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Healthcare Update 11-04-2013

See more medical news from around the web on my other blog at EP Monthly.com

Like a Nazi article touting the benefits of gas chambersPress Ganey CMO Thomas Lee writes article about current “surge” in “patient experience” published in Health Affairs.
Dr. Lee’s definition of “professionalism” that he and his organization apparently expect us to latch onto includes willingness of physicians to work together to “meet[] patients’ needs,” not wasting resources, and being very concerned about data on your performance – even if that data is statistically insignificant and wholly inappropriate to use.
So if we don’t “meet a patient’s needs” for large doses of narcotics and if we perform testing that we believe is clinically appropriate but which is then retrospectively deemed to be a “waste of resources” and then we don’t bow down to Press Ganey’s little red, yellow, and green boxes, then according to Dr. Lee, we must now be labeled as “unprofessional.”
Another out of touch “physician” who is writing surreptitious articles for his employer.
How low will Press Ganey go to make a buck?Knife in head

Meh. Just a flesh wound … or maybe not. Chinese man walks into emergency department with fruit knife sticking out of his head. Occurred when some kind of a “game” got out of hand. Knife actually penetrated his skull and required three hours of surgery to repair. Then the doctors sent him home with the knife. I can just hear him when he gets home and starts playing the “game” again: THIS time I go first!

The White House has a brigade of Twitter attack drones just waiting to use your tax dollars for their salaries while they blast anyone who portrays the government and/or the Unaffordable Insurance Act in an unflattering light … for example an elderly survivor of metastatic gallbladder cancer who is now unable to keep her insurance plan because of Obamacare regulations. Some commenters called White House staffer Dan Pfeiffer (@pfeiffer44) a “douchebag” for attacking the patient. I think that’s being degrading to women’s hygiene products.

Is that ACEP newsbyte about emergency medicine accounting for only 2% of all healthcare spending really true? Politifact says that it is … mostly. Politifact did cite a 2013 study showing that the cost of emergency care was between 5% and 10% of the total amount of healthcare spending.

“Zero tolerance” in some UK hospitals after multiple “high profile” attacks on emergency department staff. Consultants note that emergency department staff deal with violence on a daily basis, yet the only measures they take to curb the violence is to make sure cameras are in place so they can catch the perpetrators after the act.
When hospitals refuse to provide adequate security for their employees and are aware of the high potential for violence, perhaps the hospital administrators should be civilly and criminally liable for any injuries sustained by their employees.

Michigan House Bill No 4354 (.pdf) would make it much more difficult to sue physicians or hospitals for EMTALA-related care. Requires proof by “BY CLEAR AND CONVINCING EVIDENCE THAT THE LICENSED HEALTH CARE PROFESSIONAL’S ACTIONS CONSTITUTED GROSS NEGLIGENCE.” This is a very high legal hurdle.
Article notes that “the liability in such medical situations has many specialists declining to be on call.” A study performed by the Michigan College of Emergency Physicians showed that states such as Georgia and Texas that enacted similar reforms had an increase in physicians.
Apparently the concept that we can’t “sue our way to better health care” is beginning to take hold.
Notice how all the attorneys in the comment section argue against the legislation.

Head of Veterans Affairs writes a letter to US Representative Lynn Jenkins assuring her that the Topeka VA Medical Center is providing “correct patient care.”  The emergency department has been on “diversion” for much of the past six months, has not provided trauma services, and is only providing urgent care services. And the hospital is having repeated “staffing issues.” A neurologist at the facility was accused of molesting five female patients. There is an ongoing investigation into how one hospital employee was prescribed 3,800 pain pills, muscle relaxants, and anxiety medications in a year. One trauma surgeon and his physician wife left the facility because of “a leadership vacuum” and “bureaucratic turf wars.”
Hey, but if General Eric Shinseki says that the Kansas VA Medical Center is providing correct patient care, that should be good enough for everyone.

When a medical certificate is required in order to file a criminal or civil case, the reports become an item of value that can be purchased illegally. In Bangladesh, emergency department physician gets caught charging 5,000 Bangladeshi Taka (about $65) for creating a report showing “grievous” injury to a patient. The real problem is that later the same physician charged the patient’s “opponents” 15,000 Bangladeshi Taka (about $200) to create a report about the same patient saying his condition was normal.
Don’t think the same thing doesn’t happen in the US with insurance company exams and expert witness work. In a medical malpractice case, one of my colleagues obtained conflicting reports about the same patient from the same expert — one favoring the plaintiffs from the plaintiff’s side and one favoring the defense from the defendant’s side.

Rating the raters. From @gruntdoc tweet, the Hospital Association of New York State is putting out a report on different hospital report cardsUS News and World ReportConsumer ReportsHealthgrades, and Leapfrog all got the lowest grades. Even the Joint Commission and the CMS Hospital Compare site only got 3 of 5 stars.
So why are people paying attention to ratings from such lowly rated reporting agencies?

Hospital in Cork, Ireland having staffing problems due to difficulty in recruiting physicians. “The more overcrowding and more difficult the conditions become – the less likely people are to want to work in them.”
Coming to a hospital near you?

British Columbia hospital emergency departments “in chaos” due to high volumes, poor staffing by hospital administrators, and lack of inpatient beds. At Fraser Health Authority’s emergency department last week, there was a backlog of 78 patients waiting to be seen.
Another article notes that one nurse was responsible for taking care of 11 patients in one emergency department while a patient in a hallway bed at another facility was read his last rites in front of a bunch of strangers.
And yet another article notes how the ICU director of the hospital quit when the emergency physicians said that they might not able to leave the ED and run up to the ICU during codes.
But don’t forget that the care is free …
Is this the type of system we want in the US?

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