The $29,000 Appendectomy! (Brought to You by Cost-Shifting)

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This past May my married daughter suddenly developed abdominal pain.  She was promptly diagnosed as having appendicitis, and within 12 hours after the pain started, she underwent an appendectomy. Twelve hours later she was discharged from the hospital.  Her entire hospital stay, including emergency room evaluation, testing and surgery, lasted less than 24 hours.  She had absolutely great care throughout and was back to her busy schedule within a few days.

Why am I bringing this up on the eve of the Supreme Court’s decisions on several key elements of the Affordable Care Act (ACA)?  Because the hospital charges for less than 24 hours of hospital care were $29,000!!  That’s right, over $1,000 per hour.  Thankfully she has health insurance through her husband, so she only needed to pay $585.  If she didn’t have insurance, she’d be facing that staggering $29,000 bill.  Remember, this does not include the surgeon’s, anesthesiologist’s or emergency room doctor’s charges.

A couple of points:

  • The $29,000 stated cost is the result of cost-shifting.  Remember, my daughter only had to pay $585 which is 20% of the amount that her insurer had negotiated with the hospital.  If you do the math, the negotiated charges to the healthcare insurer were $2,925.  The insurer paid 80% of that which was $2,340 and my daughter paid the $585 balance.  Cost-shifting occurs when one group of individuals pays less than another group for the same service.  Hospitals use this tactic to make up for the loss they incur by providing care to someone without insurance who will not be able to pay the bill or to an insurer whose payment is actually below the cost of that service.
  • The non-insured patient could negotiate with the hospital and probably satisfy their debt at an amount much lower than $29,000.  The hospital would probably be very happy if they received anything over the $2,925 that they get from an insurer.  The trouble is, the non-insured individual doesn’t know how much might be acceptable to the hospital, and the hospital doesn’t have to tell them.

This happens all the time, though the difference isn’t usually this huge.  If you have health insurance and have had medical care recently, you have received an EOB (Explanation of Benefits) notice from your insurer that lists the services you received, how much the negotiated fee is, how much your insurer paid & how much you owe.

While this lack of transparency may hide the true cost of care, there is nothing fraudulent or illegal about it. I guess I prefer not to be playing these number games.  The cost of an appendectomy at a specific hospital should be the same for everyone.  There is a lot to consider about the individual mandate, but if the Supreme Court upholds its constitutionality in the ACA, I believe we’ll move closer to that goal by decreasing the need for cost-shifting.

What do you think?  Have you seen these huge differences between what’s billed by a hospital or doctor and what fee is accepted?

For Your Health – Dr. Bob

Nutrition Basics – Healthy Servings & Portions

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Just How Much Is A Serving?

The key to healthy eating is learning the size of a serving for each of the foods you eat and eating the recommended amounts each day. This next table gives you some examples for each Food Group.

Food   Group

1   Serving
Grains 1 slice bread
1 oz dry cereal
1/2 cup cooked rice, pasta, or cereal
Vegetables 1 cup raw leafy vegetable
1/2 cup cut-up raw or cooked vegetable
1/2 cup vegetable juice
Fruits ½ cup fruit juice
1 medium fruit
¼ cup dried fruit
½ cup fresh, frozen, or canned fruit
Fat-free or low fat milk and equivalent milk products 1 cup fat-free or low-fat milk
1 cup fat-free or low-fat yogurt
1½ oz fat-free, low-fat, or reduced fat cheese
Lean meats, poultry and fish 3 oz cooked meat, poultry, or fish (1 oz meat = 1 egg) (Limit egg yolk intake   to no more than 4 per week due to high cholesterol in yolks.)
Nuts, seeds and legumes ⅓ cup or 1½ oz nuts
2 Tbsp peanut butter
2 Tbsp or ½ oz seeds
½ cup cooked dry beans or peas

So, if you are planning to have 4 servings of fruit today, you can attain that by eating 1.25 cups of dried fruit.  Since a serving of lean meat, poultry or fish is 3 ounces, you should eat no more than 6 ounces a day of any of them if your healthy meal plan is 2000 total calories a day.

 Portion vs. Serving

These terms are often used interchangeably, but I tend to use “portion” to refer to the amount of a Food Group that is served for a specific meal, and serving refers to the amount appropriate for the day.  So, the 6 oz. of meat for the day is the daily serving that can be eaten in one 6 oz. portion at dinner, two 3 oz. portions at lunch and dinner, three 2 oz. portions at breakfast, lunch and dinner or some other combination.  Most of us in the United States do not think in terms of these daily serving sizes or meal portion sizes.  Thanks to our experience eating out, we typically over-estimate what a portion should be.  Taking the time to weigh and measure your food until you can better judge the quantity you’re eating is an important step to eating healthy.

 What do you think?  Tell us about your experiences with portion control.

For Your Health – Dr. Bob

Nutrition Basics – The Food Pyramid & MyPlate

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The Food Pyramid

Until recently, the National Institute of Health (NIH) had talked about a practical system to help Americans eat healthier which they called the Food Pyramid. They divided foods into six Food Groups and recommended the number of daily servings for each of the Food Groups. The macronutrients we described in previous posts, Carbohydrates, Fats & Proteins, are contained within these Food Groups. The following table was taken from the NIH website. It tells you how many servings of a specific Food Group you should eat per day.  The Food Pyramid approach has been replaced by the MyPlate concept which is explained below.

Food   Group

Daily Servings For 2000 Calorie Meal Plan
Grains

6 – 8
Vegetables

4 – 5
Fruits

4 – 5
Fat-free or low fat milk and equivalent milk products

2 – 3
Lean meats, poultry and fish

2 or less
Nuts, seeds and legumes

4 – 5 per week

ChooseMyPlate.gov

Recently the United States Department of Agriculture (USDA) replaced the Food Pyramid system with this easier approach to help people more easily focus on these tips for healthy eating:

  • Make half your plate fruits and vegetables
  • Make at least half your grains whole grains
  • Switch to fat-free or low-fat (1%) milk
  • Enjoy your food, but eat less
  • Avoid over-sized portions
  • Drink water instead of sugary drinks

While this is helpful, many people want to know from a nutritional viewpoint how large is a serving of a specific food.  That’s what I’ll cover in the next post.  Check out the Learning Center at www.InsightsForHealth.com for more information.  Meanwhile, please leave any comments for discussion.

For Your Health – Dr. Bob

More Basic Nutrition – Fats & Proteins

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Last time I wrote about Carbohydrates.  Today, I want to share some basic nutritional information about Fats & Proteins.

Fats are made up of glycerol and fatty acids and due to this complexity, take the longest time to release their energy. Since they hold the most energy per gram of any other macronutrient, the body stores most of its excess energy as fat. In addition, fats are important components of the walls of cells and other structures of the body.

Fats are classified by the degree of “saturation” of their chemical bonds. Those likely to raise levels of the bad cholesterol, LDL, are the saturated and trans fats. Therefore, you should try to eat more monounsaturated and polyunsaturated fats and avoid trans-fats and saturated fats.

Proteins are made up of chains of amino acids and are literally the building blocks of the body and form the enzymes & hormones that control its chemical reactions. Proteins are found in meat, poultry, fish, meat substitutes, cheese, milk, legumes, nuts and in smaller quantities in starchy foods and vegetables. The body breaks proteins down into their amino acids to reuse them. The body can make most of the amino acids it needs from other substances, but there are some, the essential amino acids, that it must get from food. All the necessary essential amino acids can be obtained from meat protein. However, not all the essential amino acids can be found in plant protein. When a person increases their amount of exercise it is important that they have enough protein to build muscle and prevent its breakdown. Many people ordinarily eat inadequate amounts of protein, so they either need to eat more protein-rich foods or take protein supplements.

In the next post I’ll talk about portion size.  By the way, this information and more can be found at the Learning Center on www.InsightsForHealth.com.  Check it out sometime.  Meanwhile, please leave your comments.

For Your Health – Dr. Bob

Some Nutrition Basics – Carbohydrates

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Macronutrients – Carbohydrates, Fats & Protein

When trying to eat healthier as part of your weight loss plan, you need to learn the basics of nutrition.  I’ll spend the next few posts covering those basics or you could click here to be taken to the www.InsightsForHealth.com Learning Center Module on Nutrition.

Nutritionists often refer to carbohydrates, fats and proteins as  macronutrients and vitamins and minerals as  micronutrients. We require a relatively small amount of the micronutrients, and they have no caloric content. The macronutrients do have a caloric content with fats having the highest caloric density. So, of the three, fat is the most efficient storehouse for energy.

Macronutrient

Calories Per Gram

 USDA Daily % Caloric Recommendation

Carbohydrate

4
45% – 65%

Fat

9
20% – 35%

Protein

4
10% – 35%

Carbohydrates are classified as simple or complex. The simple sugars are smaller and include glucose and fructose. Since they are smaller molecules they get absorbed from the gastrointestinal tract very quickly. Glucose is the only source of energy used by the brain, so the body has several mechanisms to convert the other macronutrients into glucose if the glucose level is running low. Complex carbohydrates are actually simple carbohydrates linked together. They include corn, beans, root vegetables (potatoes), pasta & grains. Because they are larger, extracting energy from them takes a bit longer than from simple carbohydrates, but it is still relatively rapid. The body stores only about one day’s worth of energy as carbohydrate in the form of glycogen in the liver and muscle.

In the next post I’ll talk about fats.  Meanwhile, you can check out this information and more at www.InsightsForHealth.com.

I’ll look forward to any comments you may wish to leave..

For Your Health – Dr. Bob