The Mayo Clinic – touted by the Obama administration as a system that provides quality care at a reduced cost – turned around and smacked House Democrats in the face over the recent health care reform proposals. A Washington Times article quotes Mayo Clinic officials as stating that the plan will lower quality and increase costs because the outcomes are not patient-focused or results-oriented. “The real losers [with this plan] will be the citizens of the United States.” Ouch.
In other news, President Obama mentioned in a White House press conference that he changed his mind and now thinks that the Mayo Clinic sucks.
Comparing healthcare systems in different countries may help the US come up with a viable alternative to our current system. John Aravosis from America Blog describes a situation in France where his emergency department visit at a specialty hospital cost him a rocking $32. Something doesn’t sound right about that story. If it is really true, insurance companies would spend less money by purchasing an air fleet and sending patients with potentially expensive medical problems to France for emergency care. Anyone else have experience with the French system that could comment more about it?
More violence in the emergency department. An ED admitting clerk was shot three times by her former boyfriend outside the hospital and then stumbles inside full of blood.
I usually don’t believe that the number of malpractice suits against a physician should be used as a measure of a physician’s competence. I know several excellent physicians who have been sued 5-10 times. I have been sued several times myself. Unfortunately, when there’s no reliable way of measuring a desired metric such as physician quality, pencil pushers will take things that can be measured and try to make the argument that the data apply to the metrics. That being said, should an ophthalmologist who has been sued 50 times be subject to discipline just because of the number of lawsuits against him?
The largest medical malpractice verdict in Tennessee history was just handed down against an OB/Gyn physician that allegedly ignored a patient’s complaints about an unusual breast lump, stating that the lump was probably a cyst or a fatty deposit. Instead, the lump was a cancer that later spread to the patient’s liver. The jury awarded almost $24 million to the patient and her husband.
Here’s a WTF moment for you. Two nurses wrote a complaint with the Texas Medical Board after they became concerned with patient safety when a physician kept trying to sell patients herbal medications. Kind of like an IRS agents offering to sell you tickets to the IRS ball just before an audit? The nurses included patient identification numbers, but no names, with the complaint. The story isn’t clear, but apparently medical records were also sent to the Medical Board. When contacted by the county sheriff, none of the patients complained about their care. The District Attorney then filed criminal charges against the nurses after the doctor complained about being “harassed”.
In other news, the Winkler County District Attorney could not be immediately reached for comment, but later was found at home taking a chamomile extract bath with vanilla bean infusion prescribed by the involved physician.
Defensive medicine may not exist, but this doctor does a pretty good job of describing this figment of our imagination. Interesting that Congressional Budget Office statistics show that $30 billion was spent to defend against and pay malpractice claims in 2008, but that money was only 1.5% of the total 2008 healthcare expenditures. Also interesting that hospitals provided more than $35 billion in uncompensated care in 2008.
I admit that this ACEP article isn’t a “news flash” and leans toward being propaganda. Even if it is propaganda, the article and the story it tells raise a valid point. In some larger cities, ambulance diversion is a huge problem. According to this Washington Post article, diversion happens all the time in Washington, DC. You may not get to go to the closest hospital if you are having an emergency. In addition, the overburdened EMS system may not be able to get to you in a timely manner. Will these problems improve with socialized medicine?
The medical practice climate is tenuous in the Los Angeles region. LA hospitals are reportedly having difficulty finding subspecialists willing to take call for emergency department patients. Big problem. For example, even if patients make it to an emergency department with a life-threatening subdural hematoma, it won’t do them much good if there’s no neurosurgeon there to operate on them. ED physicians can try to stabilize patients, but we can’t do the lifesaving surgery. To maintain coverage, hospitals are paying physicians $250 to $4000 per day to take call and provide patients with care. How long will they be able to continue those payments with massive state budget cuts?
California’s attempts to erase a $26 billion budget deficit by cutting health care will likely push California’s economy further toward bankruptcy according to this LA Times article. Instead of paying for home health care, California will force patients receiving those services to go to nursing homes – at triple the cost. Poison control services and insurance for children of low-income families will be eliminated ending up in more of those “low cost” visits to the emergency department. California’s plan may be as much about cost shifting as it is about cost saving, though. If California cuts payments to the hospitals for emergency services, the hospitals eat the costs of indigent care, not California.
There’s more to the game than direct costs, though. According to the article, a 2006 study tracking similar budget cuts in New York City back in the 1970s found that less than $10 billion in cuts to healthcare, education and law enforcement in New York City over four years led to at least $54 billion in additional costs over a 20-year period. Consequences included higher rates of HIV, a worsened tuberculosis epidemic and a spike in homicides.
Looks like a good trade-off to me, there, Arnold.
New Brunswick, Canada apparently has a poor reputation with Canadian physicians and not too many docs want to work there. ED physicians working in clinics and smaller hospitals are then pulled to work in larger regional emergency departments. Then the clinics and hospitals close. Guess what happens next? All the patients go to other nearby emergency departments and cause an even greater crowding problem. “Then the waits just get longer and longer and there’s more consequences and more possibility, or probability, that something might happen while you’re waiting.” Sound familiar?