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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.

4 comments

  1. Primary care clinics – primarily staffed by PAs and NPs – are the worst offenders about sending ’emergencies’ to the ED when the patient really needs an outpatient workup for their 9 months of cough or their chronic fatigue issues that ‘suddenly got worse’ (but they really didn’t) or the non-specific abdominal pain (that the PCP says ‘and they’re tender in the RLQ’).

    No, they don’t need emergency care. They either need a semi-urgent workup that the insurance companies make impossible or they need a thoughtful, well-laid out plan to get things done over a month or two.

    My proposal: a place to refer patients that need semi-urgent workups for serious but not critical illnesses that can take 2-3 days and come out with a reasonable answer…. now if only a place like that existed.

    Right: direct admit to the hospital.

    What? That doesn’t happen any more? Why ever not? Oh. Payors. AND the fact that few clinic docs have held on to inpatient privleges.

    And WHY aren’t PCPs calling the hospitalists for direct admits? Oh, right. Time. Which gets back at Payors again.

    • Your plan is spot on, but you’re right – many payors make it difficult to obtain proper testing (most tests now require pre-authorization) and most patients don’t want to wait months for a solution to their problems.
      A semi-urgent workup would also require the ability to create a differential diagnosis and work through that differential diagnosis when ordering a workup. Unfortunately, the evolving model of medical care seems to be increasingly focused on saving money and quick evaluations with referrals to other providers who have unbearably long waiting lists rather than on making timely diagnoses.

  2. As an engineering undergraduate, we always said that how you do on a test does not matter, what matters is how you do relative to everyone else. (I had the top grade at the end of a course with a 27% average.) The same thing holds for patient satisfaction scores. if you have a 97% and everyone else has a 100% then you are in trouble. In the same manner, you can have a 30%, but if everyone else has 25% then you are golden.

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