WhiteCoat

Healthcare Update 02-10-2010

2-9-2010 10-33-32 PM
Screw the client. According to the headlines of this news release (see above), juries have just started awarding verdicts directly to medical malpractice law firms, not to the patients who suffered the injuries. Foreshadowing?

More hospitals jumping on the “no dialysis for you” bandwagon. As they refuse to provide outpatient dialysis for patients, they have seen their emergency department visits increase.
Dialysis patients showing up in Grady Hospital’s emergency room receive dialysis only in “life-or-death situations.”
One Las Vegas hospital saw its number of emergency department visits for dialysis-related issues more than double in 2009. Now the hospital spends $700,000 per month providing dialysis services in its emergency department.
Doing some simple math, if the hospital spends about $8.4 million/year on emergency dialysis now, its costs have gone up by about $4 million in the past year – just for dialysis-related medical problems. In this hospital, the total number of emergency department visits for dialysis was 243, meaning that each patient gets about $35,000 per year in medical resources.

Ever wonder what kind of calls come in to a poison center’s hotline? Read the Illinois Poison Center’s blog and find out. 35 calls between midnight and 7AM. Some interesting, some sad issues. Those of you from Illinois who want to help keep the poison center in business can also use a link on the site to send an e-mail to Illinois’ governor or add a donation.

Guarantee: Get seen in this emergency department within 15 minutes or your visit is free.
The catch is that the clock starts ticking “after you finish your paperwork.”
I would be interested in seeing how this system is implemented.
It appears that they have the opportunity to cherry pick paying patients and filter out the patients who don’t have the means to pay before they put themselves on the hook for free services. “Sorry, ma’am, but part of the paperwork included with patients who have no insurance is a $200 co-pay and a satisfactory medical credit check. What’s that? No co-pay? You’ll need to go to the ancillary paperwork department.
The emergency department is new and there are only 8 beds. When it gets busy, the slow lady in the lunch line for non-emergent cases will probably be the long waits for the paperwork to be finished. I give them 9 months before they repeal the policy. Until then, the concept looks like it is bringing them a lot of good PR.

I mentioned this case in a previous Healthcare Update, but now it is going to trial. Will criminal charges against nurses who reported a physician’s actions to the Texas medical board affect the willingness of others to report actionable physician behavior? Interesting discussion in the comments section at Overlawyered.com.

Emergency visits in LA suburb more than double in less than 10 years. Of those patients, 50% have Medicaid, 30% are self-pay (where hospital collects less than 5% of bills), 10% are Medicare and 10% have other insurance. Will increased volumes offset lower payments?

Less access to health care for NY citizens. St. Vincent’s Hospital in New York closing due to massive debt.

Meanwhile, Deaconness Hospital in Indiana is expanding its emergency department. That way, when nursing homes send patients there and refuse to take them back, the patients will have a place to stay.

Edwin Leap has an all-too-appropriate post about what message boards in the emergency department should say. Some of the good ones:
‘Sorry about the wait, but after all, your symptoms started 10 years ago, right?’
‘We can access your recent narcotic prescriptions online. Creepy, isn’t it?’
‘If you can throw a chair, your back pain isn’t that bad.

Like a scene from that canceled NBC television show about emergency departments …
A 24 year old Ohio mom – who is pregnant with twins – starts having trouble breathing and left arm pain. She goes to the emergency department and is diagnosed with … a heart attack! At 24 years old!
Before she can go for her triple bypass surgery, the medical staff decides to deliver the 32 week old babies by Caesarian section … in the emergency department.
Now mom and babies are doing fine.
In other news, top Ohio plaintiff attorneys are recommending that the patient sue the hospital for $60 million because the scar from the Caesarian section makes her pubic hair line uneven and has forever ruined the patient’s sex life.

Britney Spears goes to hospital emergency department … in caravan … with police escort. Sounds like an emergency.

How far in debt is our country? Go to this web site to see real-time measures of our national debt broken down into multiple metrics. Just have someone ready to catch you in case you faint.

16 Responses to “Healthcare Update 02-10-2010”

  1. ERP says:

    That 15 minute guarantee hospital is barely such. It is a rinky-dink place with 8 ER beds where almost everyone that is actually sick has to be transferred. Sounds more like an urgicare centre to me.

  2. Steve says:

    From an article on MSNBC about mistakes made by veterinarians…

    “The AVMA stands by the state discipline system, Hochstadt said. At the same time, the group has staunchly opposed efforts to allow courts to impose non-economic damages for animals, arguing that the move would drive up costs, push vets out of the profession and create many of the problems found in the medical malpractice realm for humans.”

    http://www.msnbc.msn.com/id/35286379/ns/health-pet_health/

  3. hannah says:

    Bleh. I hate it when they use dialysis to prolong end-of-life (pally care) decisions. Coming from a personal standpoint, re. my grandfather. Yes, dialysis is PROLONGING his life but because dialysis “makes him better” nobody is looking at ways to make the quality of his life better. The man is dying and just because dialysis takes care of the short-term doesn’t mean that the 10000 other things wrong with him don’t matter.

    /rant

    • throckmorton says:

      Hannah:

      The patients at Grady are mostly diabetics and under age 50. Several are young mothers who lost their renal function due to eclampsia. For what its worth.

  4. Elizabeth says:

    There’s some funny stuff in that Poison Control blog (along with some very sad stories). “A 68 year old man accidentally used capsaicin cream instead of hemorrhoid cream.” Ouch!

  5. throckmorton says:

    The article about LA suburb ER visits hit home. Because of SCHIP we are seeing more and more kids in our EDs because they have went from private insurance to Medicaid/SCHIP. As a result of its low reimbursement, pediatricians have stopped taking the kids with it so they flood the EDs. Are you seeing this in your center?

  6. paul says:

    i thought cali had caps on pain n’ suffering?

    • Matt says:

      He’s a 41 year old paraplegic, who apparently led an active lifestyle before. The lost income and past and future medical bills could easily be in the millions. Although it’s not clear from the news release how the award was broken down – Cali may not apply the cap until after the verdict has been rendered. Basically, this guy’s lost quality of life for the rest of his life, probably 30 years, is worth less than one year’s salary for his surgeon. But it’s all about fairness, huh?

      That’s one reason why the claim of “we’ll stop doing defensive medicine if you give us caps” never makes much sense. A significant injury will have verdicts in the millions regardless. But logic has never been the strong suit of “reformers”.

      • paul says:

        well we don’t have all the facts so who are we to judge what happened in this case?!?

        sound familiar?

      • Matt says:

        I agree, that’s why I used the word apparently. But that’s just an example. It’s not hard to imagine an injury that leads to medical costs in the 7 figures, is it? Not to mention lost income if you can’t work.

        The point I was making isn’t related to whether the jury was right or wrong.

  7. A. J. Campbell says:

    Nurse Anne Mitchell, criminally prosecuted for reporting substandard medical care to the Texas Board of Medicine, was acquitted after less than an hour of jury deliberation.

    The jurors must have gotten into an argument about who was going to be the foreperson; otherwise they would have returned their verdict even faster.

  8. aGuy says:

    Sorry, the best one in the poison control blog has got to be number 8. How they keep from laughing (and crying at many of the others) I don’t know…

  9. CholeraJoe says:

    So many things to comment on:

    First – the crooked pubic hair line. There is a woman left in the US with pubic hair? I thought they all waxed. The crab louse has been placed on the endangered species list as a result.

    Second – Deaconess in Evansville’s ER expansion. That facility is a major trauma center for most of southern Indiana, northern Kentucky and SE Illinois. They get their share of nursing home patients, but need the extra space to support the trauma service.

    Third – Brittney gets a tampon stuck and it’s a major media event. Sheesh.

  10. ” St. Vincent’s Hospital in New York closing due to massive debt”…..a hospital closed in the River City..one of the largest and oldest ones. However they’re keeping the ER and psych unit open. Does this make any sense????

  11. Ron Miller says:

    This is a fair jab to be sure. But let’s not put too much meaning into a PR firm screwing up its press release.

  12. [...] can make it sound, notes WhiteCoat, as if the law firm itself rather than its client was awarded the [...]

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