WhiteCoat

Healthcare Update 12-12-2009

Healthcare insurance does not equal healthcare access. Physicians are suing the state of Florida because more than 1.2 million children on Medicaid are not receiving access to critical medical care. Some children covered under Medicaid are unable to find any orthopedists willing to fix their broken bones. More than 750,000 children received no dental care because “reimbursement rates are among the lowest in the country” and 30% of Florida counties have fewer than two dental providers willing to treat Medicaid patients. A Florida official stated that “We have a system that is growing by-double digits, where providers are paid less and less each year. Access is limited, outcomes are not measured … I’d say that’s a bad system.”
Oh, and Florida’s defense to the lawsuit? The plaintiffs don’t have legal standing to pursue the claims because “the Medicaid program promises money but not necessarily the delivery of health services.”
Hey, but at least all the Medicaid patients have insurance. Wonder how much their insurance will be like the insurance proposed in this new health care bill …

These insured patients still end up in the emergency department. Before state Medicaid cuts, many dentists would not accept Medicaid patients because of low reimbursement rates. After Michigan cut dental coverage to 400,000 Medicaid recipients, officials expect emergency departments visits to increase by 10%. One woman recently died from complications that went untreated due to loss of Medicaid dental benefits. Hey, but at least all the Medicaid patients have insurance. That’s what everyone needs from this health care bill. Insurance.

One way NOT to get faster care: Threaten to kill the staff in the emergency department because they aren’t seeing your child quick enough. Grabbing the security guard by the throat and attacking the nurse won’t help either. Enjoy your stay in the Greybar Motel, ma’am.
In other news, due to the throwdown given to the mom by the security guard during the incident, JCAHO is now mandating that hospitals remove all security personnel as a patient safety measure.

Should hospitalists be performing pelvic exams on admitted patients if those pelvics have already been performed in the emergency department? Do women prefer males or females performing their pelvic exam? And who goes singing “come out come out wherever you are” to the cervix when performing a pelvic exam?? These answers and more at Happy Hospitalist’s blog.

One lucky dude (or “dood” if you’re Nurse K). Man walks into emergency department feeling “sick and disoriented.” Shortly afterwards, his heart stopped beating and he collapsed. 47 minutes, 4,500 chest compressions and 8 defibrillator shocks later, he was back in the land of the living. Doctors kept him in a medically-induced coma and cooled his body with special cooling pads. Three days later, he woke up and started talking. Not many people survive codes and even fewer end up well enough to walk out of the hospital.

Ohio balances budget on backs of patients. Ohio legislators recently imposed a “franchise fee” on hospitals amounting to 1.5% of all operating expenses (not a percentage of profits, mind you). That fee amounted to $19 million for one hospital and $22 million for another hospital. In order to balance their own budgets, now hospitals are cutting staff and cutting services. “More layoffs and service reductions will mean longer waits and higher costs for all patients.”

Minnesota hospitals “shed jobs and services” as they brace for $43 million in revenue cuts when the state terminates 7hcmc1109some programs for indigent care. Such cuts would “tip this hospital over” and “would mean unacceptable deaths for patients who can’t get care” according to one emergency physician. One hospital will no longer provide non-emergency care to uninsured patients from outside its county and plans to cut 150 to 200 jobs.
A spokeswoman for the Catholic Charities noted that “homeless shelters and community health centers — as well as police — will have their hands full with the drug-addicted and the mentally ill who will be off their medications and on the streets.”
A picture within the article of a man holding a sign says it all.

Health care reform ideas from a retired physician. Some good ideas, including mandatory co-pays for all non-emergent medical care, pre-trial malpractice screening panels, and committee review for treatment options of complex medical cases.

Will several Chicago hospitals close after a county sales tax rollback? Some Chicago area clergy members warned that closures were imminent.

A well-written story about the life of one Washington DC area “frequent flyer” in the Washington Post. The article also highlights how frequent flyers can harm themselves by reinforcing the “boy who cried wolf” phenomenon. It mentions how another intoxicated mugging patient was treated with a “sequence of blunders” after medics smelled alcohol on his breath and assumed that he was drunk. In reality, the patient had a head injury. The frequent flier in the story, Kenny Farnsworth, repeatedly called 911 for choking sensation but never followed up with a primary care physician. Eventually he was diagnosed with a deformed hyoid bone and the problem was corrected with surgery. Now, Mr. Farnsworth’s “911 call volume has fallen dramatically.” The comments section to the article is brutal.

4 Responses to “Healthcare Update 12-12-2009”

  1. throckmorton says:

    For what its worth, 11% of all the visits to our fast tracks are dental related.

  2. SeaSpray says:

    Even with *dental* insurance ..that covers more than the dental insurance on the health plan ..in our case ..does not come close to the good health insurance coverage we have.

    I know EDs get their share of drug seeking dental patients..but sadly ..regular people who don’t have dental have no choice but to go either.

    Lucky guy sounds like he had a miracle. I’d REALLY like to know if he experienced and NDE (near death experience). ??

    “Enjoy your stay in the Greybar Motel, ma’am.” That’s funny WC. :)

  3. Dr. Greenbbs says:

    I think therapeutic hypothermia should be standard of care for the specific subpopulation that meet criteria (i.e. short downtime, spontaneous return of circ within an hour, immediate cpr, v-fib arrest).

    I met my first patient that was saved because of therapeutic hypothermia about 3 weeks ago. It was a truly spectacular moment that I’ll never forget.

  4. DensityDuck says:

    Re: Farnsworth “frequent flier”

    It says right there in the story that he goes to the ED because he doesn’t want to wait until the doctor’s office is open. He gets away with it because the law allows him to.

    What would help to sort this out would be some kind of 24-hour non-emergency clinic, where he could go get his “swelling legs” checked out. From the sound of things that’s basically what the fire station is doing now.

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