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Standing at Your Desk – A Healthy ‘Fad’?

Since mid-October, I have been experiencing a pinched nerve in my lower back. Anyone who has experienced this type of condition knows the pain can be excruciating, as my symptoms also include numbness or weakness of my lower back and left leg. Lumbar radiculopathy is typically caused by a compressed spinal nerve root, which results with pain in the leg rather than in the lumbar spine. Why this happened to me is unknown, but I would speculate it gradually developed from daily running when not biking. Having ‘additional’ birthdays may also be another reason!

With the help of a physical therapist, I perform various daily exercises at home (or in the office). Despite PT, however, the searing pain persisted enough to have an MRI performed, confirming the Lumbar 4 location. As I wait for the next elevated level of care – most likely an epidural steroid injection – I judiciously use Tramadol, a synthetic analgesic opioid medication that is used to treat moderate to moderately-severe pain. For me, the best relief is to simply sit down, which allows me to forgo Tramadol. Accordingly, I spend more time sitting at my desk working on projects that don’t require traveling to outside meetings. Needless to say, having these physical limitations are wreaking havoc on my daily activities…and exercise routine.

I share this ‘protected health information’ because I am intrigued by the latest craze – the stand-up desk – a desk that allows you to stand up while working at the computer. You will find ads in newspapers, magazines and the internet about these desks, often touting why it is so much healthier to be working on your feet rather than, well, your bottom.  The purported health benefits of these desks are both broad and deep. One website listed at least seven potential health benefits when using such desks:

  1. Standing Lowers Your Risk of Weight Gain and Obesity
  2. Lowers Blood Sugar Levels
  3. Lowers Risk of Heart Disease
  4. Appears to REDUCE BACK PAIN!!!
  5. Helps Improve Mood and Energy Levels
  6. May Boost Productivity
  7. May Help You Live Longer

Fantastic! I want…no…I NEED to have a stand-up desk!

Due to our sedentary office jobs and daily living habits, American workers burn around 140 fewer calories per day compared to 59 years ago (1960). In July 2016, The Lancet issued study results that indicated 60 minutes of daily physical activity (e.g. brisk walking, pleasure biking, etc.) may help offset health risks of having to sit eight hours a day at the office. This November, The Department of Health and Human Services (HHS) issued updated activity guidelines for Americans to help combat the fact that nearly 80 percent of U.S. adults and adolescents are insufficiently active. The health benefits of exercise are clearly not fake news, as there is too much scientific research to refute the naysayers.

Cautionary Note

Before buying into the aforementioned stand-up desk ‘craze,’ one might want to consider some research that at least tempers its glowing accolades.  Aaron Carroll, professor of pediatrics at Indiana University School of Medicine, writes well-researched blogs about healthcare and policy. Recently in the New York Times, Carroll wrote a compelling piece about why standing-desks are ‘overrated,’ winnowing fact from fiction.

I will not take up my sitting time by regurgitating Carroll’s article, but I would like to summarize his ‘finding’ with the following: Exercise is important for our health, but merely standing is NOT considered to be ‘exercise.’ Sitting may not be the problem on why we are unhealthy, but rather, it may be a “marker for other risk factors that would be associated with higher mortality.”

Personally, I’m intrigued about standing while working at my computer. But first, my lower back must heal before I can stand for any period of time. For now, my lofty expectations about using a stand-up desk have been adjusted at a more reasonable (and comfortable) level…that of my office chair!

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Psst…Bezos, Dimon and Buffett: Let’s Lift the Veil on Medical Prices

This past week, we learned of a bombshell joint announcement from three significant U.S. business leaders on fixing our healthcare system: Jeff Bezos (Amazon), Jamie Dimon (JPMorgan Chase) and Warren Buffett (Berkshire Hathaway). These three individuals and organizations plan to form a new independent healthcare company for their 1.1 million employees in the U.S.  In the past, many other large business organizations have attempted to transform this healthcare system that is ripe for disruption and widely considered wasteful and inefficient. To date, however, such activity has met limited success. Conventional wisdom suggests these three behemoth companies do not have critical market power to make inroads on transforming an industry intent on gobbling up more of the U.S. economy.

So, what is different with this latest announcement? Based on this rather skinny declaration, we know very little and only time will tell.

We do know, however, this ‘new’ approach cannot happen soon enough. David Cutler, a Harvard health economist, calculated that administration accounts for nearly a quarter of the total healthcare cost in the U.S. – double the rate in the next bloated country. Karl Vick wrote quite succinctly in TIME magazine: “The U.S. healthcare system is the antithesis of Silicon Valley. Grossly inefficient and user-unfriendly, it may be the least transparent enterprise outside of the Kremlin – and just as awash in money.”

Is it possible this new coalition may propel other employers (and other payers) to band together and look for local alternatives to drive transparency in an industry that is notorious for obfuscation? The common word that is often used to change a particular industry is ‘disruption.’ Harvard professor Clayton Christensen started the Christensen Institute to address how industries can be changed (disrupted), usually through technological innovation.

The ‘pricing’ veil – A personal experience

This past December, after experiencing dizziness and double-vision, coupled with a slightly slower speech pattern, a family member was taken to an urgent care center in Mankato, MN. After undergoing a few initial tests, it was recommended the patient be transferred by ambulance to a hospital two miles away – presumably for more in-depth testing that was not available at the urgent care facility. Needless to say, this sudden turn of events was loaded with confusion over the cause of the medical problem and the impending worry.

As a patient or a family member of a patient, we seldom are prepared for what issues and challenges we face when seeking care due to a sudden medical ‘episode’ or ‘emergency.’ In fact, we typically fly by the seat of our pants when we enter the unknown world of healthcare. Even the well-intentioned medical staff are sometimes bewildered by the symptoms and possible causes of those symptoms.

Confusion reigns further when, in our case, the hospital’s electronic medical records don’t communicate with the tests previously performed at the urgent care center just 30 minutes earlier – even though both facilities are part of the same medical system! Because of this, identical tests (EKGs, blood work-up, etc.) were replicated at the hospital – unnecessary charges equating to additional costs for the payers – and increased revenue for the provider(s). I’m still working on that issue, by the way.

Thankfully, my brother and his wife were with us, which was both comforting and beneficial while attempting to discern the next course of action relating to tests and treatments. By default, we quickly assumed the role of being the ‘patient advocate’ – a daunting task.

Gratefully, the bank of medical tests found no cause for the aforementioned symptoms, although not knowing the cause remains a concern. As many of you know, the shock does not end when the patient is discharged following a litany of medical tests that occurred during a two-night stay. The second shock wave arrived a few weeks later in the form of an ambulance invoice in the snail mail and a host of ‘explanation of benefits’ found on our carrier’s website for all the other charges that occurred at the urgent care center and hospital.

The invoice for a two-mile ambulance joyride was only $1,887.79, while the urgent care facility chimed in at about $5,744.* The hospital invoice for tests and a two-night stay represented the price of a brand spanking new mid-level automobile – $24,579.40. All told, the total charges were $32,211.19, while the carrier applied their ‘network savings’ of $2,779.35.

In their recent article, “Why the U.S. Spends So Much More Than Other Nations on Health Care,” authors Austin Frakt and Aaron Carroll make the case, using a recent study in JAMA along with other research, that higher prices are the real culprit, more so than higher utilization of services by Americans when compared to residents of other countries. Yes, despite the increase in population size and the aging of U.S. citizens, health spending greatly outpaced the spending found in other countries, even after adjusting for other factors. Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health is quoted in the Frakt/Carroll piece saying, “The U.S. just isn’t that different from other developed countries in how much healthcare we use. It is very different in how much we pay for it.

Why is this ‘pricing’ problem happening in the U.S., you might ask? Much of this has to do with fundamental limitations of competition in the American healthcare system. This veil of secrecy has little to no accountability on how prices are determined. Bezos, Dimon and Buffett are looking to blow up this highly-guarded industry standard. The rest of us can no longer afford to play the role of ‘innocent bystanders.’

After discussing the dearth of sensibility in healthcare pricing with a friend who works in the insurance industry, he sent me the following comical YouTube clip that cleverly attempts to address the medical price conundrum.

My recent family experience was yet another reminder that no matter our professional background, seldom are we prepared to confront the shock and confusion of the healthcare we receive…and the bills that result from that care.

The status quo in healthcare must be blown up. If existing players and stakeholders resist being part of real solutions, then the eventual sea change will sweep them into a new reality that may be difficult to survive.

As ‘real’ payers of healthcare, maybe employers can become the change they wish to see in the healthcare industry. After all, sometimes business interests can align with those of humans.

But only time will tell.

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*Some billing discrepancies remain while attempting to discern a number of charges found on Mayo’s list billing with what was paid by my insurance carrier.  The list-billing from Mayo, I’m convinced, was clearly not meant to be a consumer-friendly document.