Many of the elected officials who I respect--President Obama, our own Idaho congressman Walt Minnick, and anybody else appropriately fired up about health care reform--say that we will all be better off when the records of our blood tests, medical procedures and office visits are made accessible by computer. It sounds simple and beautiful. Two and a half years after starting to use such computerized medical record keeping system I have a few opinions about how good it is, and what it is really good for.
In a state of unrealistic optimism, many health care reform proponents are saying that electronic medical records will, when combined with Americans adopting healthier lifestyles, save enough money to pay for health care for the presently uninsured. Healthier lifestyles are indeed a money saver, but I'm not exactly sure what transformation is supposed to happen to make us eat less crap and stop smoking.
On the other hand, though, a computerized medical record is not a cost saving device.
Having records kept in a way that is readable, easily communicated, and coordinated with things like recommendations for preventive medicine does make patients' care better. Or it would, if doctors could learn how to use it. Some health care providers take to computers like seals to the ocean, and some find that it just doesn't suit their style. Some run screaming in the other direction. When we launched our computerized medical record keeping system, everyone reduced the number of patients they would see in a day by half, and even with that everyone in my office at some point became so frustrated and hopeless that they cried. After adjusting to the system, which took a year, (yes, a year) we no longer cry, but we still can't see as many patients in a day as we could when we were scrawling notes on paper, and phoning in orders for various things. Because of the stress of adjusting to the new system, several providers left our practice, which resulted in staff cutbacks, service cutbacks, and almost made our business fail.
Now, about 2 1/2 years later, we have recovered. We know how to use our system, and it only crashes occasionally. It helps me remember what I did last time, to know what other docs did at remote locations, to review results, and my notes are always legible. If someone wants a note produced I can do that pronto, and I have instant information about drug interactions, costs and medication allergies. I can ask questions, document answers, and not have to ask the same questions again.
But it's not cheaper. Because I can document all I have done conveniently, I can bill more successfully for what I do, but it all takes time, and so I see less patients and each one costs the insurer, or the individual, more. Overhead for us is probably a bit higher, because, although we no longer have to handle paper charts, we now have to pay many 10s of thousands of dollars yearly on tech support, after the hundreds of thousands of dollars that the software and hardware cost in the first place. The software is also, still, deeply flawed.
Electronic medical records really are the wave of the future. This particular progress is unavoidable, and in the end, a positive step. But, though it is better in so many ways, it is not going to save the billions of dollars that we need to save to balance our federal budget.
Sunday, August 30, 2009
Do no harm
After finishing medical school, we all stood together in the big hall where we had been educated for 4 years, and took the hippocratic oath. The only part of the oath that I remember well is "primum, non nocere." Those words recognize that a doctor has the ability to harm as well as help, and needs to have the humility to recognize that.
Today in the New England Journal of Medicine, the most well regarded journal of research and practice for internists, an article appeared that referred to medical harm. I think it may be available to non subscribers at http://content.nejm.org/cgi/content/full/361/9/841 . The author looks at the evidence of help and harm from radiological procedures that are done to prevent disease.
The number of CAT scans and heart imaging studies that are done is rapidly increasing, and yet there is no evidence these save lives or improve health in most instances. There are definitely times when they are helpful or appropriate, but most of them may be time and money wasted.
But waste is only part of the picture. Most imaging procedures expose people to radiation, and at this point, with the amount of tests people have been getting, about 2% of cancers may be attributable to radiation from CAT scans. The number of CAT scans performed has quadrupled since 1992, and when I look at the graph, there does not seem to be any evidence of this growth slowing. So the extra CAT scans done today will be responsible for an even larger percentage of cancers in future years.
It is hard to track the harm done by radiation exposure because it happens so many years after the actual procedure, which makes it difficult for doctors or patients to put the harm concept together with the test that's done "just to make sure everything's OK." In order to do no harm, we so strongly need good doctor and patient education about the reasons to do and not to do expensive testing, and more universal understanding that what we pay the big bucks for in medical care is not necessarily what makes us healthier.
Today in the New England Journal of Medicine, the most well regarded journal of research and practice for internists, an article appeared that referred to medical harm. I think it may be available to non subscribers at http://content.nejm.org/cg
The number of CAT scans and heart imaging studies that are done is rapidly increasing, and yet there is no evidence these save lives or improve health in most instances. There are definitely times when they are helpful or appropriate, but most of them may be time and money wasted.
But waste is only part of the picture. Most imaging procedures expose people to radiation, and at this point, with the amount of tests people have been getting, about 2% of cancers may be attributable to radiation from CAT scans. The number of CAT scans performed has quadrupled since 1992, and when I look at the graph, there does not seem to be any evidence of this growth slowing. So the extra CAT scans done today will be responsible for an even larger percentage of cancers in future years.
It is hard to track the harm done by radiation exposure because it happens so many years after the actual procedure, which makes it difficult for doctors or patients to put the harm concept together with the test that's done "just to make sure everything's OK." In order to do no harm, we so strongly need good doctor and patient education about the reasons to do and not to do expensive testing, and more universal understanding that what we pay the big bucks for in medical care is not necessarily what makes us healthier.
Thursday, August 27, 2009
Why do doctors make so much money?
In the discussion of why American health care is so expensive, it is certainly necessary to entertain the question of why doctors salaries are as high as they are. The average American makes $38,000 a year, and the average primary care doctor makes around $150,000 a year. These numbers vary by geographical region, certainly, and the primary care doctors I talk to in my small Idaho town mostly make less than $100,000. But they certainly do command a higher salary than teachers or carpenters or most university professors at our esteemed and underpaid state university. So why is this?
To practice medicine, a doctor has to finish 4 years of university, 4 years of medical school and at least 3 years of residency as an MD in training. In order to get into medical school, they need to be in the top of their university classes, and have finished a set of premedical requirements that is heavy in science and math. Medical school is an order of magnitude harder than university. The first two years are spent trying to memorize a tremendous amount of information on anatomy, physiology, biochemistry and the myriad of diseases of the human body, along with their molecular mechanisms and present treatments. The second 2 years are spent intensively practicing medicine, usually in a hospital setting, under the close supervision of teaching doctors and residents in training. Medical school is long, hard and painful, and is essentially all consuming. After these 4 years an MD degree is awarded and the graduate starts residency. The residency years are paid, but at a lower rate than many jobs. In 1987, in my first year out of Johns Hopkins, I worked about 80 hours a week, was often up all night, caring for desperately sick and wildly complicated patients, and made about $18,000. That was the most money I had ever made in my life and I was very proud. But it wasn't even minimum wage, I don't think. After 3 years of this, the resident becomes a full fledged, employable, and usually indebted doctor. On average, a new doctor will have over $150,000 in educational debt.
So the freshly fledged doctor emerges, blinking, into the sunlight of the real world, with enough debt to have bought a house, exhausted, and jobless. The new job, once obtained, is hard. There are new systems to learn, the pace is faster than in training, and the new guy frequently will be given the extra work that nobody else wants. The hours are long, and many of them unpaid.
Now don't get me wrong. I have no cause to complain. I have the best job in the world and I love it. It was just really hard to get to this point, and I don't think that many qualified people would do it if the salary weren't good.
To practice medicine, a doctor has to finish 4 years of university, 4 years of medical school and at least 3 years of residency as an MD in training. In order to get into medical school, they need to be in the top of their university classes, and have finished a set of premedical requirements that is heavy in science and math. Medical school is an order of magnitude harder than university. The first two years are spent trying to memorize a tremendous amount of information on anatomy, physiology, biochemistry and the myriad of diseases of the human body, along with their molecular mechanisms and present treatments. The second 2 years are spent intensively practicing medicine, usually in a hospital setting, under the close supervision of teaching doctors and residents in training. Medical school is long, hard and painful, and is essentially all consuming. After these 4 years an MD degree is awarded and the graduate starts residency. The residency years are paid, but at a lower rate than many jobs. In 1987, in my first year out of Johns Hopkins, I worked about 80 hours a week, was often up all night, caring for desperately sick and wildly complicated patients, and made about $18,000. That was the most money I had ever made in my life and I was very proud. But it wasn't even minimum wage, I don't think. After 3 years of this, the resident becomes a full fledged, employable, and usually indebted doctor. On average, a new doctor will have over $150,000 in educational debt.
So the freshly fledged doctor emerges, blinking, into the sunlight of the real world, with enough debt to have bought a house, exhausted, and jobless. The new job, once obtained, is hard. There are new systems to learn, the pace is faster than in training, and the new guy frequently will be given the extra work that nobody else wants. The hours are long, and many of them unpaid.
Now don't get me wrong. I have no cause to complain. I have the best job in the world and I love it. It was just really hard to get to this point, and I don't think that many qualified people would do it if the salary weren't good.
Wednesday, August 26, 2009
Cost shifting--is that why hospitals charge so much?
If health care costs go down significantly, as providers order less unnecessary tests, and as tests and procedures come down in price due to the incentives of actual competition (OK, I'm making a rather huge and optimistic assumption) hospitals will see less money coming into radiology departments and labs. When there are more primary care doctors available to see patients, and patients seek care earlier in the course of their illnesses, there will be less patients seen in emergency rooms, and hospitals will see that revenue go down.
Or will they?
If we truly get universal healthcare, the amount of uncompensated care that hospitals have to cover will be dramatically reduced or completely eliminated. Right now if an uninsured young man is brought into the emergency after a gunshot wound, that man will get top of the line trauma care, with specialists called in, multiple imaging procedures, needed surgery and medications, and the hospital will simply eat those costs. It is not clear to me how great of a loss of income hospitals will face if there is comprehensive and cost saving health care reform.
At this point our hospital runs in the black, though not far in the black. When I look at the hospitals charges for tests and procedures I see that they are significantly higher than I think they should be, comparing them to the same procedures done at doctors' offices or the same procedures a few years ago. But hospitals spend huge amounts of money on uncompensated care, or poorly compensated care, and high charges for tests and procedures are part of the income that offsets these losses.
For a health care reform solution that saves significant amounts of money to allow hospitals to survive, there must be universal health insurance, and that health insurance must adequately compensate hospitals for their services.
While everything is on the table, medicare and medicaid payments to providers (doctors and hospitals) needs to be on the table as well. I know these payments are barely adequate or inadequate to pay for a doctor's services in the office, and I expect they are also close to inadequate in their payments to hospitals. In order for patients who are insured with a publicly funded plan such as medicare or medicaid to be assured access to care these programs must pay providers for what they do.
Or will they?
If we truly get universal healthcare, the amount of uncompensated care that hospitals have to cover will be dramatically reduced or completely eliminated. Right now if an uninsured young man is brought into the emergency after a gunshot wound, that man will get top of the line trauma care, with specialists called in, multiple imaging procedures, needed surgery and medications, and the hospital will simply eat those costs. It is not clear to me how great of a loss of income hospitals will face if there is comprehensive and cost saving health care reform.
At this point our hospital runs in the black, though not far in the black. When I look at the hospitals charges for tests and procedures I see that they are significantly higher than I think they should be, comparing them to the same procedures done at doctors' offices or the same procedures a few years ago. But hospitals spend huge amounts of money on uncompensated care, or poorly compensated care, and high charges for tests and procedures are part of the income that offsets these losses.
For a health care reform solution that saves significant amounts of money to allow hospitals to survive, there must be universal health insurance, and that health insurance must adequately compensate hospitals for their services.
While everything is on the table, medicare and medicaid payments to providers (doctors and hospitals) needs to be on the table as well. I know these payments are barely adequate or inadequate to pay for a doctor's services in the office, and I expect they are also close to inadequate in their payments to hospitals. In order for patients who are insured with a publicly funded plan such as medicare or medicaid to be assured access to care these programs must pay providers for what they do.
Tuesday, August 25, 2009
Cost transparency--what's not to like?
Cost transparency, that is making sure that patients and providers know what everything costs at a time that is relevant for discussing options, is a great idea. The effects of sharing this kind of knowledge would be powerful. Cost could become part of conversations about what is the most appropriate care. A patient could ask if a particular $3000 test would really change their treatment, for instance. If everyone knew, up front, what things were supposed to cost, billing errors and fraud would be much easier to identify. And when things cost way too much, we could start asking why, and begin the process of making these costs competitive.
There are, however, some pretty serious obstacles to making this information available.
I would like a patient to know, before she even sits down with me, how much her visit will cost. Unfortunately, I don't know. The amount of time and complexity of the encounter, including office procedures that might have to happen, will unfold during the visit. Now the patient could have a sheet that gives costs for various things that might happen, but that, too, gets pretty complex. Here is an example. Just recently we raised our rates for office visits. Now a detailed office visit, which may take about 30 minutes and involve research or consultation with other doctors, carries a price tag of $160. That is the price that all insurance companies and uninsured patients see on their bill. Medicare will pay $86, Premera $127 and Blue Cross about $150. Depending on the patient's specific policy, they may have to pay a part of that as a copay, or even be billed for the difference. The uninsured are discounted according to whether they pay at the time of service, and sometimes, at the discretion of the provider, their financial situation.
For costs to be truly transparent, they must be presented in a way that just about anyone can understand, without requiring that person be computer savvy or able to sift through a packet of insurance materials.
Providers of medical goods and services could be required, at the time of service, to provide a list of costs of the most common items that they offer and provide information on costs for less common items quickly at a patient's request. Insurance companies could be required to produce an easily understandable list with information on how much they pay to be available to the patient at the time they received services. This information could be accessed online or by telephone by the provider's staff.
The trick with all of this is to make the information clear, relevant and to avoid adding a layer of complexity to an already complex system. Processes that require more time per patient inevitably make an office less efficient, and thus more expensive, which is exactly what we're trying not to do.
A single-payer health insurance system would make cost transparency a piece of cake, but maintaining truly independent health insurance companies does make the process more challenging.
There are, however, some pretty serious obstacles to making this information available.
I would like a patient to know, before she even sits down with me, how much her visit will cost. Unfortunately, I don't know. The amount of time and complexity of the encounter, including office procedures that might have to happen, will unfold during the visit. Now the patient could have a sheet that gives costs for various things that might happen, but that, too, gets pretty complex. Here is an example. Just recently we raised our rates for office visits. Now a detailed office visit, which may take about 30 minutes and involve research or consultation with other doctors, carries a price tag of $160. That is the price that all insurance companies and uninsured patients see on their bill. Medicare will pay $86, Premera $127 and Blue Cross about $150. Depending on the patient's specific policy, they may have to pay a part of that as a copay, or even be billed for the difference. The uninsured are discounted according to whether they pay at the time of service, and sometimes, at the discretion of the provider, their financial situation.
For costs to be truly transparent, they must be presented in a way that just about anyone can understand, without requiring that person be computer savvy or able to sift through a packet of insurance materials.
Providers of medical goods and services could be required, at the time of service, to provide a list of costs of the most common items that they offer and provide information on costs for less common items quickly at a patient's request. Insurance companies could be required to produce an easily understandable list with information on how much they pay to be available to the patient at the time they received services. This information could be accessed online or by telephone by the provider's staff.
The trick with all of this is to make the information clear, relevant and to avoid adding a layer of complexity to an already complex system. Processes that require more time per patient inevitably make an office less efficient, and thus more expensive, which is exactly what we're trying not to do.
A single-payer health insurance system would make cost transparency a piece of cake, but maintaining truly independent health insurance companies does make the process more challenging.
Why isn't malpractice reform an issue for the democratic party?
Malpractice reform is not traditionally an issue that Democrats support. Why?
I think it is because democrats feel strongly that everyone, no matter how poor or disenfranchised, has a right to his or her day in court.
This is good: we are right to hold on to systems that allow people who have been wronged to be heard. But our tort system does not work in the case of medical injury and malpractice.
Most people with a medical injury never sue for malpractice. Most of their injuries are too small for a lawyer to take the case, and many of the injured don't want to enter into the complex and contentious world of the legal system.
Most cases that go to court are ones in which a person has a very bad and often expensive outcome, in which a lawyer could hope to get an amount of money worth his or her time. Most of these cases have no convincing level of negligence, and so there is no significant benefit for the injured party.
During the time that the case is being prepared, usually a number of years, the injured party must continue to be injured, and so has a powerful motivation not to get his or her life back on track, and not to heal up from whatever bad thing happened. The provider being sued is encouraged by the lawyer representing him or her to feel sure of how good and appropriate the care was, and thus not learn from any mistakes.
I have noticed that in my hospital when something bad happens to a patient, and there is no perceived risk of a malpractice suit being brought, that the whole medical community comes together with meetings and discussions to figure out just what happened, and what can be done to make it never happen again. They will organize educational opportunities, change protocols, talk to patients and families who were involved. If the event has a threat of malpractice, all discussion is hushed.
Doctors live in fear of being called into a malpractice case, which will use up countless hours of their productive life, and leads to bitterness and isolation. The vast majority of doctors will at some point be sued for malpractice, but that doesn't make it any easier on each individual, who is ashamed and shaken.
Bottom line--the malpractice system is horribly ill. It is damaging to everyone who comes in contact with it, and continuing to do it they way we do is a huge missed opportunity for improving health care and reducing unnecessary costs.
To fix the problem, in a way that is substantial and could really work, we need major changes. The whole process of taking care of medical injury and negligence could be taken out of the courts and placed in the hands of a board, consisting of physicians and lay people, with the ability to give no-fault compensation to the injured party, analyze and remedy whatever process led to the injury, and educate and punish, if appropriate, anyone who was negligent.
I think it is because democrats feel strongly that everyone, no matter how poor or disenfranchised, has a right to his or her day in court.
This is good: we are right to hold on to systems that allow people who have been wronged to be heard. But our tort system does not work in the case of medical injury and malpractice.
Most people with a medical injury never sue for malpractice. Most of their injuries are too small for a lawyer to take the case, and many of the injured don't want to enter into the complex and contentious world of the legal system.
Most cases that go to court are ones in which a person has a very bad and often expensive outcome, in which a lawyer could hope to get an amount of money worth his or her time. Most of these cases have no convincing level of negligence, and so there is no significant benefit for the injured party.
During the time that the case is being prepared, usually a number of years, the injured party must continue to be injured, and so has a powerful motivation not to get his or her life back on track, and not to heal up from whatever bad thing happened. The provider being sued is encouraged by the lawyer representing him or her to feel sure of how good and appropriate the care was, and thus not learn from any mistakes.
I have noticed that in my hospital when something bad happens to a patient, and there is no perceived risk of a malpractice suit being brought, that the whole medical community comes together with meetings and discussions to figure out just what happened, and what can be done to make it never happen again. They will organize educational opportunities, change protocols, talk to patients and families who were involved. If the event has a threat of malpractice, all discussion is hushed.
Doctors live in fear of being called into a malpractice case, which will use up countless hours of their productive life, and leads to bitterness and isolation. The vast majority of doctors will at some point be sued for malpractice, but that doesn't make it any easier on each individual, who is ashamed and shaken.
Bottom line--the malpractice system is horribly ill. It is damaging to everyone who comes in contact with it, and continuing to do it they way we do is a huge missed opportunity for improving health care and reducing unnecessary costs.
To fix the problem, in a way that is substantial and could really work, we need major changes. The whole process of taking care of medical injury and negligence could be taken out of the courts and placed in the hands of a board, consisting of physicians and lay people, with the ability to give no-fault compensation to the injured party, analyze and remedy whatever process led to the injury, and educate and punish, if appropriate, anyone who was negligent.
How to fix it
The problem:
Health care costs too much, insurance costs too much, and people are suffering because of money spent directly in bills or indirectly through taxes. Because of the cost of insurance and health care, too few people have access to it.
Scope of the problem:
Huge. Because of the lack of access, America’s indicators of overall health, including infant mortality and average age at death aren’t as good as most countries we consider our peers. Because of the cost, average Americans’ take-home salaries are significantly lower than they would be and federal and state governments are unable to afford other basic services such as education and other social services.
Causes of the problem:
1. Doctors practice medicine that is not cost effective because of worry about malpractice, and perceived patient expectation that costs are not a consideration where health is concerned.
2. The number of primary care physicians is shrinking because primary care physicians are not paid as well as medical specialists who do procedures. Doctors who do primary care try to do as many procedures as possible because they are paid better for them. Because they are paid poorly, primary care doctors have to see more patients, and so they spend less time with each patient. It takes more time in an appointment to discuss with the patient whether they actually need an expensive procedure or medicine than to simply order the procedure or medicine (examples: MRI or CT scans, x-rays, and antibiotics.) One MRI scan costs about as much as 50 office visits.
3. Even though insurance companies make it difficult for doctors to order tests or expensive medicines, the threat of malpractice is so great that we spend the time it takes to get authorization to do these things, and subsequently have even less time to spend with patients.
4. Almost no stakeholder, not patients or doctors, knows how much anything in medicine costs. The insurance rules and coverage are so complex that costs of procedures, medications, office visits or referrals are not known at the time they are prescribed so cost cannot even enter the equation.
5. Because billing is so complex, and insurance rules are so complex, certainly a huge amount of billing mistakes and fraud happen on a regular basis.
6. The staffs and administrations of insurance companies are very large and expensive and the billing departments of doctors’ offices have to be large and expensive to deal with them. The system is adversarial rather than cooperative and wastes a great deal of money.
7. Medical devices, procedures and medicines are too expensive because the risk of liability reduces competition. iPods have gotten cheaper and better in the last 5 years and MRIs and appendectomies have gotten more expensive.
8. Uninsured and low income patients don’t come in to see a primary care doctor because they can’t afford it. Instead, they get the most expensive kind of care, which is hospital based, when their preventable problems become emergencies.
Solutions:
1. Cost transparency: patients and doctors need to know what everything they do will cost ahead of time. Patients should know the cost of an office visit when they see the doctor and know what their portion of that cost would be. Doctors should know that as well. The same is true for surgeries, scans, lab tests, medications. This will not be practical in every situation. There will be emergencies and unexpected costs, but these things should be the exception not the rule. Doctors will find it much easier to practice cost effective medicine when they actually know what the costs are. This will require a significant change in the way insurance companies operate.
2. Tort reform: doctors practicing cost effective medicine need to be protected from being sued for being responsible about expenditures. Some level of tort reform on a federal level to prevent lawyers from benefiting from huge settlements will help get doctors to do what they already know how to do: take care of patients.
3. Pay adequately for primary care: it takes time and intelligence to counsel patients in such a way that they feel satisfied without unnecessary tests or medications. Surgical specialists will also be more likely to counsel patients rather that doing procedures if they are compensated adequately for the time spent counseling.
4. To alleviate the primary care shortage, consider a program to subsidize medical education for primary care doctors. High educational debt drives graduates into high compensation practices including specialty medicine and primary care in big cities.
5. Educate doctors in cost effective medicine. We are required by our malpractice carriers to take continuing education in risk reduction, and it would be simple to require a certain amount of time for learning about cost effective practice in order to qualify for updating our licenses. A large amount of research has already been done in the field of effective medicine and evidence based practice, such that there are clinical practice guidelines for many common diagnoses. Doctors know these exist, but are usually not familiar with them.
6. Provide adequate insurance to those who can’t afford it, based on the most effective and efficient models available. (Consider Medicare, Group Health, and other countries with good health indicators.)
Bad Ideas:
I have read many proposed solutions to the healthcare crisis, and a few have seemed particularly poorly conceived.
1. Across the board cuts in payments to doctors: if we make less money for each patient we see, we will have to see more patients in a day, and do more procedures in a day to pay off our educational debt, which will make health care less effective and more expensive. Costs for procedures and medical equipment may need to be cut, but that needs to be combined with some significant changes that allow it to be easier for us to do business. Doctors in the US do not make significantly more money, corrected for cost of living and average salary, than doctors in countries whose health care systems are more cost effective. In Moscow, Idaho, primary care physicians make about the same salary as a good accountant does. Medical education takes a minimum of 7 years postgraduate education and is very expensive and competitive. If the practice of medicine doesn’t offer a decent competitive salary, the people who are qualified to go into medicine will do something else, and physicians will leave their practices.
2. Requiring low income patients to shoulder more of their insurance and healthcare costs: In my experience, low income patients have no extra money to spend on insurance or co-pays and simply will not pay these bills. If there is a “public option” insurance offered by the government and patients on minimum wage are told they need to shoulder 15% of the costs and pay 20% of their medical bills, they will either remain uninsured or will fail to pay their portion of bills, and lose their access to their doctors for bad debt.
Health care costs too much, insurance costs too much, and people are suffering because of money spent directly in bills or indirectly through taxes. Because of the cost of insurance and health care, too few people have access to it.
Scope of the problem:
Huge. Because of the lack of access, America’s indicators of overall health, including infant mortality and average age at death aren’t as good as most countries we consider our peers. Because of the cost, average Americans’ take-home salaries are significantly lower than they would be and federal and state governments are unable to afford other basic services such as education and other social services.
Causes of the problem:
1. Doctors practice medicine that is not cost effective because of worry about malpractice, and perceived patient expectation that costs are not a consideration where health is concerned.
2. The number of primary care physicians is shrinking because primary care physicians are not paid as well as medical specialists who do procedures. Doctors who do primary care try to do as many procedures as possible because they are paid better for them. Because they are paid poorly, primary care doctors have to see more patients, and so they spend less time with each patient. It takes more time in an appointment to discuss with the patient whether they actually need an expensive procedure or medicine than to simply order the procedure or medicine (examples: MRI or CT scans, x-rays, and antibiotics.) One MRI scan costs about as much as 50 office visits.
3. Even though insurance companies make it difficult for doctors to order tests or expensive medicines, the threat of malpractice is so great that we spend the time it takes to get authorization to do these things, and subsequently have even less time to spend with patients.
4. Almost no stakeholder, not patients or doctors, knows how much anything in medicine costs. The insurance rules and coverage are so complex that costs of procedures, medications, office visits or referrals are not known at the time they are prescribed so cost cannot even enter the equation.
5. Because billing is so complex, and insurance rules are so complex, certainly a huge amount of billing mistakes and fraud happen on a regular basis.
6. The staffs and administrations of insurance companies are very large and expensive and the billing departments of doctors’ offices have to be large and expensive to deal with them. The system is adversarial rather than cooperative and wastes a great deal of money.
7. Medical devices, procedures and medicines are too expensive because the risk of liability reduces competition. iPods have gotten cheaper and better in the last 5 years and MRIs and appendectomies have gotten more expensive.
8. Uninsured and low income patients don’t come in to see a primary care doctor because they can’t afford it. Instead, they get the most expensive kind of care, which is hospital based, when their preventable problems become emergencies.
Solutions:
1. Cost transparency: patients and doctors need to know what everything they do will cost ahead of time. Patients should know the cost of an office visit when they see the doctor and know what their portion of that cost would be. Doctors should know that as well. The same is true for surgeries, scans, lab tests, medications. This will not be practical in every situation. There will be emergencies and unexpected costs, but these things should be the exception not the rule. Doctors will find it much easier to practice cost effective medicine when they actually know what the costs are. This will require a significant change in the way insurance companies operate.
2. Tort reform: doctors practicing cost effective medicine need to be protected from being sued for being responsible about expenditures. Some level of tort reform on a federal level to prevent lawyers from benefiting from huge settlements will help get doctors to do what they already know how to do: take care of patients.
3. Pay adequately for primary care: it takes time and intelligence to counsel patients in such a way that they feel satisfied without unnecessary tests or medications. Surgical specialists will also be more likely to counsel patients rather that doing procedures if they are compensated adequately for the time spent counseling.
4. To alleviate the primary care shortage, consider a program to subsidize medical education for primary care doctors. High educational debt drives graduates into high compensation practices including specialty medicine and primary care in big cities.
5. Educate doctors in cost effective medicine. We are required by our malpractice carriers to take continuing education in risk reduction, and it would be simple to require a certain amount of time for learning about cost effective practice in order to qualify for updating our licenses. A large amount of research has already been done in the field of effective medicine and evidence based practice, such that there are clinical practice guidelines for many common diagnoses. Doctors know these exist, but are usually not familiar with them.
6. Provide adequate insurance to those who can’t afford it, based on the most effective and efficient models available. (Consider Medicare, Group Health, and other countries with good health indicators.)
Bad Ideas:
I have read many proposed solutions to the healthcare crisis, and a few have seemed particularly poorly conceived.
1. Across the board cuts in payments to doctors: if we make less money for each patient we see, we will have to see more patients in a day, and do more procedures in a day to pay off our educational debt, which will make health care less effective and more expensive. Costs for procedures and medical equipment may need to be cut, but that needs to be combined with some significant changes that allow it to be easier for us to do business. Doctors in the US do not make significantly more money, corrected for cost of living and average salary, than doctors in countries whose health care systems are more cost effective. In Moscow, Idaho, primary care physicians make about the same salary as a good accountant does. Medical education takes a minimum of 7 years postgraduate education and is very expensive and competitive. If the practice of medicine doesn’t offer a decent competitive salary, the people who are qualified to go into medicine will do something else, and physicians will leave their practices.
2. Requiring low income patients to shoulder more of their insurance and healthcare costs: In my experience, low income patients have no extra money to spend on insurance or co-pays and simply will not pay these bills. If there is a “public option” insurance offered by the government and patients on minimum wage are told they need to shoulder 15% of the costs and pay 20% of their medical bills, they will either remain uninsured or will fail to pay their portion of bills, and lose their access to their doctors for bad debt.
Monday, August 24, 2009
How to waste over $21,000 before lunch
Health care in the United States is too expensive, and because it is too expensive, a large number of Americans do not have access to it. The story that is not being told in the national debate about health care reform is what exactly costs too much, and how to remedy the situation. Unnecessary costs directly related to the practice of medicine are only a portion of the waste, but the magnitude of this kind of expenditure may be huge. Saving a fraction of this money could make it possible to give health care to everyone who needs it, withhitout any negative impact on our national budget.
The schedule below is a reasonable scenario of what happens in many primary care offices. The costs are inexact, but within range. The major causes for this waste are pretty easy to remediate: 1. primary care doctors don’t spend enough time with patients because they are underpaid for counseling. 2. Providers and patients don’t know what things cost. 3. Doctors are afraid of being sued for malpractice. 4. Our culture in medicine discourages considering costs in decisions about care.
This is my morning, as a primary care doctor in rural Idaho. It is not a real morning, but it could have been.
8AM—arrive at the hospital, perform two treadmill tests with nuclear imaging, ordered by physicians for patients at low risk, because of concern about malpractice should they have a heart attack. Each costs $3000, one unnecessary, the other of which could have been done without nuclear imaging at my office for $200.
9AM—see two patients at the hospital. One remains in the hospital because she can no longer live at home and can't afford to go to any of the extended care facilities that have openings, at a cost of $1000 for the day. The other is there because she wasn’t insured and waited too long to see a doctor for her migraine headache, costing $2500 for her MRI scan of the head and $1200 for her day’s stay at the hospital, and $600 emergency room fees.
9:45—get to the office late because the uninsured patient was news to me, so I didn’t plan on seeing her. See my first patient who has a physical scheduled. She wants “a complete lab workup” even though all of her labs were normal last year and nothing has changed, because her insurance will cover it. She has been having back pain. Since I don’t have time to talk to her about the natural history of back pain I order an MRI scan and physical therapy. Labs: $120, MRI$2500, 8 physical therapy appointments $1000.
10:30—next patient has numbness in his fingers when he is anxious. He can’t afford counseling and I don’t have time to discuss relaxation techniques with him so I refer him to a neurologist. He will see the neurologist 3 times, at a cost of $150 per visit, and she will order a head MRI scan for $2500.
10: 45—next patient has a cough and a stuffy nose for 4 days. I think it is viral, but she is sure she needs antibiotics. I don’t have time to explain the side effects and futility of antibiotics so I prescribe an antibiotic. She says the generic doesn’t work. Cost is $120 for that and $200 for an inhaler which is what I think will work, though if she just waited she wouldn’t need that. Because she smokes and I am worried about being sued, I order a chest ex-ray. That is another $200.
11:00—patient comes in for followup on his diabetes. He has been in poor control, but since I don’t have time to counsel him on diet and exercise in a way that will probably have an impact, I prescribe a new medication. He is already on generic pills, so I have to prescribe insulin, and because time is an issue, I use the newest insulin delivery system which is easier to explain. This costs $150 and doesn’t make him any happier, plus his risk for complications is just as high because he will continue to gain weight.
11:15—the next patient comes in for followup of an abdominal CAT I ordered because I didn’t have enough time to counsel the patient on how to avoid constipation. The CAT discovered a cyst on his kidney and a nodule on his adrenal gland. He is beside himself with worry, even though both of these things are usually normal findings. I reassure him that I will get a followup CAT scan to make sure they are normal, which will use a better technique and cost $2000 (but I don’t tell him this because I don’t know what it will cost and have no idea what his insurance will pay.) Because he is so worried I don’t have time to see my next patient who has to leave, and go to the emergency department with her pneumonia at a cost of $1500.
So… before lunch over $21,000 has been wasted. And this may significantly underestimate potential for cost savings because most primary care providers in the US see more patients than this, often one every 10 or 15 minutes, and have even higher rates of testing and referrals than I mention.
It is likely that, with malpractice reform, increase in payment for counseling in primary care, a knowledge of and willingness to discuss costs, and the universal access to health care that would then be affordable, nearly all of this $21,000 + could be saved.
The schedule below is a reasonable scenario of what happens in many primary care offices. The costs are inexact, but within range. The major causes for this waste are pretty easy to remediate: 1. primary care doctors don’t spend enough time with patients because they are underpaid for counseling. 2. Providers and patients don’t know what things cost. 3. Doctors are afraid of being sued for malpractice. 4. Our culture in medicine discourages considering costs in decisions about care.
This is my morning, as a primary care doctor in rural Idaho. It is not a real morning, but it could have been.
8AM—arrive at the hospital, perform two treadmill tests with nuclear imaging, ordered by physicians for patients at low risk, because of concern about malpractice should they have a heart attack. Each costs $3000, one unnecessary, the other of which could have been done without nuclear imaging at my office for $200.
9AM—see two patients at the hospital. One remains in the hospital because she can no longer live at home and can't afford to go to any of the extended care facilities that have openings, at a cost of $1000 for the day. The other is there because she wasn’t insured and waited too long to see a doctor for her migraine headache, costing $2500 for her MRI scan of the head and $1200 for her day’s stay at the hospital, and $600 emergency room fees.
9:45—get to the office late because the uninsured patient was news to me, so I didn’t plan on seeing her. See my first patient who has a physical scheduled. She wants “a complete lab workup” even though all of her labs were normal last year and nothing has changed, because her insurance will cover it. She has been having back pain. Since I don’t have time to talk to her about the natural history of back pain I order an MRI scan and physical therapy. Labs: $120, MRI$2500, 8 physical therapy appointments $1000.
10:30—next patient has numbness in his fingers when he is anxious. He can’t afford counseling and I don’t have time to discuss relaxation techniques with him so I refer him to a neurologist. He will see the neurologist 3 times, at a cost of $150 per visit, and she will order a head MRI scan for $2500.
10: 45—next patient has a cough and a stuffy nose for 4 days. I think it is viral, but she is sure she needs antibiotics. I don’t have time to explain the side effects and futility of antibiotics so I prescribe an antibiotic. She says the generic doesn’t work. Cost is $120 for that and $200 for an inhaler which is what I think will work, though if she just waited she wouldn’t need that. Because she smokes and I am worried about being sued, I order a chest ex-ray. That is another $200.
11:00—patient comes in for followup on his diabetes. He has been in poor control, but since I don’t have time to counsel him on diet and exercise in a way that will probably have an impact, I prescribe a new medication. He is already on generic pills, so I have to prescribe insulin, and because time is an issue, I use the newest insulin delivery system which is easier to explain. This costs $150 and doesn’t make him any happier, plus his risk for complications is just as high because he will continue to gain weight.
11:15—the next patient comes in for followup of an abdominal CAT I ordered because I didn’t have enough time to counsel the patient on how to avoid constipation. The CAT discovered a cyst on his kidney and a nodule on his adrenal gland. He is beside himself with worry, even though both of these things are usually normal findings. I reassure him that I will get a followup CAT scan to make sure they are normal, which will use a better technique and cost $2000 (but I don’t tell him this because I don’t know what it will cost and have no idea what his insurance will pay.) Because he is so worried I don’t have time to see my next patient who has to leave, and go to the emergency department with her pneumonia at a cost of $1500.
So… before lunch over $21,000 has been wasted. And this may significantly underestimate potential for cost savings because most primary care providers in the US see more patients than this, often one every 10 or 15 minutes, and have even higher rates of testing and referrals than I mention.
It is likely that, with malpractice reform, increase in payment for counseling in primary care, a knowledge of and willingness to discuss costs, and the universal access to health care that would then be affordable, nearly all of this $21,000 + could be saved.
Sunday, August 23, 2009
What to Expect From a Stay at a Luxury Hotel
There's nothing quite like staying at an outstanding luxury hotel. The service is excellent, the facilities superb and the entire experience leaves you feeling relaxed, invigorated and utterly spoilt. Yet there are plenty of so-called luxury hotels out there who are not worthy of the title, who fall short in some critical area and leave their guests wanting more.Every hotel is unique, and there is no checklist or official seal of approval that marks out a great hotel from a merely average one.
But if you are staying at a hotel that claims to be one of the best, there are certain philosophies of excellence that you should expect to be followed. Whether you are staying at a tiny boutique hotel with only a dozen rooms or a massive 5 star resort hotel, here are some of the things you should look out for to really test the quality of your accommodation.Superb attention to detailWhat marks out a true luxury hotel from the pretenders is the attention to detail. There are a thousand and one little ways in which a luxury hotel can demonstrate its quality, from a complimentary bottle of champagne when you arrive to a main hall that seems like a work of art. The best hotels are those which take great pains to instil quality in every possible way, and which even the most hard to please perfectionist would struggle to find fault with.Highly personalised serviceA truly great luxury hotel stands or falls on the quality of its staff. They should be polite, knowledgeable and helpful, but above all you should be treated like an individual, not as just another patron.
If you have individual needs or desires, staff at a true luxury hotel will work hard to accommodate it. Not all will go as far as the staff at President Wilson Hotel in Geneva, who once hired a crane to get a requested bed up to the penthouse suite, but if you stay at a luxury hotel, expect personalised service!Luxurious accommodationIf you have paid luxury hotel prices, you should expect your room to be of the highest quality. To say the least, the room should be spotless when you arrive, but more than that, it should exude luxury and comfort from every corner.
In many boutique hotels, each room is individually designed for that personal touch, but whether your room is one of a kind or one of a hundred identical rooms, a luxury hotel room should ideally leave you with nothing to complain about.Top quality facilitiesThe sense of luxury shouldn't stop at your room. Luxury and boutique hotels often have additional facilities attached to them - restaurants, spas, gyms and so on. If they do, then they should be of same quality that you would expect from your room and the main hotel. If a hotel has outstanding rooms but a mediocre restaurant attached to it, or a perfunctory sports centre or hotel bar, it is a missed opportunity to truly dazzle its guests.
Getting Pampered at a Luxury Hotel
You have been working for a very long time. You give your all to your job and you feel like you deserve a vacation. But what kind of a vacation do you want to take? Do you want to take one that features nothing more than a bed and a view of the beach? Or do you want to take a vacation that lets you live in the lap of luxury for awhile? One that gives you the opportunity to feel like a celebrity? This is where luxury hotels come into play.
What Is a Luxury Hotel?
You probably know what a regular hotel is, but do you know what the difference is between a regular hotel and a luxury hotel? A luxury hotel is defined as a hotel that is designed to offer unique pampering services to their guests. A luxury hotel can provide you with the ultimate, relaxing experience, allowing you to feel as though you truly are getting your moneys worth, rather than just providing you with a bed and a bathroom for a few nights. Here are a few of the different types of pampering services you can expect the majority of luxury hotels to offer.
Spa Treatment
No luxury hotel would be complete without giving their guests access to a spa treatment option. The majority of luxury hotels have spas right in their hotel. These spas are designed to offer the ultimate in comfort and may feature a number of choices that you can choose from, such as:
• Massages• Facials• Pedicure/manicure• Mud bath• Wraps (ex. Seaweed wrap)• Reiki• Hot stone massage
Many luxury hotels also include a salon that is attached to their spa, so that you can get a pedicure, a facial, and can come back from your vacation with a new hairstyle.
Pet Services
Many luxury hotels also offer pet services. They know that your pet should be as pampered as its owner should be, and so they give you the option to have your pet taken care of as well. They may offer walking services, and gourmet meals. Some luxury hotels allow your pet to dine on caviar of its own! There are even some luxury hotels that have luxury suites that are designed specifically for your pets to stay at, allowing you to feel secure in knowing that they are being well taken care of.
24 Hour Butlers
If you are truly going to splurge, go to a luxury hotel that offers a 24 hour butler option. A 24 hour butler is an attendant that is there to see to your every need. If you want to have a glass of milk at 2 am, the butler will get it for you. If you would like to have new towels at 5 am, your butler will be happy to comply. Having 24 hour butler service is truly a very luxurious option to select. When it comes to luxury hotels, there are many different choices that you can make. More and more hotels are offering luxury accommodations, making it easy to feel like a celebrity, if only for a day or two.
When You Bring Children to a Luxury Hotel
Traveling to a luxury hotel is great when you’re a single person, but what if you are a traveling with children? Going to a luxury hotel with children can be frustrating, especially when you’re trying to enjoy your time alone. If you do need to bring children with you to a luxury hotel, there are plenty of things that you can do so that you’ll all enjoy yourselves!
First of all, bring someone with you to the luxury hotel if you can. If you’ve got more than one child, or even just one, bring someone along with you to help you to take care of this kids. This will give you the time to slip away and enjoy a romantic dinner and will actually give your babysitter the chance to enjoy a luxury hotel that they may not have been able to afford otherwise. A teenaged babysitter is a good idea, as they usually don’t have many other plans, and they will not be as likely to want to get away and do things on their own and will, instead, stay in the luxury hotel.
Most luxury hotel establishments have babysitting services that you can use These babysitting services at luxury hotels all hire the best babysitters in the area, so that they can let others know that they hire trustworthy people. It is fine to ask to meet the babysitter at the luxury hotel ahead of time so that you know that you can trust them, and don’t feel ashamed to ask to see their credentials.
If you’re going to a luxury hotel that is in a major city, try to carve out some family fun time. There are tons of things that you can do outside of the luxury hotel with your children, including going to museums and hitting a park or two. It may be hard to carve out a few hours, but doing so will make your children much happier to spend time with the babysitter, whoever you get or bring with you, and will give you the time you need outside of the luxury hotel to attend to business or to sightsee on your own.
Enjoy time in the room together! Luxury hotels have tons of great things that you can do in the hotel room itself, and if they know that you’re bringing kids along with you, ask them what accommodations they have in place for children who are traveling to the luxury hotel with their parents. Often you can get them to install video game systems and to bring in some great DVD’s for your kids to watch in the luxury hotel room when you’re trying to have a few minutes of peace and quiet in your own room.
The idea of bringing children to a luxury hotel seems a bit frightening, especially when you’re a single parent or one who isn’t used to entertaining children at a hotel. But most luxury hotels, however, go out of their way to accommodate people, no matter if they’re single or a parent, so make sure you as your concierge if there is anything they can recommend that you do whenever you have children along with you at a luxury hotel.
Luxury hotels in London – Hallmark of Comfort and Elegance
If you have the money to splurge on accommodation during your business or leisure trip to London, London luxury hotels is the best bet. Frequented by all kinds of travelers, there are various luxury hotels in London. You can choose from the several luxury hotels in London that are superbly located in prime locations and close to tourist attractions, shopping, restaurants, business establishments and transport links.You can have a look at three of London luxury hotels: The K West Hotel, The Athenaeum Hotel, and The Chesterfield Mayfair HotelThe K West HotelLocated outside the congestion zone of London but minutes from the West End. The K West hotel in London is a very chic well designed luxury hotel. Notting Hill and High Street Kensington are just minutes away and if you take the Central Tube you are 10 minutes from Bond Street. Well designed luxury hotel, The K stands for a Kerry Hotel.
Guests can enjoy their stay in the contemporary chic hotel with clean lines and full service.Guest can treat their taste bud to delectable and new menu crafted by Chef Sam Sweeney in the hotel’s stylish restaurant. Admire the beautifully decorated interior of the restaurant having leather seating in rich reds and blues, with dark wood, stainless steel and glass.Pamper yourself in The K Spa which is absolutely luxurious. Spend some quite and relaxing moment here which is a perfect cosmopolitan retreat. Enhance your lifestyle in an holistic and enjoyable way by their treatment. You can also be a part of Spa lunches.The Athenaeum HotelThe Athenaeum Hotel is a fine hotel and spa. It is a family owned and run luxury Hotel group in the United Kingdom. The friendly staffs and impeccable service will compel you to come back and stay every time you visit London.
The suites and rooms beautifully blend English elegance with modern technology. While staying in this hotel, guests can get remarkable views of Green Park towards Queen Elizabeth's Buckingham Palace, thus making it truly incredible.Get a taste of English cuisines that re served in the dining room. For all diners, the facility of valet parking is available.After a tiring day relax at the spa at the Athenaeum, which is exclusive to their guests. Or guests can simply rejuvenate in the Jacuzzi.Business travelers can held their meetings in the stylish business meeting rooms that are blended with 21st century technology. Guests can also utilize these rooms to elegant private dining for weddings or any special occasion.
The Chesterfield Mayfair HotelThe Chesterfield Mayfair is a four star luxury hotel tucked off Berkeley Square. Superbly located, this hotel is one of eleven outstanding luxury hotels sprinkled around the world run under the Red Carnation Flag. Your stay will be made very pleasant by friendly and efficient staffs.There is lot to do in the hotel. Book lovers can explore the Library whereas you can taste delectable cuisines at the Butlers Restaurant. Take out time to visit the airy Conservatory and relax in the intimate bar. Choose to stay here as it is the perfect base to explore London just minutes from Bond Street.You can select any one of these three hotels for a remarkable experience in London!
The Hallmark Of Best Luxury Hotels And Luxury Resorts
Everyone, at some point in their lives, would like to experience a holiday in the best luxury hotel. Defining luxury is a very subjective thing as each person has their own ideas. Nonetheless, there are some features that everyone would expect a luxury hotel or resort to have.
The best luxury hotels offer sumptuous settings with first class services. Guests at these establishments should feel completely indulged and the experience should provide a welcome escape from the normal rigours of daily life.
At the best luxury hotels no expense is spared to create the exclusive ambience that is so highly sought after. Floors of marble, doors of ebony, velvet draped windows and gilt banisters are features that appear regularly. Nothing basic is good enough. The standard amenities of other hotels are represented by the high-end versions in luxury establishments.
At the top hotels and resorts you can expect to find the most attractive and expensive beddings often of linens and silks. Towels and robes are thick and luxurious and usually embroidered with the hotel crest. There are complimentary toiletries and cosmetics often from designer houses like Chanel. You will be equipped with cable television and high speed internet access. There is often a mini bar stacked with refreshments. Business visitors are well looked after and provided with desks and the daily newspaper of choice.
The best luxury hotels are not difficult to find. They usually advertise themselves quite well on the internet. Their names are listed at airports and with car hire companies. Taxi driver always know where they are. If you are going to another country, you can find the best luxury hotels by consulting a travel agency that specializes in luxury accommodation. Such agencies are easy to find on the internet. Check your chosen destination's official tourist information website. They are very likely to list all the top hotels in the country.
The best luxury hotels are very usually landmarks in their own right and are examples of a country's most notable architecture. They are usually to be found in the most central or the most exclusive locations. City hotels are located in easy reach of tourist attractions and shopping centres.
Luxury resorts are usually to be found wherever there is something in the natural environment that is likely to attract visitors. A country's beach resorts are likely to be home to most of their best luxury hotels. Luxury resorts are often in far flung provinces where they can provide a haven of peace, tranquillity and luxury.
Sunday, August 2, 2009
The Benefits of Advanced Online Hotel Bookings
Online hotel booking is one of the latest techniques in the arena of internet that allows travelers to book a hotel located anywhere in the world and that too according to your tastes and preferences.
In other words, online hotel booking is one of the awesome facilities of the internet. Booking a hotel online is not only fast as well as convenient but also very cheap. Nowadays, many of the hotel providers have their sites on the web, which in turn allows the users to visit these sites and view the facilities and amenities offered by each of them.
The benefits offered by online hotel booking is endless. Foremost is that it enables you to compare and choose a hotel in a desired location and that too according to your requirements. Since many of the hotel websites furnishes information along with ratings as well as exterior and interior pictures of the hotel, it helps users to get a clear idea of hotel, prior to its booking.
In hotel websites, they not only provide hotel details but also a brief info on the place as well as its attractions. This in turn allows the users to get an idea of the place they are going to stay.
Another awesome benefit of booking a hotel online is that it helps you to compare rates. Majority of the hotels across the globe provides details on both regular rates and specials. This feature enables you to book the right hotel with facilities and amenities you require at a rate you can live with.
Apart from these specials, booking hotels online in advance can fetch you more discounts. You can save much more, if your business or vacation plan is flexible enough to match with some particular dates that offer discounted rates.
Booking hotels online is quite easy. All you have to do with regard to booking online is to search for hotels in your desired location, in top search engines such as Google or Yahoo. Then, thousands of results will be displayed.
Select one among them that goes with your requirements. Once you chosen a hotel of your taste, inform them regarding your requirements and which type of room you are looking for. In addition to accommodation, some hotels may provide packages inclusive of transportation within the place, sightseeing, dining, and opportunities to enjoy a variety of recreational activities.
It is evident from the aforesaid discussion that online hotel booking provides substantial benefits. But, it is important to make a thorough investigation before choosing an online hotel booking facility.
First of all, check whether the hotel company you have chosen is legitimate, since identity theft is becoming common nowadays via hotel transactions. It is therefore advisable not to give your vital information such as credit card number unless sure of legitimacy of the hotel providers.
Further, there are certain unscrupulous hotel firms promising great deals at first, and on receipt of bank account details or credit card information, they may charge incredible later. Hence, it must be checked for.
Likewise, beware of such hotel companies requiring immediate action. Al though, it may be true there may be shortage of rooms especially in peak seasons, try to check for the reputation of the company, particularly if it is a less-known hotel booking agent or company.
The next thing you have to check is whether the website has privacy policy. If the website doesn't have one, then think twice prior to giving your details. Likewise, prior to booking a hotel, it should be confirmed that you have all of the transaction's details in writing. Additionally, it must be made sure that the hotel is going to provide you the room of your specifications and preferences.
Unless specified properly, sometimes you will be compelled to spend your much awaited holidays in the back corner of a top-notch hotel. Further, it must be ensured that the hotel you have chosen is strategically located and within easy reach of almost all attractions and facilities like airport and railway station. Ratings and reviews or feedbacks serve as an important aid to select the most appropriate hotel that goes with your needs and budget. However, it is recommended to read the reviews written by the real users.
Despite anything, booking hotels online is fast, easy, and economical, and unquestionably make your business or vacation trip hassle free.
Saturday, August 1, 2009
What To Look For In A Luxury Hotel
Staying at a hotel can be one of the best, and most relaxing experiences that many people will ever have, especially if the hotel of choice is a luxury hotel. Finding a luxury hotel that will meet your vacationing or weekend getaway needs may take a little digging, but it will be well worth it.
What is a Luxury Hotel?
Hotels are given a rating from zero to five stars - five star rating being the best. When a luxury hotel is rated, there are different things about it that are given a rating, and the rating is averaged to give it the hotel star rating.
In the United States, Europe, and England, there are star ratings for hotels, though each area uses a slightly different way to rate them. The star rating is meant to help people who want to choose a luxury hotel based on certain criteria.
Room size, comfort level of the room and especially the bed, noise level audible in the room, cleanliness, decor, amenities provided, and service of the luxury hotel staff are all rated during the overall process of reviewing the luxury hotel. The bottom line, though, is that if you want a luxury hotel, you will want to look for a four star rating at the least, and possibly a five star rating.
The star rating is not the only thing which distinguishes a luxury hotel from other hotels. Most often a hotel will be considered a luxury hotel if the rating is at least four, and there are other unique things about the luxury hotel, such as a particular focus or special perks that are not common to other hotels that are not considered to be in the luxury hotel category. Having a spa, in room massage, offering child care, and even having a special theme throughout the hotel may help as one establishment is deemed a luxury hotel.
Special Perks
Usually a luxury hotel will offer special perks. You may be able to find a luxury hotel that will offer perks and amenities in almost any area including family fun, romantic adventure, and exotic treatments.
Finding what you want in a luxury hotel can make your vacation time or weekend getaway even more memorable.
There is a luxury hotel option available in many price ranges and one can be found by looking for the star rating. Make sure when you look at the rating of a luxury hotel, you look at the ratings for the individual categories that have been rated. If comfort and room service are more important to you than space and a blow dryer, then give those things precedence over the other.
Give yourself the vacation you deserve with all the comforts you will want when you are away from home. A luxury hotel will help you do just that. With the best in ratings, the best in perks, and the amenities offered that mean a lot to you as you relax and enjoy yourself, a luxury hotel will make your time away even better than it would have been.
Staying at a luxury hotel will mean that you are giving yourself the best there is to offer. A luxury hotel is available for your convenience and in many price ranges. A luxury hotel will offer the best - it is up to you to take it. Bye Take Care !!
How To Save Money While On Vacation
A holiday does not have to cost you an arm and a leg if you know how to look for and take full advantage of the many exciting money saving offers that are available to you throughout the internet. Many companies offer specific online savings and packages that you cannot find anywhere else. These online savings and offers are available to you online only, so you will have to visit their websites to take advantage of them, and they are not made available to those who visit them offline.
Many travelers can enjoy a bundle of savings by booking hotel reservations, airline tickets, or car rentals online. Additionally, they can also find packages that will allow them to do many things they will enjoy for a fraction of the cost. These packages can often include many exciting attractions you can see within an area, hotel, transportation, and sometimes certain meals are included with in the packages. Packages are geared towards every interest, for example, they could be geared towards specific destinations world wide, such as Paris, Italy, Florida, Hawaii, and the like.
Other packages could be geared towards specific events or activities, such as hiking, camping, jungle adventures, cruises, singles events and trips, couples geared outings, musicals, major shopping trips, or site seeing in exciting new places. There are many websites on the internet that are available to you by simply using one of the many popular search engines. Websites like expedia.com offer a one stop shopping source for flight tickets, trains, car rentals, and hotel reservations. In addition, they offer advice on traveling, points of interest, and an easy to use online reservation request.
The internet has made it so much easier to plan a trip that the whole family can enjoy, you can plan your entire itinerary right on the internet and find some excellent travel and safety tips that you could use. If you need to purchase new items to take with you on your holiday you can also do that online with many special deals from online retailers that sell the products you need.
Take full advantage of all the internet has to offer by booking your entire holiday online and safe a ton of money in the process. After all a holiday is enjoyed so much more, when it is a bargain and money saving one. It will leave you more money to spend on necessities and fun things you want to do!
Romantic Luxury Vacation at European Castles
Romantic Luxury Vacation at one of European Castles
Today royal families are few and far between, but there remains a romantic lore and mystique surrounding the lifestyle of kings and queens, lords and ladies who lived hundreds of years ago, and rightfully so. These wealthy and prominent individuals vied with each other for power and prestige and built lavish homes to showcase their wealth. Since most royal descendents cannot afford to maintain a castle as their private home, adventuresome travelers who are looking for the best in luxury travel can experience the romance of the days of yore by planning a luxury vacation getaway at a castle that has been restored to 5-star expectations and beyond.
And true castles these are, huge rambling buildings adorned with gargoyles, towers, turrets and steeply sloped roofs. The old castles, built in the centuries before electric lighting, feature expansive windows that give unparalleled views of carefully manicured lawns and ornate gardens fit for a modern king and queen. For those who are seeking a vacation that provides royal treatment, what better place to find such luxury than at an authentic castle retreat?
The ultimate in romantic travel, luxury castle vacation venues are available throughout Europe. The best feature the latest in modern amenities such as on-site spas while offering traditional royal amusements like horseback riding and custom hunting and fishing excursions. Typically, on-site dining is of gourmet quality served in elegant surroundings of the ancient formal dining room. Travelers who vacation at these luxurious imperial residences should understand that they are also contributing to the preservation of these magnificent historic treasures for future generations.
Castle hotels in Ireland offer world-class accommodations and five-star service. These castles, surrounded by hundreds of acres of private grounds, are ideal for those who are seeking a quiet luxury vacation. Spend time in the formal gardens or wander the private grounds for peace and solitude. Irish castle vacations have particular appeal for golf enthusiasts. Top rated golf courses abound in Ireland plus some castle resorts offer a private golf course as well.
For those who desire the ultimate in privacy, smaller Scottish castles may provide the perfect luxury vacation experience. Nestled in scenic locations, fully restored estates dating back to the 1500’s that have been renovated to five-star standards are available for rent by the week or the month. Although smaller than the castle hotels, these estates boast a dedicated full-time staff to cater to the guest’s every need and provide a perfect hideaway in a historically romantic setting.
Germany is the ideal location for travelers looking for a romantic locale. The famed Romantic Road that winds its way through southern Germany from Wurzburg to Fussen through historic architectural districts is one of the world’s most popular tourist routes, especially in summer. Instead of joining the throngs of tourists on the Romantic Road, experience romantic German castles firsthand on the German Castles Road, which extends from Mannheim on the Rhine River to Neckarzimmern in the Neckar River Valley. Here luxury-minded travelers can choose from dozens of elegant five-star castle hotels.
Luxury Hotels in Pakistan
Who says nobody can have fun in Pakistan? With so many beautiful places and virtually unlimited possibilities for hiking, trekking, mountaineering, and other sports, a trip to Pakistan can be your ultimate Pakistani escape. Here are some excellent Pakistani luxury hotels where you can stay while enjoying your trip to this wonderful but unfortunately a little understood country.
Subscribe to:
Posts (Atom)