WhiteCoat

Healthcare Update 12-23-2009

This guy must have been really naughty this year. An assailant brutally beat a man who was stacking wood near his home, leaving him with gashes and bruises over most of his body. Emergency department staff were amazed that the patient was not in worse shape. Police are on the lookout for one of Santa’s reindeer.

Beating a 5-week-old infant to the point that she has to go to the emergency department won’t garner you much sympathy in the comments section of a newspaper post.

Could this be why Michael Jackson liked using propofol as a sleep aid? Studies have shown that up to 50% of patients sedated using propofol have a sexually-orientated dream. Apparently some patients actually believe that they have engaged intercourse when they awaken and some have even complained to state medical boards about the sexually inappropriate actions of physicians treating them. Wow.

Former news anchorman Tom Brokaw involved in motor vehicle accident that kills another motorist.

Is David Hasselhoff becoming a frequent flyer? His daughter called 911 after he had a seizure. According to the article, Hasselhoff has been hospitalized for alcohol poisoning “more than five times in the past few years.”

Miami Thrice. South Florida tops the list of ATRA’s judicial hellholes yet again.

Will looming pharmacy reimbursement cuts affect Medicaid recipients’ access to medications? The Deficit Reduction Act mandates $8.4 billion cut in Medicaid spending – most coming from decreases in reimbursement to pharmacies for prescription drugs. A Government Accountability Office study showed that if those cuts were implemented, pharmacies would lose an average of 36% on every prescription they filled. Expert testimony in a lawsuit seeking to prevent the cuts showed that 10,000 to 12,000 pharmacies, most in underserved areas, would close because of the cuts. Many other pharmacies would likely stop participating in the Medicaid system. Access to prescription medications for Medicaid recipients would be significantly decreased.
But at least those patients have insurance, right?

Michael Woods’ Rhode Island children may be “financially secure” for the rest of their lives, but now Rhode Island’s governor Don Carcieri is proposing to cut almost $4 million in payments to hospitals that treat the poor. If the proposal becomes law, hospitals will likely have to lay off staff, which will naturally decrease the services available to everyone. The government that has the power to provide everything to you has the power to take everything away from you.

House votes to postpone 21% physician payments cuts until March 2010. Hey. Good work! Substandard payments for two more months before a lot of doctors leave Medicare. Woo hoo!

Obama extends COBRA subsidy another two months. Now anyone laid off before February 28 will be eligible to receive the subsidy – which pays two thirds of COBRA premiums for 15 months.

Given the above, is anyone beginning to wonder why the government is waiting until March to implement these decisions that would diminish access to medical care? Is there some decision everyone is going to have to vote on in February?

Another example of someone with “insurance” unable to obtain medical care. A patient has a hemangioma in his brain, but no doctor will perform surgery on him because the reimbursements that his Medicaid insurance pays are so low. “Doctors tell him that his condition is operable — but that they can’t accept him without conventional insurance.” Even with insurance, his family is being crushed by medical bills.

Hospitals that spend the most on end-of-life care may be penalized under the new health bill. Medicare pays UCLA an average of $50,000 during a patient’s last six months of life, while Medicare pays Mayo Clinic only half that much. The health care bill would create a study on how to reward hospitals for providing “cost effective” care (read that as “low cost care”) and possibly penalize “high-cost” centers through lower payments.

Should rural specialty hospitals with less than one patient per day coming to their emergency departments be required to have emergency physicians on site 24 hours per day? Rural hospitals say that it is a waste of resources. Would such a practice amount to a slippery slope?

12 Responses to “Healthcare Update 12-23-2009”

  1. CholeraJoe says:

    I’ve had propofol for general anesthesia twice in the last 11 months, but alas no dreams of doing the nasty with Danica Patrick, or anyone else for that matter.

  2. Good potpouri of information. About the propofol–we use it a lot in our ER for conscious sedation and I have yet to have a patient mention anything exciting about it! Well, maybe they just don’t want to admit it.

  3. Andrew Wiggin says:

    I’d like to be the MD at a rural ED that served one person a day.

    A

  4. Soronel Haetir says:

    You seem to think spending huge sums on end of life care is a bad thing, I just don’t get it. Is extending a terminal patient’s life from six months to six months two weeks really worth tax payer outlay? I would answer that question ‘n’.

    • WhiteCoat says:

      On the contrary, I think that end of life care is often wasteful and that hospice care is tremendously underutilized.
      The problem is that the term “end of life care” is necessarily retrospective. We don’t want to spend wastefully in the “last six months of life.” So exactly how do we prospectively determine when the “last six months” starts? We can’t reliably pick the date that someone will die.
      If a patient has a terminal diagnosis, we need to stop rearranging the deck chairs on the Titanic while still providing that patient with compassionate comfort care.
      On the other hand, the focus on limiting spending in the last six months of life has the potential to become a means for limiting care to patients who are likely to live longer than six months – nursing home patients, brain injured patients, ventilator patients, dialysis patients, etc.

  5. DefendUSA says:

    WC-
    That story on Brodniak- by Kristoff is pure props. Michele Malkin found that the man IS being treated by OSHU for his illness. You can google it.

    • LibraryGryffon says:

      Here’s the info: http://michellemalkin.com/2009/12/02/unbelievable-update-the-crappiest-nytimes-column-on-obamacare-just-got-crappier/

      From Michelle Malkin’s site, on December 2nd:

      “Today, I did something that Pulitzer Prize-winning NYTimes columnist Nick Kristof apparently didn’t do: I talked to a spokesman at the Oregon Health Sciences University in Portland, Oregon.

      “I called them up after OHSU’s Dr. Johnny Delashaw left a comment about Kristof’s piece spotlighting the horrible plight of John Brodniak, an Oregon man with a neurological condition that he says no one would treat.

      “Kristof used Brodniak’s plight to argue for universal health care, decry Brodniak’s deadly lack of insurance (even though he got Medicaid coverage in August), and lambaste doctors for refusing to treat Brodniak due to low reimbursements.

      “Well, OHSU confirmed for me two things:

      “1) OHSU is a safety-net hospital not far from where Brodniak lives. The hospital accepts all Medicaid patients and would not turn Brodniak away.

      “Okay, are you ready for Number 2?

      “2) Brodniak is a patient at OHSU — and has been a patient there for the past three weeks.

      “In other words, at the time Kristof’s article was published this past Sunday, Brodniak was already being treated and cared for by some of the best neurologists in the country!”

    • WhiteCoat says:

      Thanks for the update.

  6. Mama On A Budget says:

    I lived in a rural area where our nearest hospital didn’t have ER docs on staff 24/7 – you had to call as you were coming in so that they could call the doc in.

    True story – friend’s son grabbed a hot curling iron while she was getting ready to go to a party. She quickly called the host to say she wouldn’t be coming… taking kid to the ER. The host called one of the ER docs for her – since that doc was also supposed to be attending the party. Otherwise we never would have known the ER didn’t have a doc there all the time.

  7. Katherine says:

    So Grandma really was run over by a reindeer!

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