Yvonne Chilik Wollenberg

Which is harder, losing weight or losing debt? 

Doctors hit another HMO with racketeering charges

Thousands of doctors in Pennsylvania may be eligible to join a class-action suit against Keystone Health Plan Central, an HMO, and its former owners, Capital Blue Cross and Highmark. The original suit, filed in October 2001, alleges that the defendants together operated as an entity to defraud physicians through a variety of methods. For example, the complaint alleges that, when contracting with physicians, Keystone intentionally misrepresented, and failed to disclose, internal HMO policies and practices that were designed to systematically reduce, deny, and delay reimbursement. Now a US District Court has okayed class-action status for two racketeering claims and one alleging payment delays. However, the court denied class-action status on the claim that Keystone breached its contracts with both primary care providers and specialists. Although the HMO did so in the same general way, the court said, it used means that are best adjudicated separately. 

These health plans aren't very popular							

Consumer-driven and high-deductible health plans, which offer lower premiums but greater out-of-pocket costs, attracted only 8 percent of privately insured adults in 2006, a rate virtually unchanged from the year before. Those with the relatively new plans aren't terribly happy with them either, says the study released by the Employee Benefit Research Institute and The Commonwealth Fund. Only 36 percent of those in high-deductible plans say they would stay with their plan if they had a choice, compared with 63 percent who have comprehensive coverage. (High-deductible plans have deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage.) 			

The percentage of identity theft victims under the age of 18 crept up to 5 percent at the end of 2005, according to the most recent data available from the FTC. That represents 500,000 children, says the Identity Theft Resource Center, a nonprofit group offering victim assistance. Those whose IDs were stolen during childhood often don't learn of the crime until they try to open a bank account or get a driver's license. To protect your children's identity, be very stingy about handing out their personal information. 

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Doctors say this ratings system clouds the issue

On average, graduating allopathic medical students owed 8.5 percent more last year than their counterparts in 2005, according to the Association of American Medical Colleges. New doctors who attended public colleges owed a median $120,000 including premed borrowing, while those in private colleges racked up educational debts of $160,000. Overall in 2006, nearly 87 percent of graduates had incurred educational debts, with 14 percent owing $200,000 or more. 

Safety concerns may color patients' perception

Patients define "medical error" more broadly than clinicians, and it's important that physicians recognize these differences, according to a study published in the January issue of the 

Joint Commission Journal on Quality and Patient Safety

. For example, clear communication and provider responsiveness are particularly important for patients. If these are missing, says lead author Thomas E. Burroughs, patients are more likely to perceive that an error has occurred when it hasn't. In addition, a strong link exists between patients' concerns about medical safety and their satisfaction with the entire hospital experience. The study found that certain groups-middle-aged patients, African-Americans, and parents of pediatric patients-were more likely to worry about medical errors, as were patients who experienced longer lengths of stay, more-severe illnesses, and those admitted through the ED. On the other hand, patients treated in small and rural hospitals reported the fewest concerns, regardless of the severity of their illness. 

Speaking of fuel economy, 2008 model cars will sport new stickers that better predict their actual gasoline use, says the US Environmental Protection Agency. The EPA is changing how it estimates fuel economy to take into account real-life factors, such as high-speed driving, aggressive accelerations, air conditioning, and driving in cold temperatures.  

Medicare reprieve for doctors-and patients

Plan now to maximize your car's resale value							

Aside from buying a car with a high resale value, you can protect your investment by choosing features that used car buyers will want down the road, such as antilock brakes, alloy wheels, CD player/changer, leather seats , and navigation system. You should also stick with a popular color, such as black, white, or silver. 

Remodeling will cost you more, earn you less

The costs of home projects keep going up, but the value of the work is shrinking, says an annual survey conducted for 

 magazine. A major kitchen remodeling cost a national average of $54,241 in 2006, with an 80 percent return on resale. The same project cost an average of $43,862 in 2005 but earned back 91 percent of the costs. Midrange bathroom remodelings set homeowners back an average of $12,918 in 2006, with an 85 percent resale value, compared to $10,499, with a 102 percent return, in 2005.  

Criminal actions or merely mistakes?							

The Wisconsin Department of Justice recently filed criminal charges against a nurse who mistakenly administered an epidural intravenously, resulting in a patient's death. Now the Wisconsin Hospital Association warns that the DOJ's action could have a negative impact on the quality of care statewide because it sends a chilling message to healthcare providers in the state and those interested in practicing there. Moreover, the WHA contends that "mistakes will occur." It argues that because of the nature of healthcare delivery, the risk of a mistake "can be minimized" but not eliminated. 

In a statement, the Institute for Safe Medication Practices supported the WHA's position: "Patient safety is better served by determining the system-based weaknesses that led to this error, sharing lessons learned with others, and taking action to prevent similar errors, rather than engaging in egregious criminal prosecution of a single individual." 

A new prepaid MasterCard lets you dole out an allowance and set limits on where your kids can spend their money. The Allow Card (

), issued by South Dakota-based First Bank & Trust, includes 35 parental controls, including blocks on specific merchants. You'll also soon be able to keep your children from using the cards to get extra cash from an automated teller machine. But this peace of mind isn't cheap. You'll pay an activation fee of $19.95, $3.95 in shipping, and a monthly fee of $3.50 per account. 

Don't count on your broker to save you money							

Buying a load index fund through a broker will probably cost you three times as much in fees over time than if you bought a no-load version on your own, says a new study. Investors who buy equity index funds through a broker usually end up in load funds that carry higher operating charges, says the study from Zero Alpha Group, a network of independent investment advisory firms, and Fund Democracy, a mutual fund shareholder advocacy group. Assuming a 10 percent annual return, the average investor making a $10,000 investment, held over 20 years, would pay about $2,582 in expenses for a no-load equity index fund that doesn't charge 12b-1 fees, used to cover sales and marketing expenses. If the no-load 

 charge these fees, however, the investor's bill comes to $3,744. That amount more than doubles for load funds that carry 12b-1 fees, to a whopping $7,600. 

Patients are of two minds when it comes to access

				Gaining access to their medical records across an electronic network makes most patients leery, according to a survey commissioned by the Markle Foundation. While nearly two-thirds of respondents said they'd like to be able to retrieve their medical records electronically-especially when changing doctors-four out of five people raised concerns about identity theft or fraud and feared that marketers could use their data without permission. If safeguards to protect their identity were in place, however, three out of four patients would be willing to share their personal information to help improve the quality of care and identify disease outbreaks. 			

Medicare reprieve; home remodeling; medical errors

A national standard isn't good enough for this court

Collisions with deer caused an average of $2,800 in property damage in 2005-2006, and the crash rate has gone up almost 6 percent from last deer season, says State Farm. Accidents involving deer are more frequent in the fall and winter, when the animals are migrating and mating. Deer are also most active between 6 and 9 p.m. Pennsylvania has the highest number of deer crashes, followed by Michigan, Illinois, and Ohio. 

Interest-paying accounts barely make cents

The average yield for a checking account that pays interest is the highest in more than three years, but it's still a dismal 0.34 percent, says 

. That's up from a mere 0.27 percent in 2003. To get that measly rate, you'll have to make an initial deposit that's seven times that of a noninterest-bearing account and park an average of $2,660 in the account to avoid paying average fees of $10.74 a month.  On the other hand, more than 60 percent of noninterest-bearing accounts have no balance requirements or monthly service fees. For those that do charge a monthly fee, the average is only $2.52. 

Will Google replace The Merck Manual?							

Searching with Google may help you formulate a differential diagnosis, according to a study published in the 

. Australian researchers took a sample of diagnostic cases presented in 

 and did a search for each case without knowing its differential diagnosis or conclusion. Researchers used terms they believed would rule out nonspecific results and selected "statistically improbable phrases" (such as "cardiac arrest sleep") whenever possible. Then they compared the correct diagnosis as published in the case records with the three most prominent diagnoses returned by the search engine that best fit the signs and symptoms. Google was correct 58 percent of the time. Sometimes, the search engine gave the correct diagnosis, but researchers thought it wasn't specific enough. In one case, Google returned a diagnosis of extrinsic allergic alveolitis instead of extrinsic allergic alveolitis caused by 

Nearly half of holiday shoppers get a little something for themselves, too, says a survey released by Bill Me Later, an online payment service. About 48 percent spend more than $50 on themselves, while 23 percent plunk down more than $100 on "self-shopping." Men and women both like to treat themselves to clothing more than anything else.  

More people are losing their homes							

The Royal Pharmaceutical Society of Great Britain, the professional and regulatory body for pharmacists in England, Scotland, and Wales, plans to launch a pilot program to help patients identify bona fide online UK pharmacies. The RPSGB has designed a logo that would appear on the website of pharmacies registered with the society and enable visitors to link to the society's online registry of pharmacists and pharmacy premises. (All pharmacists in Great Britain are required to register with the society.)  

Energy prices will always be volatile, but strong demand out of Asia, generally healthy economies in the US and Europe, limited excess production capacity, and ever-present geopolitical risk are likely to keep prices elevated. That, in turn, means more business for Tidewater, as energy companies increase their spending to meet demand. With oil prices relatively low over the past two decades, management actively repurchasing the stock, and shares sporting a lean price-earnings  ratio, Tidewater's three-to-five-year target price is $84-a nearly 60 percent jump from the current price. 

 the editor of The Prudent Speculator, the investment newsletter rated No. 1 for total return performance for 25 years by The Hulbert Financial Digest. Buckingham also manages the Al Frank Fund and Al Frank Dividend Value Fund, mutual funds that focus on undervalued and out-of-favor companies.  *Data through Nov. 30, 2006. Source: Morningstar

When saying "I'm sorry" just isn't enough

The Leapfrog Group, a national coalition of large healthcare purchasers, is asking hospitals to agree to be held accountable for "never events"-medical errors that occur rarely, are clearly identifiable, largely preventable, have serious consequences, and should never happen. Under the proposal, when such an error does occur, hospitals must apologize to the patient, notify at least one reporting agency (the JCAHO, for instance), perform a root-cause analysis, and either waive all costs directly related to the event or pay for additional care that's needed as a result of the original treatment. However, the group suggests that the specific details of "waiving costs" should be handled on a case-by-case basis. The 28 Serious Reportable Events (as defined by the National Quality Forum) include operating on the wrong body part, leaving a foreign object in the patient, and discharging an infant to the wrong person. Hospitals agreeing to the policy would be recognized publicly through the 2007 Leapfrog Hospital Quality and Safety Survey. AHA President-elect Richard Umbdenstock says the AHA agrees with the policy, which "articulates what many hospitals are already doing."  

First offered 25 years ago as supplements to traditional pensions, 401(k) plans have taken over the realm of retirement savings. Twice as many workers are covered by 401(k)s as by traditional pensions, says the Investment Company Institute, a national association of investment companies. Through the end of 2005, 401(k) plans had 47 million active participants, compared to 21 million who participate in private-sector defined-benefit pension plans.

Deer crashes, mortgage foreclosure; MCAT discrimination?

Author | Yvonne Chilik Wollenberg

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