WhiteCoat

Healthcare Update — 02-02-2011

Welcome to the belated edition of this week’s update and the first post that I have ever made from work — because I have been snowed in at the hospital for the past 2 days.

Shameless plug for songs involving me by name – The ER Blitz. Tex now has over 100 songs in his repertoire. And he still has a damn good blog, too. When is the greatest hits album coming out?

These don’t go in your grandma’s bubble bath. When seasoned drug users state that “this is nasty stuff” and that they “would not be disappointed to see it banned,” you know that states are going to take notice. “Bath salts” are causing psychosis in people that snort them. The active ingredient, methylenedioxypyrovalerone or MDPV, is being outlawed in many states.

Choose one from Column A and one from Column B. House Republicans considering whether to turn Medicare into a fixed payment “voucher” system where the government gives you a voucher to buy a private health insurance plan once you hit “Medicare” age. Democrats rightly note that “privatization will make the cuts previously proposed by either party look tame.”

Put on your snowshoes — and donate blood. Blood supplies are running low due to the bad weather in several areas of the country.

Bureaucracy adds another layer of costs to medical care. Physicians are having a difficult time entering information into the computers to create the electronic medical records that the federal government wants. Now more and more emergency departments are employing “scribes” to enter the information.

Another Pennsylvania emergency department closes due to “consolidation.”

In San Diego, one hospital is expanding its emergency department and laying off almost one quarter of its staff – due to reductions in payments from Medicare and Medicaid

Medicare is “cracking down” on fraudulent ambulance calls. I’m sure that patients like the one in the article who called an ambulance for chest pain then signed out of the hospital 10 minutes later to go to the nearby bar will be dissuaded from defrauding the system in the future when they get a huge ambulance bill.

11,500 patients treated in emergency departments each year for snow shovel-related injuries. More than half have muscle strains. Twenty percent fall, 15% are struck by shovels. About seven percent of patients had cardiac-related issues and those issues resulted in about 100 deaths per year.

Eating fruit can kill you. Man goes to emergency department with muscle spasms and jerking after eating three slices of starfruit. A physician’s assistant in the ED consulted Dr. Google and discovered that patients with kidney problems who eat the fruit could develop seizures and death.

Sometimes waiting in the emergency department can be bonding time with your kids. Read this fun story about a mom who sat in the ED with a child who injured his ankle.

President Obama considers “fixing” the Affordable Healthcare Act but rules out changing issues relating to pre-existing conditions.

20 Responses to “Healthcare Update — 02-02-2011”

  1. Mad Rocket Scientist says:

    “Choose one from Column A and one from Column B. House Republicans considering whether to turn Medicare into a fixed payment “voucher” system where the government gives you a voucher to buy a private health insurance plan once you hit “Medicare” age. Democrats rightly note that “privatization will make the cuts previously proposed by either party look tame.””

    How would this make the cuts bigger?

    • WhiteCoat says:

      Let’s make sure that we’re talking about the came “cuts” first – cuts in services.

      Adding a voucher system just creates a second layer of bureaucracy to the whole picture.
      First, you get the voucher. Then you have to shop around for an insurance company which (1) will accept you as an insured, (2) will cover you for the care you need, and (3) doesn’t cost a lot more in premiums than the voucher that you received.

      Then, assuming that you can find such an insurance company, you move forward and hopefully get the care you need in a timely fashion.

      But, if you are able to purchase insurance, but none of the medical providers takes your “insurance” (as one example: Medicaid), then you have worked all your life and paid into the system to receive detritus in return.

      What happens if you can’t find an insurance company that is willing to accept your voucher as payment? You are the proud owner of a financial instrument with no value. You’ll be happy to see that you paid Medicare taxes for 40 years so you could get a piece of paper with Uncle Sam’s stamp on it instead of medical care.

      Oh, and then when few people can get insurance for their vouchers, the feds can point fingers at the “greedy” doctors and insurance companies that won’t provide care to all of these sick Americans with vouchers in their pockets.

      • Ian Random says:

        I had a brief low level stint in the insurance industry decades ago and the company actually administered Medicaid. The weird part was in order to make it work, they actually had to pay more to doctors than normal. It was something like 10%.

  2. Anonymous says:

    -Really, going to the ED because you slipped and fell (or somehow hit yourself with the shovel?). Oh noes my shoulder hurts so it must be life threatening! In the 22 years of my life I’ve never once been to an ED.

    -It is interesting how Obama started out with “you don’t like it, go f yourself” attitude when he had a Congress lock-step behind him on this healthcare thing. He’s obviously setting himself up for the “I’ll compromise, but only on insignificant things” tactic. Then when re-election rolls around he’ll push how republicans were out to get him, it was Bush’s fault, and he was the one trying to be a middle-grounder all along.

    The Medicare cracking down article is such a joke. Yeah, like I’m going to “screen” and deny you transport so if I get it wrong I get sued to bankruptcy.

  3. midwest woman says:

    just curious Dr. White Coat. does your er computer talk to the inpatient hospital computer? At my facility, the ER uses one system and the hospital uses another. When patients come to the floor all the stuff you guys put in, we re-enter.
    I brought this up in light of the scribes being utilized to enter info.

    • WhiteCoat says:

      Some areas crossover and some do not. We have two systems and users have to open up the system for the emergency department records in order to read the notes. However, labs and other tests done in the emergency department cross over into the ED chart and also are accessible to the main hospital system.

  4. Tex says:

    Hey Whitecoat, thanks for the plug!

  5. Hueydoc says:

    I agree about Obama.
    When Medicare says they are going to “crackdown”, what they mean is they are not going to pay- not stop the abuse. The patients will still do what they always do- refuse to pay.
    And due to HIPAA and incompatible systems, I can rarely get an old chart or floor chart on our system- so much for access.

  6. tracy says:

    Puts down bath salts. ;)

  7. PharmerElla says:

    In our ED we have been using scribes for the past 2 years. One scribe assigned to each provider during their shift. It has made everyone’s life easier! Now the providers don’t spend extra time dictating at the end of their shift and the notes are in the computer almost immediately so the inpatient folks know what went on while the patient was in the ED. I’ve also heard that it has increased reimbursement since the scribes can concentrate on documenting the required stuff that the insurance companies look for.

    • throckmorton says:

      We looked into scribes. In our area, employees cost 2.1 times their salary when you include all the additional costs such as insurance, retirement, etc. To have a scribe for each doc per 24 hours would mean we needed 12 scribes. Here is the breakdown. There are three docs. We did not include the PAs and ANRP. Each scribe worked 8 hours shifts. Pay plus benefits plus shift differential meant and average cost of $27/hour times 8 hours per doc per shift. Three additional hires are needed because of weekends and vacations. This makes the average cost $34/hour. So you have $34/hour(24hours/day)3 docs (52 weeks/year). Cost so far is $122,400.00.
      The ED lost money last year as the uninsured genereally dont pay. Better documentation does not let you recoup from those who arent going to pay anyway. So we figured out we could spend a $125K to have pretty paperwork or we could try to stay afloat.

    • WhiteCoat says:

      Throckmorton is point on as usual.
      The efficacy of a scribe system depends upon your payer mix.
      In our state, Medicaid pays the hospital for either a procedure, a radiographic study, or the clinical visit. Pick the highest paying charge – you get nothing for the others. If 50% of the emergency department patients are Medicaid and the Medicaid patient needs a CT scan, the ED chart could be filled out to comply with a Level 1 or a Level 5 and the hospital would still get paid the same. In our state, Medicaid pays doctors roughly $22 for evaluating a cough/cold and about $85 for treating a heart attack. CT scans are reimbursed at about $250.
      Scribes would only drain the resources in such a system.

  8. tracy says:

    Just when i was wondering, “i wonder what the training would be, to become a scribe?” Darn.

    It would be some way to get in to the world of health.

  9. Moose says:

    FYI: West Penn in Pittsburgh has been shutting down for the past 5+ years. When they merged with the Allegheny Health System [about 10? yrs ago] the plotting of West Penn’s fate seemed to start.

    FWIW, the problem isn’t simply “another ER in Pgh shutting down” but that this is the 2nd – and last – hospital in that section of the city to go. There’s a cluster of hospitals in the University area [run by University of Pittsburgh Medical Center], 5-10 miles that way, and another hospital with ER 10 miles in another direction, across a river [also run by UPMC] and… Yeesh.

    UPMC is no better, they’ve been closing ERs in “unprofitable” [read: poor] areas.

  10. MiniMedic says:

    I would LOVE to open my veins and donate some of the lovely O+ blood running through them, I really would, but my weight wavers between 100-110 pounds, which disqalifies me from donating. It’s a pity, because I’m fairly healthy otherwise.

    (I’m 5’2″, in case someone wanted to consult that BMI chart.)

    • Ed says:

      I know the feeling. 4 gallon + donor. Now I can never donate again due to a false positive on a hep test. Retested, at my expense (my health, after all), and all good. But the Red Cross won’t touch me. :(

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