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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update — 04-08-2013

Columbus, OH paper compares hospital wait times from 15 different hospitals throughout central Ohio. Metrics include minutes until diagnostic evaluation, minutes until pain medication, minutes until admission decision, and minutes from admission to room placement. I just wonder how accurate the metrics are. It isn’t like self-reported data like this can’t be manipulated. Evanston Northwestern Hospital in Chicago suburbs also making news because of its wait times – nearly twice the national average. The problem with providing patients with insurance: When the insurer cuts payments, what happens if providers won’t take your insurance? Government cuts payments to providers so that it costs more for cancer clinics to provide chemotherapy to some Medicare patients than the government reimburses. To stay afloat, some cancer clinics have now begun turning away Medicare patients needing cancer infusions. Now patients go to hospitals where the charges for cancer treatment are higher and the waits for treatment will likely be longer. But we’re going to be insured! And we can keep our doctors, too! Patients gone wild. Two brothers in Lebanon “attack” an emergency department, smashing windows and insulting the doctors and nurses on duty. In other words … a normal day in a typical American emergency department. And their Press Ganey scores probably stink for that day, too. What a great story. Six year old Long Island kid treated in emergency department raises $275 with a fundraiser and uses the money to buy coloring books for other emergency department children. Remember how CMS promised to give incentive payments for “meaningful use” of electronic medical records? Not so fast. Rules changing. Now it is doing random audits of 5-10% of all applicants to see whether they should actually get their bonus payments. Self-reporting isn’t good enough any more. Wouldn’t it be interesting to see what would happen if all providers went back to paper records? Canadian paramedics visiting patients with “non-urgent” issues to keep them out of emergency departments. The only question I have is who determines whether the issues are “non-urgent”? A second interesting Medical Economics article. What are the tech trends that will affect how doctors practice medicine in the future? Interesting to consider. Remote patient monitoring. Personal health records with biometric security. Cool stuff. More than 25% of Oklahoma patients enrolled in Medicaid. Of those, about a quarter used the emergency department a total of 528,000 times at a cost of $170 million. Oklahoma is now trying to determine how to deal with the high utilizers – those who use the ED more than 15 times every 3 months. Speaking about Oklahoma … Oklahoma Dentistry Board officials are deciding whether to pursue criminal charges against a dentist. Officials found rusty instruments, “potentially contaminated drug vials” and “improper use of a machine designed to sterilize tools” in the dentist’s office. The Oklahoma Dentistry Board accused the dentist of re-inserting needles in drug vials after their initial use and using the same drug vials on multiple patients. This happens often in medicine. The dentistry board also stated that a sterilization machine hadn’t undergone monthly testing in six years. Concerning, but when the Board officials tested the machine was it not properly sterilizing equipment? They did test the machine, right? Were the rusty instruments used on patients? Where was the rust located – on the handles or on the surfaces that come into contact with patients? In addition, the dentist allegedly allowed dental assistants to administer IV sedation when only dentists are allowed to perform such acts. For each charge, the dentist could face up to four years in prison and a $10,000 fine. Are the ...

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Healthcare Update — 04-01-2013

This case report is entirely bizarre. Patient gets awarded more than $800,000 after visit to doctor resulted in incorrect diagnosis of cancer when the patient really had pneumonia and caused patient to have amputation of her foot. A trial was held on the case four years ago with a verdict in favor of the doctor, but the judge declared a mistrial because Washington State jurors were referring to the plaintiff’s Japanese attorney as “Mr. Miyagi” and were making other racist comments against him. Then, the article notes that the doctor had been disciplined by state regulators for making “erroneous diagnoses” and for prescribing methadone to drug-addicted patients. So now Washington State physicians’ licenses can be on the line for failing to perfectly diagnose patient symptoms and for prescribing medication for one of its intended uses. I admit we don’t have all the information behind the license actions, but the article makes the Washington State Medical Board sound a little overeager to discipline physicians. Congratulations! You delivered a healthy 6 month old! 15 lb 7 oz baby delivered vaginally in UK. More than 20 doctors reportedly assisted in the delivery. Curing patients gone wild? Australian hospital emergency department guards petitioning to carry guns at work. Medical workers claim that it will make emergency departments more dangerous. Australian patient held four days in emergency department waiting for psychiatric bed to open up. Shortage of beds creates high demand. Patient’s mother alleges that his condition worsened because of the long wait. Not that anything like this could happen in the US. Oh wait. What a coincidence. LSU is closing their mental health emergency department, resulting in other hospital emergency departments having to care for “an additional 2,000 people who are a danger to themselves or others, who are desperately in need of stabilization and potential further hospitalization.” When medical services are curtailed, the patients needing those services don’t just disappear.

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Healthcare Update — 03-25-2013

Another medical issue with overweight patients: Intramuscular injections. An Epi-Pen may not work in patients who are obese since the distance through the subcutaneous fat to the muscle is greater than the length of the needle. This study showed that in more than 4 of 5 obese children, the subcutaneous fat layer was too thick for an IM injection one quarter of the way down the thigh. In nearly 1 of 5 obese children, the subcutaneous fat layer was too thick three quarters of the way down the thigh. In those patients, the study suggested injecting the calf. I suppose the manufacturer could be forced to make autoinjectors with longer needles, but then non-obese patients would theoretically risk getting a bone marrow injection of epinephrine. How good are emergency physicians at dispositioning psychiatric patients when compared to psychiatrists? Not horrible, not great. 95% of patients assessed as “definitely admit” were admitted by the psychiatrist. For other emergency department psychiatric patients, there was an 87-90% concordance rate. Sugary drinks may kill 25,000 people each year. That’s nothing. SALT [allegedly] causes one out of 10 deaths in this country each year and more than 2.3 million deaths worldwide in 2010. Wonder what that sphincter Michael Bloomberg is going to do with this information. Salt tax? Force NY City hospitals to draw serum sodium levels on all patients? Outlaw salt shakers in restaurants? Or maybe he could just go after the salt shakers with the larger holes and call them “asSALT” weapons. Bwaaaaaahahaha. Sometimes I crack myself up. Another nice article by Alicia Gallegos at AM News. Liability involving patients who overdose on medications is increasing. Families of suicidal patients who overdose on medications are blaming physicians who prescribe the medications … and winning. According to the article, physicians are having also disciplinary actions taken against them if they prescribe medications to a “doctor shopper”. This is getting ridiculous. When pain patients complain that they are treated like “drug seekers,” this is part of the problem why. Maybe the next step should be forcing all patients to sign a statement requiring them to list any doctors that have prescribed them medications, any medication that they have at home or have access to at home, and any medications or street drugs they are using or have used in the past 12 months.

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Healthcare Update — 03-18-2013

The Veteran’s Administration intentionally changed and hid data to avoid providing costly yet critical medical care to soldiers from the Gulf War? A head VA epidemiologist alleges that more than two thousand veterans responding to a study felt like they would be “better off dead”. In 95% of those cases, the VA did nothing to assist those veterans with follow up care. In a subsequent study when the same epidemiologist attempted to ensure follow up care for potentially suicidal veterans, he allegedly had disciplinary actions instituted against him. If that’s true, I wonder how everyone else will be treated once they have medical insurance under the UnAffordable Care Act. American College of Obstetricians and Gynecologists advises against using the da Vinci robots for hysterectomies. Robotic surgery adds about $2000 to the cost of surgery and “there is no good data proving that robotic hysterectomy is even as good as, let alone better than, existing and far less costly minimally invasive alternatives.” I hope that other specialty societies have the integrity to make similar inquiries. All those hospitals that spent millions of dollars on these machines to keep up with the Joneses may just be in for a big surprise. Insurance companies expect health insurance premiums to rise 20% to 100% once the UnAffordable Care Act is implemented next year. Department of Health and Human Services responds that it is misleading to look at the one provision of the UnAffordable Care Act because “taken together, the law will reduce costs.” Well, gee, that broad unsubstantiated assertion sure convinced me. You know all those things your hospital does to stop the spread of clostridium difficile infections? Yeah. They don’t work (.pdf file). 42% of hospitals implementing such policies noted decrease in c. difficile rates while 43% of facilities noted an increase in c.difficile rates. Can’t wait to see the spin that the Joint Commission puts on this one.

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Healthcare Update — 03-11-2013

Doctor treats child born to HIV positive mother with full three-drug regimen of HIV drugs one day after birth instead of one or two drug regimen typically used until an HIV infection can be confirmed. Treatment continued for 18 months, then the patient’s mother stopped bringing the patient to appointments. The child is now 30 months old, has been off HIV medications for a year, and has no HIV infection according to ultrasensitive testing performed at Johns Hopkins. Now the doctor’s colleagues are planning a celebration. Of course, if the child did poorly or had a bad reaction to the medications, the doctor would likely have been arrested, lost her license, and sued for millions. More warnings about superbugs. MRSA is bad enough, but what happens when the organisms living in all of our intestines become resistant to antibiotics? Patients gone wild returns. Minnesota goof screams profanities and disrupts medical care. Tied down in four point restraints until police arrive. Will likely be charged with disorderly conduct. Wow. If every patient that did this kind of thing was charged with disorderly conduct and whisked off to jail, our ED volumes would drop by a good percentage. Electronic medical records are supposed to improve care, right? In this study, alert fatigue caused 30% of VA doctors to miss important alerts. 87% of doctors said that the number of alerts they received was excessive and more than half blamed the design of the EMR for the problem. Quite possibly better than the lollipop story. Police find loaded gun in woman’s hoo hah during search. Also had crystal meth in her butt crack. And THAT, dear readers, is why they call it “dope.” You think your wait in the emergency department is long? Try going to LA County Medical Center where the wait averages 12 hours at some points. In the past, certain people have equated high wait times to a poorly run hospital, but we won’t go there. Spider bites may be a common complaint when coming to the emergency department, but the complaint often turns out to be a MRSA infection. As the Milwaukee Brewers General Manager discovered, bites from other arachnids may also require an emergency department visit when you try to squish them up in a tissue. British Columbia emergency physicians describe horror stories in their emergency departments allegedly due to funding issues and overcrowding. Performing CPR on the waiting room floor? Even I haven’t heard of that one before. Nurse in New York caught stealing medications from nursing home patients. Not sure how to take the wording in this article. Polish man walks into emergency department with screwdriver sticking two inches into his forehead, article reports that there was no damage to the patient’s brain. South Carolina inmate grabs an officer’s gun during emergency department visit. Second officer “fires shot to subdue him” – inside the emergency department. Inmate then gets taken back to jail. What happened to the gunshot wound? Did medical malpractice kill Bruce Springsteen’s saxophonist? Clarence Clemons’ brother, an attorney, pursues malpractice litigation against doctors for Clemons’ stroke. Could medical malpractice climate in Florida be changing? Bill working its way through Florida House would increase burden of proof on medical malpractice claimants and would limit who can serve as an expert witness. Also protects hospitals from liability for actions of their contracted health providers. Florida Medical Association attorney notes that Florida’s current malpractice laws are “doing a disservice to our state and are a driving force in a physician’s decision to leave critical-need specialities, retire prematurely and even leave to practice in another state.” We’re ...

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Healthcare Update – 03-04-2013

Drunks caught on security camera beating each other in a Turkish emergency department waiting room. Best part of the video is when one dope pulls off his belt to start hitting people and his pants fall down. Then he waddles about swinging his belt like a little kid with a load in his diapers. Another bamblance theft from the emergency department. If you don’t know why it’s called a bamblance, you need to listen to the video below (strong language alert). This latest ambulance theft occurred at University of Michigan. Many of the commenters to the article suggested that the patient was going to a different emergency department due to the wait times. httpv://www.youtube.com/watch?v=bBa0blUoE8U FDA stifling pharmaceutical innovation through excess regulation. You don’t say. Scary that the average time and cost involved in developing a single drug approved by the FDA is 12 years and $1.2 billion. How much will you be charged for your emergency department visit. This study in PLOS-ONE gives you a good idea of what you should be charged. Keep in mind, though, that the numbers are “median” values, meaning half of patients got charged more than those numbers and half of patients were charged less than those numbers. The range of charges was ridiculous. For a UTI, the lowest charge was $50 while the highest charge was $73,002. That doesn’t mean some poor patients actually paid $73,000 for a Bactrim prescription, only that insurance was billed that much (which is still a crime).

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