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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update 07-16-2012

Some inner-city New York hospitals have figured out how to save money in malpractice premiums … they “go bare.” Interfaith, Kingsbrook Jewish, and Wyckoff Heights all insure themselves for lawsuits and two of them have set aside no money for judgments. Lawyers call it “irresponsible.” Feeling suicidal? Text me about how you feel. Patients with emergency psychiatric issues prefer cell phone-based or computer-based interventions to the traditional face-to-face interactions. Text messaging, e-mail, and social networking sites were preferred over traditional interventions by 90% of patients for at least one psychiatric topic. Next up: A game titled “REALLY Angry Birds.” Dallas patient who went to pick up Norco refill for post-surgical pain arrested and forced to stay in jail overnight on suspicion of obtaining a controlled substance by fraud when pharmacist calls wrong physician to confirm prescription. Physician says he never wrote prescription. CVS isn’t commenting. How about just “oops”? Then there’s this doctor in California who was arrested for prescribing addictive medications to people with no legitimate need. One of the undercover officers brought copies of his x-rays to show him how severely his back had been injured. In reality, the x-ray was that of a German shepherd.

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The Individual Mandate For Dummies

This cartoon was sent to me in an e-mail. Overly simplistic, but illustrates the issue. Credit here.

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Healthcare Update — 07-13-2012

Difficult ethical dilemma. With limited resources, what should be done about the 10% of Medicare patients who use nearly two thirds of the Medicare’s hospital spending? End of life care also accounts for a large amount of spending – rough estimates show that about 22% of Medicare spending is for end of life care. And what do we do with families of terminal patients who want “everything done” but who can’t or won’t pay for the care? Then read about this case where there really was a “death panel“. What do you think should have been done? What are some of the strangest cases seen in New Zealand emergency departments? Pretty much the same types of things seen in American emergency departments. Some of the more notable cases: A man who put a nail gun to his head and pulled the trigger because he didn’t think nails could penetrate bone (he was wrong) … and a man who cut his foot with a shovel while “digging to Russia.” I discussed a previous study on the same topic, but there was another study just published showing that insurance companies will not refuse to pay for a hospital bill if patients leave AMA — that is until they see the results of these studies. “911, will this be Visa, MasterCard, or American Express?” Folsom, California fire department to begin charging $225 for every call requesting a paramedic. That’s a little less than Sacramento Metro Fire Department which already charges $275 for medical calls. Wondering what happens if people don’t pay. Get kicked out on the side of the road if the credit card is over the limit? Undocumented immigrant files complaint against Parkland Hospital in Texas because he allegedly was refused care without an ID and then because he had to wait too long for care once he did show an ID. HOPING that this company doesn’t CHANGE its address because of health reform bill. Health care equipment manufacturer DeRoyal Industries contemplates layoffs of some of its more than 2000 employees due to the medical device excise tax in the health care reform bill. DeRoyal president states “The medical device tax constitutes the largest cost increase DeRoyal has experienced in its 40-year history.” Hat tip to Instapundit for the link. California man refuses to leave emergency department. Police called. Man pulls down his pants then bites officer on hand. Nova Scotia municipality of Digby holds hearing to discuss emergency department closures, board travels in from out of town … then two people show up. It isn’t just the “meth mouth,” it’s also the burns. Meth lab fire victims cost 60% more to treat than other burn victims … prolly because the explosions ignite patient’s lungs and burn off the patient’s hands and faces. The article also shows a picture of a real life “meth lab” if you haven’t seen one before. Meh. Old news — see this article I wrote about the same subject almost two years ago. Still worth repeating, though. Antibiotic resistance becoming a crisis. And pharmaceutical companies aren’t doing the research into creating new antibiotics because doing so isn’t cost effective. Now President Obama has signed an “FDA Safety and Innovation Act” that provides pharmaceutical companies with a total of 10 years exclusivity in selling any new antibiotics they develop.

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Healthcare Update — 07-06-2012

Hmmmm. Sunburns and skin cancer versus loss of libido and shrunken male genitals. Which to choose? According to this expert, the oxybenzone contained in most sunscreen causes smaller penis size in children, loss of libido in adult males, and fibroids/endometriosis in females. There may be a scientific basis behind the Crazy Cat Lady Action Figure (hey – I didn’t name it, they did). Study shows that women infected with common cat parasite Toxoplasma gondii are 50% more likely to commit suicide. Dr. Art Caplan brings the argument a step further (registration required to read link) by recommending that cat owners be taxed for their unhealthy lifestyle choice and for all the asthma attacks that the cat dander causes. Well, at least their insurance rates should go up. Wait. That’s happening already? Ah, nevermind. Doctor infects himself with hookworms to show how the hookworm saliva can alleviate the symptoms of some intestinal diseases. It worked! Chronic pain patients are in for a world of hurt … literally. The FDA is now cracking down on unapproved manufacturers of oxycodone. Companies have 45 days to stop manufacturing unapproved oxycodone before the FDA begins suing them and seizing their products. Look for the price of new “approved” oxycodone pills (with the exact same formulation) to cost somewhere around the $3 per pill price range. “Safety by overregulation” strikes again. Now that Medicaid cuts have forced Bamberg Hospital in Georgia to close in bankruptcy, residents are finding that the lack of nearby emergency medical care is problematic. Patients with heart attacks walk in to the local primary care physician’s office and must be sent by ambulance to the nearest emergency department more than 20 miles away. The small town doctor worries that his elderly patients may not make it to a hospital in time when they’re having an emergency. Safety nets don’t work as well when you cut holes in them.   Teenager … in Florida … shoots himself in head so that he can wake up from a bad trip after ingesting “shrooms” then lives to tell about it. Another problem with electronic computer records … the data in the records can be changed. Australian hospital executive caught changing data in emergency department records to make wait times and ED stays appear shorter than they really were. 20-30 records PER DAY were changed from late 2010 to present. Investigators are having a difficult time finding out who made the changes since the system had only eight active logins in 259 workstations across the hospital – CLERK, NURSE, DOCTOR and BEDMAN. The logs were also “unreliable” and not proactively checked. When governments place a priority on benchmarks, they will get the benchmarks. In this hospital’s case, the benchmark door to doc time was either 30 or 60 minutes and a large number of patients were reported as being seen at either 30 or 60 minutes. The benchmark ED stay number was 240 minutes and an “unusually high” number of patients were discharged from the ED exactly 240 minutes after their arrival. Another article quotes a doctor who stated that the system is more focused on getting statistical results than qualitative patient care results. Exactly. Don’t kid yourself. This system is being gamed anywhere that benchmarks are set and if you want to rely upon the benchmarks … well … I’m glad you’re happy with your decision. Study in England extrapolates that alcohol is involved in nearly 2 million emergency department visits in England and Wales every year — which amounted to 21% of all emergency department patients in the study. All those alcohol-related emergency department ...

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Obamacare Is Wrong, But The Chief Justice Is Right

By Birdstrike M.D. Yesterday, my 2 year old asked me, “Daddy, do clouds make rain by forming condensing nuclei of water vapor which act to form droplets which fall to the ground?”  I said, “No, son.  No.  You’ve got it all wrong.  Actually, those drops of rain are the tears of our founding fathers crying over the recent Supreme Court decision on Obamacare.” As I predicted it would many months agoon Student Doctor Network, the Supreme Court upheld the Supreme Court upheld the Affordable Care Act (ACA).  I was against “Obamacare” as it has come to be known, from the very beginning.  I am still against it, for reasons too numerous to count.  On the face of it however, the entire rationale for declaring Obamacare unconstitutional was absurd, and rather disingenuous.  Amongst the 2000 pages of this behemoth of a law, the one portion that makes the most sense is the “individual mandate”, which is the single portion that actually attempts to require all Americans to take at least a sliver of responsibility for the cost of their own health care expenses.  This is the one and only portion of it that is actually revolutionary and acts to reverse the central core of what is wrong with the health of our people, and our healthcare system itself: the complete lack of responsibility of so many individuals for their own health, and healthcare expenses. Like many of you, I wished that the Supreme Court would overturn the law so that we could rebuild it in a way that makes sense both to patients and physicians, and less so to politicians.  However, as much as it pains me, I have to admit that Chief Justice John Roberts’ opinion was courageous and brilliant.  It tears my heart out to write it, but its true.  As I interpret it, what he essentially told America and the opponents of Obamacare was, “Don’t ask me or the spirits of our Founding Fathers to overturn your law, written by your representatives, and approved by your President with some fabricated technicality to fix your ‘Oops!’ Man up, and live with it.  Otherwise, if you don’t like it throw the fools out, elect a new government and start over, or fix it”. Indulge me for a minute and allow me to play the “What Would Our Dead Relatives Have Thought, Game”:  The Founding Fathers of this country lived under true tyranny.  They were ruled by a tyrant King that would not hesitate to jail or execute someone for speaking an opinion infinitely less offensive that my own, and simply on a whim.  Many of them lost their lives fighting for the right simply to have representation. (Remember your history class, “No taxation without representation!”?)  I’m sure they would conclude that we have that luxury, and many other life easing luxuries they did without.  (You know, real important stuff like electricity, running water, insulin for diabetics, iPhone 4s with integrated Siri personal assistant.)  They didn’t have to worry about 40 million people being uninsured.  Health insurance didn’t exist.  It wasn’t a crisis for them, that only 80% of people could get an MRI.  0% of people got MRIs.  MRIs didn’t exist.  Neither did door-to-doctor times, ED wait-time billboards, sterile technique, antibiotics, cab vouchers or Sierra Mist with a meal tray. If the “individual mandate” for all Americans to buy health insurance was severed from the ACA and we had to choose between it and the rest of the bill in its entirety, I would choose to keep the individual mandate, and strike down the other 2000 pages from this complex ...

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Healthcare Update — 06-27-2012

Supreme Court prediction: Individual mandate unconstitutional. Remainder of law stands. Both parties declare victory. Then we have to put up with talking heads putting their spin on the decision for the next two weeks. Beware what you write online … they’re watching. Study published in Emergency Medicine Journal analyzes the Twitter accounts of emergency physicians and determines that there is a “small inner network” of emergency physicians that are using Twitter to its full potential … whatever that means. Use of electronic medical records associated with sixfold drop in medical malpractice claims? I call bullshit on that one. Electronic medical records have been around for many years and the incidence of medical malpractice claims has dropped by about half in the past 10 years. Even if we attributed all of the decrease to electronic medical record use and none to tort reform efforts, that still doesn’t bear out the numbers in this study. Does it make any difference that the study was funded by a grant from the Agency for Healthcare Research and Quality? Dad upset because cost for four stitches in his son’s head at a specialty children’s hospital was twice as much as the cost for 12 stitches in dad’s leg. Hospital CEO attempts to justify cost by saying that is more costly to keep pediatric specialists at the hospital 24/7. Another example of why we need disclosure in costs associated with medical care. Dad may have made an informed decision to go elsewhere had he known the expense would be so much greater. Elderly patient with arm fracture refused admission at hospital, then goes home and develops pneumonia. Patient’s family thought she should have been admitted in the first place. One writes letter to editor of newspaper … in Florida … stating that “the ER staff is a hassled, overworked lot that moves at a snail’s pace and the ER specialists seem oblivious to ailments except with the most urgent trauma.” Washington State hospital plans to save $1 million per year by turning its 24 hour/day emergency department into a 12 hour/day walk in clinic. In other words, a lot of people who don’t have a means to pay for their care are going to soon be sent somewhere else. Jury awards family $55 million after finding that doctors at Johns Hopkins Hospital waited too long to perform a Caesarian section on a pregnant woman. Midwife was at patient’s home trying to deliver child when baby became “stuck”. Hospital allegedly delayed C-section for 2 hours. If you don’t like shots and have ulcers which prevent you from taking NSAID pills, soon you’ll be able to snort new and improved brand name liquid Toradol. A new law to correct every perceived wrong. US Treasury Department plans to ban debt collection in emergency departments of non-profit hospitals. Co-pay? We don’t need no stinking co-pay. Soon it may be against the law for hospitals to ask for it. Expert witness wins nearly $400,000 in jury verdict after American Academy of Orthopedic Surgeons published report of its disciplinary action against him for giving improper testimony in a medical negligence case. I’m scratching my head about this whole story. If you were a Democrat running for re-election, you’d say that New Jersey trial lawyers don’t want patients to receive free medical care. New Jersey trial lawyers mount “fierce opposition” to legislation that would shield doctors from liability when the doctors provide free medical care to patients. The bill failed to pass. See how suing our way to better health care works? Now doctors who might otherwise provide free medical care to indigent patients ...

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