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1209717_19610439The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
You’ll also read a lot about health care policy. I may throw in posts about life lessons, computers, and will even throw in family stories once in a while. If you’re looking for articles about politics, sports, or celebrities, you’re in the wrong place – unless the topics have some relationship to medicine.
If you want to add a guest post or to cross-post something from your blog, or if you have a patient story you want me to write about, e-mail me. See more information in the “About Me” page.

Healthcare Update 03-18-2010

If you like these, check out the satellite edition of the Healthcare Update over at ERStories. “The only thing that changes is the names.” Canadian patients dying waiting for emergency department care. One patient’s family was told that the emergency department was short two doctors and four nurses and that “there was a 16-hour wait and that I just had to be patient” – as the patient died while sitting next to the nursing station. Nurses are forced to do overtime and then “the health system is not able to retain them.” When you make the practice of medicine unattractive, not as many providers want to practice and this scenario will repeat itself. It’s called job security. Survey shows that 61% of adults in the US drink “liquid stupidity,” only 31% of adults exercise regularly, and 20% smoke cigarettes. While 64% get 7-8 hours of sleep per day, 28% get 6 hours of sleep or less. The comments to the study were … interesting, including a post of the text of a now-dead Mississippi House Bill that purported to improve obesity in Mississippi by prohibiting food establishments from “serving food to any person who is obese”. Think about this before your next one night stand. According to Bloomberg.com, one in six Americans has genital herpes. About half of all black women and 40% of black men have genital herpes. To treat the problem, GlaxoSmithKline sold $1.29 BILLION worth of Valtrex last year. Dang! Georgia Supreme Court upholds liability protections for emergency medical services. The Georgia legislature passed tort reform in 2005, finding that health care providers in Georgia were having increasing difficulty in locating liability insurance and that when the insurance was able to be found, it was extremely costly, resulting in the potential for diminution in access to health care and an “adverse impact on the health and well-being of the citizens of this state.” Potential litigants must still prove “clear and convincing evidence that the physician or health care provider’s actions showed gross negligence.” The dissent in the opinion (.pdf file) called the law “arbitrary” because it protected emergency health care providers, but did not afford the same protections to physicians who treat the same conditions in their offices or in the patient’s homes. The dissent forgot one thing – physicians can refuse to provide care to patients in their offices or at their homes. Emergency physicians provide care to all patients all the time. Protect the safety net. More evidence that “insurance for all” isn’t the answer. This New York Times article describes the difficulty that Michigan Medicaid patients are having when trying to find medical care. “With states squeezing payments to providers even as the economy fuels explosive growth in enrollment [now 47 million patients nationally], patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage.” One parent called 4 or 5 pediatricians to see her 2 year old son. None of them accepted Medicaid. She ended up having to go to a public clinic with a four month waiting list. One obstetrician who stopped providing services “feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies because of underlying health problems.” Only 2 of the 72 surgery residents who trained at one Michigan hospital decided to remain in Michigan. Not only are states cutting reimbursements for care, but they are also cutting benefits — including dental, vision, podiatry, hearing and chiropractic services for adults. Realize that, on a “dollars and cents” basis, lack of providers is beneficial to the bottom line. Less access ...

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Double Entendre

ERP here from Erstories.  A little quick post while I am out skiing. Yes, I admit I get a little juvenile on occasion during a shift.  Other staff members do as well and I think this is a good thing.  It lighten things up.  A little silly laugh because someone said something that conjures Beavis and Butt-head – style snickering helps our blood pressures come down.  Of course there is a fine line between jokes and harassment but if everyone laughs when someone says something that is unintentionally of sexual connotation, who would complain? Some of the things I have heard or had said to me: “Hey ERP, do you have a measuring tool”? “Who was that new doctor? He pissed me off by getting all up in me.” “Holy Moly, it is busy. I have never seen such a patient load.” “Yes, Doctor Newbie, I can help you get that DVD into the slot.” “Hey ERP, the new patient in room 5 has priapism, go help him take care of it.” People need to lighten up in the work place.  Sometimes things are just funny!

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Medicare Cuts Delayed Again — PHEW

I had planned to log on and write a quick post reminding docs that they have less than a week to decide whether or not to remain a participating provider in Medicare in the face of 21% payment cuts — and to encourage docs to drop Medicare. While perusing the morning news, I discovered that once again the Senate has made a last-minute decision to delay the Medicare pay cuts — this time until October 1, 2010. I’ll be linking back to my Brinksmanship article somewhere around September 15, 2010, I’m sure. According to one Senate Republican, this means that the federal deficit will increase by $100 billion. Wait. Seven months of foregoing 21.2% cuts to physicians costs the government an extra $100 billion. That means that 12 months of foregoing cuts would cost $171.4 billion (divide $100 billion by 7, multiply by 12) Dividing $171 billion by 21.2%, we get a total Medicare payout to physicians every year of $808.6 billion dollars. Mrs. WhiteCoat gets paid about $70 for an average office visit for a Medicare patient – usually after having to pay her office manager for a couple of hours of time to figure out why Medicare refused to pay the first three times the claim was submitted. Let’s round up. Say Medicare pays $100 for an average doctor visit. Dividing $808.6 billion dollars total physician payments by $100 per doctor visit means that the total number of doctor visits – just for Medicare patients – is a little more than 8 billion per year. Lets say that there are 50 million Medicare enrollees (these Kaiser numbers are from 2008, so I increased the estimate from 44.8 million to 50 million). Eight billion visits divided by 50 million patients means that every single Medicare patient is seeing a doctor an average of 161 times per year – more than three times per week every week for the entire year. Look at it another way. Dividing $808.6 billion by 50 million Medicare patients means that physicians are being paid an average of $16,172 each year for every Medicare patient in the country. So what are all of us rich doctors complaining about? How about politicians who are full of hot air. Where’s the money really going?

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Healthcare Update — 03-10-2010

If you like this, you’ll also like the satellite edition of this week’s Healthcare Update with more links over at ER Stories. ——- Dirtbag emergency department technician steals credit cards from plane crash victim’s wallet while other personnel try to save the man’s life. Then he buys himself some Armani clothes using the patient’s credit cards while the patient is dying in the hospital. HIPAA violations that occur for personal gain are punishable by up to $250,000 in fines and 10 years in prison. You’ll have to make an awful lot of license plates to buy an Armani shirt in the Big House, there dimwit. Emergency nurses: They’re overworked, underpaid, they get spit on, kicked, threatened with scissors, and are the front line for disasters. You’re paying them less than surrounding hospitals. Now their benefits are getting cut. It’s a tough economy. When there aren’t enough specialists willing to provide on-call services, patients often have to be transferred to other facilities for specialty care. In some cases, finding a hospital with a proper specialist that is willing to accept a patient in transfer can take a long time. This patient with aortic dissection wasn’t able to get timely transfer for surgical repair and a suffered cardiac arrest before the dissection was fixed. An emergency nurse noted that the receiving hospital refused to accept the patient because he had no insurance. Now the patient is blind and disabled. Who’s to blame? The system? The hospital? The physician? The patient? (thanks to Max Kennerly for the link) Down side of going to help Hatian earthquake victims: If you get sick, you may not be able to get the health care you need. Condolences to the family of this 38 year old Seattle nurse who suffered a heart attack and died while helping Haiti’s injured. You hospitals want to save money? Stop treating low income patients in your emergency department. After implementing its Urban Health Initiative, the University of Chicago doubles it operating profits for the year. During that same time period, ED visits dropped 22% and admits dropped 8.5%. One problem, though. If more hospitals take this approach, where are the poor patients going to get the more “mundane” medical care? Minnesota Governor Tim Pawlenty suggests that one way to cut health care costs is to change federal EMTALA laws so that “not every ER is required to treat everybody who comes in the door, even if they have a minor condition.” He’s now getting flamed all over the internet. See here, here, and here for examples. The thing is, EMTALA laws don’t require every “ER” to treat every patient. Hospital emergency departments are only required to provide a screening exam to everyone and to treat emergency medical conditions. Pawlenty already has his wish, and it’s not so radical, folks. To wit: (I saw that phrase in a lawsuit brief and am getting a kick out of using it, so leave me alone) More hospital emergency departments are jumping on the “pay before you see the doctor” bandwagon. Burke Medical Center in Georgia stated that it was “following the trend of other facilities” when it implemented a policy of paying your insurance co-pay or $100 before receiving treatment. If you don’t pay and don’t have an emergency condition, you’ll be given a list of outpatient clinics where you can go for care. In the same vein, do doctors in America turn away the uninsured? Absolutely. Read this HuffPo article to get a good idea of how and why. Good insights. Nebraska physician advocates personal responsibility as one way to improve this country’s health care ...

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Raisins OK, Grapes … Not So Good

Come on. Allergies to fresh fruit and vegetables? Guess all the chemicals used in processing are good for the immune system.

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Healthcare Update – 03-03-2010

Bad debt causes Arkansas hospital to implement unpopular policy – make a $50 down payment before you can see the emergency physician. What!?!?! That’s more than a carton of smokes and a case of PBR combined! Anger management classes are down the hall. Cape Cod punk getting treated for cuts to his hand he sustained when he punched a mirror then puts emergency department security guard in headlock and starts punching him in the face when security guard started “staring at him.” Lighten up, Francis … oh, and enjoy your stay the Greybar Motel. Deaconess Hospital emergency department closure “disastrous” and isn’t addressing “critical problems facing emergency patients” according to ACEP president Angela Gardner. Spot on, doc. Michigan’s Medicaid system is out of control. One in 6 Michigan residents qualify for Medicaid and it covers 40 percent of all births and 70 percent of all nursing home care. How will Michigan close the Medicaid budget deficit? Tax doctors on their gross receipts. Yeah. that will work. Up to 45% of Michigan docs already refuse Medicaid patients. Watch that number jump. Good news: Visits to Canadian hospital emergency department decrease during Olympics. Bad news: Number of patients suffering from drunkenness and assaults spiked. During the Olympic games, hospitals in downtown Vancouver were seeing an average of 17 assault victims per day – triple the usual number. Medical malpractice cases at all time low and total malpractice expenditures only 0.6% of total healthcare budget … according to Public Citizen. Oh, tort reform in Texas is a failure and a 1999 IOM study showed that doctors kill 99,000 patients every year due to avoidable errors. Yeah, that about covers it. Phil Howard speaks on tort reform. Inspiring – at least to the non-lawyer commenters. (Thanks to Mad Rocket Scientist for the link) When everything is an emergency, nothing is an emergency. Pittsburgh man calls 911 ten times in two days complaining of abdominal pain. Unfortunately, Pittsburgh just got socked with a snowstorm, there was two feet of snow on the ground, ambulances were unable to get through the roads, and paramedic calls were at twice their usual volume. At one point, 30 calls were waiting for ambulances to arrive. The man took pain pills and ended up dead. Now the city plans to have firefighters respond to some 911 calls … between fighting fires, of course. One commenter to a report of this incident on Medscape blogs noted that tax cuts can have the same effects of decreasing available personnel and increasing wait times. Another commenter stated that services in his area had been cut so thin that patients were better off taking a taxi. Inner city emergency departments have nothing on Haiti after the earthquakes. Emergency physician Scott Plantz describes his experiences in a USA Today article.

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