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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update – 01-04-2016

Drug use (especially Ecstasy) at Australian music festivals has increased significantly over the past few years. One emergency department director noted that if people knew where the dealers had concealed the drugs to get into the festival, a lot of people would “nearly vomit.” I can tell you from experience that those places of concealment aren’t limited to music festivals, either. Patients gone wild. South Carolina belle Megan Whit drives pickup truck into a couple of telephone poles, then asks responding officers for drink of antifreeze. Proceeds to channel the Queen of Hearts from Alice in Wonderland and repeatedly yells “Off with your head!” at the officer. Taken to the emergency department where she insisted she was pregnant and that she overdosed on narcotics. Then shouted obscenities in the emergency department for several hours before testing showed she had used cocaine, crystal meth, and marijuana. This is your brain on drugs. Any questions? Welcome to Crazy Town. Well-written article about a day in the life of Indianapolis trauma surgeon Jamie Coleman. Many excellent pictures accompany the article. If you’re interested in medicine, this article is a must-read. Suppose one of your New Year’s resolutions is to stop drinking. What can you expect in the next 30 days? Here’s one person’s experience. Connecticut attorneys accused of misappropriating $4.3 million from malpractice client’s settlement and of failing to provide proof of more than $600,000 in legal expenses. Initial retainer agreement calculations would have resulted in fees of $2.66 million from the child’s $25 million settlement. Attorneys from Koskoff Koskoff & Bieder allegedly took $7 million in legal fees. Grievance committee investigating the matter finds “probable cause of professional misconduct” against attorneys in the case, but article notes that they were still allowed to keep all of the money. According to the Koskoff web site, Kathleen Nastri and James Horwitz represented the client during the trial. Employees snooping in the medical records of a patient who committed suicide. Co-workers accessing a patient’s medical records that were then used against him in divorce proceedings. HIPAA violations are “widespread throughout the VA” according to one whistleblower – who was put on administrative leave shortly after filing a complaint. This ProPublica investigation revealed more than 10,000 privacy violations by the VA system since 2011. The Office for Civil Rights cited the VA for more privacy violations than any other health provider in the nation, yet the VA has reportedly never been sanctioned for these violations. But if a patient suffering from a heart attack at a non-VA facility gets tPA at minute number 31, the doctor’s employment is on the line. Nice system we have, huh?

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Healthcare Update — 12-31-2015

How well are patients in one Norwegian emergency department having their pain managed? According to this study in the Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine, not very well. Of patients with moderate to severe pain (58% of all study participants), only 14% received pain medications. The authors note that “Pain management is accepted as a quality indicator of care, and additional focus on strategies to improve pain management in the ED is necessary to ensure that all patients receive optimal pain assessment and treatment.” First of all, not all patients come to the emergency department with pain complaints. It gets idiotic when asking patients with a rash, a runny nose, or a cough about their level of pain. Second, the study required that anyone with a pain rating more than 3 of 10 be treated for pain. Demanding medication be given for 4 of 10 pain? Give me a break. Third if you want “strategies” to improve compliance, just take a page from the US playbook. Call pain the “fifth vital sign,” create some silly agency that monitors compliance and documentation of irrelevant metrics (you can call it NJCAHO), and create another agency to send out patient satisfaction surveys having little or nothing to do with assessing proper medical care. You’ll get 90+ percentile compliance guaranteed. Of course, then you’ll also create an incentive to prescribe an order of magnitude greater number of pain medication prescriptions, the number of deaths from drug overdoses will skyrocket, you’ll have to create a whole different system to monitor and track patients who become addicted to the pain medications and try to con doctors into writing prescriptions for more medications, other countries will make fun of your citizens for all the pain medications they use, the morale of the healthcare providers in your country will take a hit, and eventually fewer people will want to go into the healthcare profession. But the pain will be better controlled. Want to see what you’ll look like when you stick to that diet you’re beginning tomorrow for a New Year’s resolution? This web site will give you simulated before and after pictures. Unfortunately, it only has simulated females and it appears to be less accurate as the weight increases. But you can print up a picture to tape to your bathroom mirror to remind you of your goal each morning. Want some motivational quotes to paste under the before and after pictures? This Inc. article gives you 101 of them. Here are a couple of good exercise-related ones: The secret to getting ahead is getting started. No matter how slow you go, you’re still lapping everyone sitting on the couch. I’ve tweeted about this site before, but for those of you who missed it, if you need to get a full copy of a scientific article, but can’t afford the $30+ fee to download it, the site Sci-Hub will allow you to download full copies of research papers. Just paste the URL of the article into the site and it will provide you with a full copy of the article. It has 47 million articles in its library. Study in Gut magazine shows that taking proton pump inhibitors (“PPIs”) such as Protonix, Aciphex, Prevacid, Nexium, Prilosec, and Dexilant is associated with unfavorable changes the bacteria in the intestinal microbiome. These changes may explain increases in the rate of Clostridium difficile (“C. diff”) infections in PPI users. The study also notes that the changes in gut flora associated with PPI use are “more prominent than the effects of antibiotics.” Attack of the Glasshole 2.0 nears. Newest ...

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Healthcare Update 12-28-2015

A must-read opinion article by Theresa Brown in the New York Times. When health care reimbursement is predicated on documentation, documentation replaces the work being done. Charting is valued more than medical care. Teams of health professionals are hired not to provide medical care, but solely to evaluate the appropriateness of what other health professionals documented while trying to provide medical care. Many commonly-prescribed drugs being used in cocktails that result in overdose. One popular mix includes methadone, gabapentin, Klonopin, clonidine, and an over the counter allergy medication. During the first 6 months of 2014, of the 501 overdose deaths in Massachusetts, Fentanyl was present in 37% of overdose deaths while Klonopin and/or Xanax were present in 13% of overdose deaths. Gonorrhea becoming increasingly resistant to antibiotics. “Super gonorrhea” showing up in England. England’s chief medical officer Sally Davies warns that the sexually transmitted disease could soon become untreatable. Scary thought. Both parties in a non-monogamous relationship should take this age-old advice: “Don’t be silly, protect your Willie (or your Wilhemina).” Then again, Maryland apparently thinks that increasing taxes on alcohol will stop the spread of gonorrhea. When alcohol taxes in Maryland increased, gonorrhea rates decreased by 24%. The article concluded that “Alcohol tax increases may be an efficient strategy for reducing sexually transmitted infections.” For this to be true, the study must assume that a significant proportion of Maryland residents are sex-crazed inebriates. This is the classic “correlation” versus “causation” argument. Just because the sun rises when the cock crows doesn’t mean that the crowing causes the sun to rise. And we certainly couldn’t prevent the sun from rising by preventing the crowing. Then again, governments wouldn’t make any tax revenue by assaulting chickens. Good news for wart treatment: There is a therapy more effective than expensive visits to the dermatologist for liquid nitrogen cryotherapy. Bad news is that you have to walk around with duct tape stuck to your wart for six weeks. That’s right … duct tape treatment was effective in removing warts in 85% of cases while traditional freezing was effective in only 60% of cases. The study was from 2000-2001 and had only 61 patients, but it’s worth a try. Oh, and if you want to know how to get your Willie unstuck from inside a PVC pipe, there was an article in the “related content” for that as well. Think blowtorch. I actually had to click off of the site because the articles in “related content” kept piquing my interest. Patients gone wild. Ohio’s own Cynthia Squire arrested for “verbal onslaught” against hospital staff and Port Clinton police officers tried to calm her down in Magruder Hospital emergency department. Ms. Squire threatened to kill her boyfriend and her daughter’s boyfriend and called “everyone around her vulgar names.” In other news, Port Clinton police then responded to another call and arrested several reindeer for disorderly conduct after their interactions with an unnamed reindeer with a red nose. Infants and toddlers being prescribed strong antipsychotics such as Risperdal? I’m a little leery about this idea.

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Healthcare Update – 12-23-2015

Patients gone wild. Man shot and killed in UCLA Medical Center emergency department after attacking police and attempting to grab officer’s gun. Jenny McCarthy, call your office! At-risk patient nearly dies from streptococcal infection after failing to get immunizations. Another example of how insurance for medical care and access to medical care are completely unrelated. Massachusetts has one of the highest rates of insured patients in the country, but emergency department visits for mental health issues are skyrocketing, 76% of emergency department visits are for care after the 9-5 hours of most providers, and 60% of consumers with ER visits were unable to get a visit as soon as needed to prevent an ER visit. But at least the patients have INSURANCE! Should patients be able to record their surgeries? Sure. Just as soon as everyone can record their court hearings without paying gobs of money for a court reporter, as soon as everyone can record all deliberations of Supreme Court justices, as soon as everyone can record all private discussions with their attorneys, and as soon as everyone can record all the conversations that their legislators make with lobbyists. Why should some procedures be secretive while others have open access? I don’t always agree with Megan McArdle, but she’s spot on with this article. There’s no miracle cure for health care costs. Money quote: Doctors, hospitals, other providers don’t care about the prices for individual services. They care about whether they can cover their costs. If you drive down the price of one thing very low, other prices may rise to compensate. If you look at just some of the prices, you may seem to have won a great victory on health-care costs. But if you look at aggregated spending, you may still find that you are losing the war. Medical costs will always be a game of mousetrap and mouse. When the mice can no longer find enough food, they either leave or they die.

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Healthcare Update — 12-18-2015

Wait. 96% of Massachusetts patients have insurance, but many still can’t afford care? You mean that insurance isn’t the same as access to medical care? Where have I heard that for like the past 5 years? Tylenol has no effect on improvement of influenza symptoms, fever, or time to resolution of influenza. The study also showed that Tylenol has no effect on decreasing influenza viral load or on influenza viral shedding, either. I guess that means that Roche can market it “Tamiflu PLUS”, increase the price 1000-fold, and make obscene profits. After all, Tylenol has about the same effect on influenza as regular Tamiflu, doesn’t it? If you want to live longer, don’t go to the emergency department. Just sign up for hospice care and die peacefully. Added bonus: It will save the government billions of dollars! We can’t call it a death panel, though. This is more like death doublespeak. Seriously, we should all consider how we want to live out our final days – especially when confronted with a terminal illness. But telling patients who may have serious and treatable symptoms to just go home and have a “better death” instead of going to the emergency department comes across as a little morose. Why do patients continue using the emergency DEPARTMENT for care? Because it is always open, evaluates all patients regardless of ability to pay, patients don’t have to wait a month for an appointment, and most workups can be completed in one visit. Next question? VA Hospital no better after scandals. Culture of retaliation against whistleblowers persists. Former emergency physician states “it’s the luck of the draw if you have a triage nurse who knows what they’re doing.” Veteran discusses sitting in emergency department waiting room from early morning to late night with no reassessments or updates on wait. Another veteran notes that “it was very disheartening and very stressful to get an appointment.” And the VA system still isn’t on the Hospital Compare web site. Seems like the government would want to be the model to which all of the other hospitals would want to aspire. What are they hiding? Get ready for a hit in patient satisfaction scores. West Virginia hospital implementing 10 guidelines to limit inappropriate opiate prescribing. Expected to go statewide within the next 12 months.

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Healthcare Update – 12-14-2015

A Kaiser poll shows that 63% of Kentucky residents are in favor of expanding the Medicaid program in Kentucky. That same poll (Figure 12) shows that 65% of Kentucky residents are either on Medicaid or knows an adult benefiting from Medicaid. Won’t anyone who receives something for free be in favor of receiving more of that thing for free? Oh and don’t be bothered by the fact that a third of doctors won’t see new Medicaid patients. Everyone is getting INSURANCE! Garbage in, garbage out. Feds try to trash doctors the way that they trash hospitals by comparing “quality” metrics, but data incomplete, misleading, and suffers from “widespread accuracy issues.” Ya don’t say! AMA response here. Does anyone else find it odd that the federal government doesn’t have a “legislator compare” or a “federal department compare” web site? If a doctor or pharmacist sold drugs to a patient knowing that the drugs were of no clinical benefit, they’d be thrown in prison. When drug companies do it and the FDA allows it … meh. Business as usual. Novartis gets repeated approval from the FDA for its cancer drug Afinitor – despite serious side effects in 30% of patients and potentially fatal lung condition in 20% of patients. Oh, and patients taking the drug don’t live any longer than patients who don’t take the drug. Living out your remaining years paying $450/pill for something that causes “mouth sores, infections, fatigue, diarrhea, abdominal pain, fever, cough, headache and decreased appetite” with no improvement in survival. What a deal! To paraphrase Leona Helmsley, only the “little people” are subject to the laws around here. Tomorrow may be the sign up deadline for Obamacare, but for some people there may be another option – join a health care ministry. Look into it. It could save you a lot of money.

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