
Their first studio space, which opened three years ago on Congress Street, helped them solidify the business. Hanseth moved to California last year, but is still part of the management team, which now also includes Heather Powers.
When the chance to move into a recently renovated studio on High Street came up, they couldn't resist. Bright Star Dance World opened its new location (the blue door next the Little Tap House) on Feb. 15. Since then, dance classes have been in full swing.
Noreen, who released a belly dance instructional DVD in 2011 called "Delicious Pauses: Negative Space in Movement," teaches traditional belly dancing, a fitness class called "Lunchtime Shimmy," and ballet.
Powers teaches Fusion Belly Dance, a mix of American tribal-style and traditional belly dances, fused with hip-hop. She also teaches Pilates.
The studio offers theatrical belly dance with Joie Grandbois from Dark Follies, the goth street theater group that rehearses at the space. There's Belly Fit, a Zumba-like dance (cardio style) taught by Katy McCann, and American tribal-style belly dance taught by Joanne Rawlings-Sekunda.
In all, Bright Star instructs in six different kinds of belly dance with five different teachers. Such a supportive cast allows Noreen to spread the dance story to more places.
"I travel nationally to teach and perform," she said. Last year, she taught workshops and performed in Las Vegas, San Francisco, Dallas, North Carolina, New Hampshire, and Massachusetts. Also last year, she founded the Grace Academy, through which she teaches belly dance workshops and ballet. But that busy schedule doesn't keep her from maintaining a strong local presence.
"My classes here are my home base, and I love to share the beauty and power of belly dance," she said. "The nationwide belly dance community is incredible, and we are lucky to have an especially vibrant and supportive local community."
Portland is a food and arts town, but it's definitely a dance town, too, she says.
"Portland is a town where you can make things happen. People here are receptive to new things and exciting ideas. It's a very supportive town for new ventures," she said. "You need a good business head to make it happen, but you can."
Noreen's love of dance, especially expressive movements like belly and salsa dancing, comes from an appreciation for cultural history.
"Belly dancing is a folkloric dance in its truest form," she said. "Like salsa, everyone does it. It's the way people dance at home."
Her own style is influenced by Egyptian dance, she said, and she's learning to move while wearing a shamadan, a traditional Egyptian element that looks like a chandelier hat.
In a bridal procession or a birth ceremony (called a sebou), a shamadan dancer leads the way.
Her classes are taken by women, primarily, but she also welcomes men to participate.
"In the Middle East, it's just the way people dance — men, women, children. You don't go to a class; it comes up through the generations. It's a social entertainment," she said. "It's a dance form that honors your curves and your own personal history. Coming from ballet, it was a challenge to retrain my body. In ballet, you keep your hips level and your lines long and extended. In belly dance, you create curves and move in a sinuous way."
Regardless of the style or celebration, belly dancing for Rosa Noreen and Bright Star World Dance is a natural means of expression, as easy as rowing a boat.
For more information, visit www.BrightStarWorldDance.com.
Last Updated on Wednesday, 05 March 2014 02:38
Written by Tony Payne
During the Olympics in Sochi, we visited our son in Montana where many college students pursue their "45 degree" — a metaphor for some of the best downhill skiing in the country if you're a university student.
A couple of days before arriving in Bozeman, our son fell over a 40-foot cliff while avoiding a collision and landed on the rocks below. Gratefully, he walked away from the emergency room with only bruises. The incident reminded me, though, of all those elite athletes competing at the Olympics and the risks associated with a world-wide event.
According to a 2012 article posted on Kaiserhealthnews.org, elite athletes can access health insurance coverage through the United States Olympic Committee — but getting covered depends on how well you perform. The Elite Athlete Health insurance Program issues about 1,000 policies that are allocated among the various governing groups for specific sports (e.g. swimming, alpine skiing, badminton, track & field, etc.).
Athletes who win a spot on an Olympic roster get first crack at a policy. Those not selected for the team then are considered based on their world rankings or other similar performance-based criteria. Those who train full time but don't qualify are on their own. Since the passage of the Affordable Care Act, all Americans must now buy health insurance. One of the benefits for young competitors is the ability to remain on their parents' health insurance policy until age 26 — incidentally, 26 is the average age of America's 2014 Winter Olympics delegation.
Though these super-humans are generally the epitome of health, they are heavier than average users of health services. Nothing goes unnoticed while striving for the top of the heap. An ache, pain or cold can lower their performance and impede their constant training. Remember, more than one timed-event in Sochi was decided by hundreths of second.
Some athletic disciplines, such as gymnastics, offer individual coverage that insure against catastrophic events such as paralysis to avoid having the organization sued. Despite careful coaching and years of training, a body hurdling through the air, whether in a gym or down a mountain or over a cliff, is inherently risky.
A 2010 Newsweek article noted, however, that at the 1996 Atlanta Summer Games, those who came to watch the competition were the heaveist users of medical facilities during the weeks-long competitions. More than 75 percent of those requiring medical attention were spectators.
On the property/casualty side of insuring the Summer or Winter Olympics, just imagine everything that could go wrong and the financial consequences.
Thousands of visitors walking on snow and ice
No snow or too much snow
Safety threatening heat
Kidnap and ransom
Then, of course, there are all the travel challenges, corporate entertaining and sponsorship risks. Delays, cancellations, bad behavior and other variables all have a cost that most often can be insured — at a price.
For insurers and brokers, the Olympics are a field day of opportunity as well as an abyss of peril should things go wrong. Gratefully, the Sochi games appear to have come off without a major hitch. Most of the athletes returned home with their good health and some with medals; advertisers reached millions of viewers with product pitches from their sponsored athletes; and the world came a little closer together which helps reduce our global risks of conflict. All in all, it was a fabulous display of well-insured talent.
Last Updated on Wednesday, 26 February 2014 01:38
Written by Natalie Ladd
Forget Me Nots
A unique consignment boutique for women
190 U.S. 1, Falmouth
Many consignment shops in the Greater Portland area have clever and catchy names but none has an origin story better than Forget Me Nots. With their business located on Route 1 in Falmouth, owner Jeannine Forget (pronounced Four Jet) and her daughter M.J. Spurrr are celebrating 21 years in business.
"How we got our name is really a great story," Forget said. "I had been downsized from Blue Cross/Blue Shield and this is something I'd always wanted to do. A friend of mine had retired from the company and he and his wife were living on Peaks Island. When they heard I was going to do this business, they brainstormed and sent me a big, long list of potential names. I guess they had the time to sit and brainstorm and Forget Me Nots was on the list. It was perfect because my last name is Forget."
Open everyday, Forget and Sparr have five employees and enjoy the partnership. "How M.J. came to work here is also a great story. About a year after I opened, she came back from living in Boston to look for a job practicing law in Portland. She was working for me part time and was only going to stay as long as it took her to find the right job. After a few interviews, she decided this was way more fun. And a legal education is good for lots of things."
Known among consignment shoppers for upscale, designer items, Forget doesn't think her business has been impacted by newer consignment and thrift shop competition. "We've really established ourselves. We stay current as far as trends and better quality items go and our designer names are always authentic pieces. We have Cole Haan, Coach and Louis Vuitton bags and shoes, among others."
Also standing out from the rest is a state-of-the-art computer system that keeps inventory well managed. "People always get paid what they're owed. There's never a problem with this, which used to be an industry issue." When asked about the option of purchasing store merchandise with credit due instead of getting a check, Forget laughed. "That's part of our evil plan," she said.
Visit the website for details on location, hours and consignment policies.
Last Updated on Wednesday, 26 February 2014 01:38