WhiteCoat

Healthcare Update — 04-19-2011

US health care providers aren’t the only ones who are concerned about patients gone wild. 89% of emergency physicians in China have been threatened with violence and 37% of Chinese emergency physicians have been physically attacked. US agencies aren’t the only ones failing to address the issue, either. Chinese emergency physicians and nurses are studying martial arts to protect themselves against incidents during their shifts. I guess that keeping a 9mm strapped to your leg is out of the question.

So THAT’S where my bald spot came from. Getting weaves in your hair may cause permanent hair loss.

Attorneys collect $6.5 million settlement after nurse anesthetist overdoses child on anesthetic during eye surgery then hospital has no doctor or crash cart available to perform CPR.

Oregon prison inmate receives $130,000 in medical care while in prison, then another $390,000 in a settlement just prior to her release after prison officials allegedly “ignored or dismissed” physical complaints that ended up being bacterial endocarditis.

Unique way for doctors (or any other service provider) to stifle bad online reviews: Have customers agree to give you copyright to anything they write about you and then, if those reviews are bad, send a takedown notice to the publisher alleging copyright violations.

Wild story. Nurse collapses in home bathroom. No pulse. EMTs called. They defibrillate her 15 times. Still no pulse. CPR performed for more than an hour en route to hospital and in emergency department. Emergency physician goes to husband to inform him that they are going to stop CPR. Then the monitor starts going “blip … blip … blip”. Eight months later, she is pushing her kids down a slide on a playground.

Another reason not to give your social security number to hospitals or medical providers. Former emergency department clerk convicted of selling patient identifying data to identity theft ring. She was sentenced to 2 years in prison. On the other hand, her victims were sentenced to many years of trying to clean up their credit history.

Part of New York emergency department temporarily closed by … sewage. I was going to make a joke about not many people noticing the difference in smell, but I used to live in New York, so I’ll leave that one alone.

More problems for all those people who are going to get “insurance” from the government. In Washington State, Medicaid patients are going to be limited to three non-emergency visits to the emergency department per year (emergency visits are still covered). Washington State even has a 15 page list detailing such non-emergency conditions such as hypoglycemic coma and asthma attacks. After the third non-emergency visit, it’s either AMF-YOYO — “Adios, My Friend, You’re On Your Own” or “get some extra large silverware you hospital board members because you’re going to be eating a whole lot of costs.” State doesn’t care either way. All it knows is that doesn’t have to pay for the treatment any more.

Another emergency department closing. St. Alexius Hospital near St. Louis is closing next month due to declining patient volume and lost revenue.

“Crying wolf” can become a habit. Some Upstate New York counties are seeking legislation to require that the state review the problem of ambulance abuse. Not that it will do that much, but maybe it will bring attention to the issue. In many cases, ambulance services are run by the fire department. When patients abuse the EMS system, there are less services immediately available for true emergencies. The fire chief in Troy, NY notes that some patients call EMS “on a daily basis and want to go to the hospital, and they’re out of the hospital before the crews who have to do the paperwork.”

Insurers become innovative in trying to stifle fair payment to emergency physicians. Michigan’s Spectrum Health insurance company offered physicians certain payment rates to join their HMO and then, according to physicians, give the physicians a “take it or leave it” ultimatum. Physicians decided that the payment was too low and “left it.” Michigan state law requires that HMOs pay 100% of emergency department charges, so if the docs don’t join the HMO network, the HMO has to pay the full physicians’ fees for the emergency department visit. Now, instead of directly reimbursing the providers for the care, Spectrum Health is sending checks to the patients and having the patients reimburse the providers – adding a step before the physicians can receive their payments.
I don’t necessarily think that having patients pay for their care is a bad thing. If the hospitals or physicians are worried about receiving payment, have the patients pay at the time of service and inform them that the insurer’s policies have forced this change and that the insurer will reimburse them later. Providers would happily accept a credit card or a post-dated check for payment. If the HMOs start jerking around the patients, then the patients will find another insurer. If the HMOs keep trying to jerk around the medical providers, then maybe the emergency department charges would have to increase by another 20% to cover the added costs of doing business with the HMOs.

28 Responses to “Healthcare Update — 04-19-2011”

  1. Anonymous says:

    But I thought all asians knew karate from birth :)

    Re: 6.5 million settlement, I agree with it.

    • Dave says:

      Yeah me too. That was a whole lot of fail on multiple levels. Seems odd that “only a doctor” could do CPR. WTF. It’s also why I avoid CRNA’s at all costs.

      • KT says:

        I also think it’s pretty strange that no CPR was able to be performed because there was no doctor, and that there were no emergency supplies when anaesthesia was being administered. Definitely a case of negligence.

        However, if you read the article, this nurse was UNCERTIFIED, so I don’t understand your comment about avoiding CRNA’s.

  2. Hueydoc says:

    Matt hasn’t commented yet ?
    Must be out spending his part of that $6 million……

    • Hueydoc says:

      Oh- and the limit of 3 “Nonemergent” ER visits per year ?
      Now instead of all of them saying they have “a cough” , it will now be a complaint of ” I’m having chest pain- and a cough”.
      Plan to see Medicaid expenditures climb even higher !

      • WhiteCoat says:

        I hadn’t even thought of this, but you’re absolutely right.
        Then the state will change the rules to make the review based upon final diagnosis codes. Chest pain + cough which is coded as a Viral URI = Strike 1 against patient.
        If hospital has to pay for these visits, there will be increased pressure to diagnose more serious ailments that are not considered “non-emergency”. Use of those codes will go up, costs will go up, and state will end up in a bigger hole.

      • Hueydoc says:

        Previous experience- when our hospital tried screening out nonemergent patients, suddenly EVERYONE had chest pains! Including one mom who was trying to convince me her 6 month old baby was having chest pains !
        “He’s clutching at his chest!-and he has congestion !”
        I kid you not.

  3. VA Hopeful says:

    Re: Weaves making you go bald.

    In med school we had a patient who was getting very frequent weaves over several years. Ended up sloughing off her scalp and dying. Apparently a combination of nasty chemicals and scalp traction can do serious damage.

  4. Bill Alexander says:

    One big advantage of a post dated check is it is only good if the patient lives. Survive the procedure, or no pay.

  5. midwest woman says:

    Since I’m from the River City it made sense to close that ER. It was essentially an urgent care because the actual physically attached hospital was closed and St. Alexius aka hellhole was a good 5 miles away. Just as an aside, when Tenet sold Forest Park several years ago 6 doctors bought it. It closed within 3 years but for some reason they kept the ER open. ?????
    My little hospital which I no longer work for is dying a slow death. Also owned by Tenet I’m sure it will be sold. That will leave St. Louis University as the only hospital it owns here.

  6. Don Miller says:

    The story from Michigan about the HMO and emergency physicians sounded familiar.

    Oh yeah, it happened to me in Idaho with Neurologists and Blue Shield. About 10 years ago Blue Shield decided that the “Prevailing Rate” for Neurologists was 1/2 what they were charging. Over 90% told them to get stuffed. I tried to sign over the check from Blue Shield to the office instead of writing a check. That was no good. I had to write them a check from my personal account and deposit the Blue Shield check in my account.

    That is also when I learned some of the other dirty games Insurance Companies play.

    1. If the MRI people say they accept Blue Shield, it isn’t completely true. Blue Shield only covered $250 for any radiology procedure. The MRI people balance billed the other $1750
    2. If Blue Shield covers in-network doctors at 90% and out-of-network doctors at 60%, don’t expect your out-of-network doctor to get 60% of his bill paid. He will get 60% of what he would have gotten if he had been in-network, you will be balance billed for the rest. Example – If out-of-network doctors charge $100 for a procedure and in-network doctors charge $50, Blue Shield will reimburse $45 to the in-network doctor and $30 to the out of network doctor (Instead of the $60 you were expecting). The out-of-network doctor will balance bill the $70.

  7. paul says:

    drunk douchebag took a swing at me last night. managed to turn away from it and take the punch to the shoulder.

    i had security throw him out and told him if he tried to return i would have him arrested. i imagine it would be my fault if he then wandered into traffic and got killed.

    actually, he was a patient’s boyfriend. since he never signed in, maybe i am off the hook?

    • Hueydoc says:

      Doctors are NEVER off the hook.
      He’d claim that you should have realized he was incapable of making logical decisions and should should have had him restrained. etc…
      Where’s our usual obnoxious lawyer to tell you this ?

  8. Dr. Greenbbs says:

    We have to wear locator tags that act as panic buttons now. We have had 2 providers (a hospitalist and one of our charge nurses) get attacked in the past month, the former with such a bad head injury that he can’t work for a month.

  9. Teresa says:

    A coma is not an emergency condition??

    • Nurse K says:

      As someone who’s been in a hypoglycemic coma before, it’s not really something that needs to be treated in the ER specifically. A 911 call from someone and some glucagon or D50 should cure that quickly (assuming your relative/friend doesn’t have access to your home supply of glucagon which you all have, right?).

      The two times I needed help in my lifetime, one that included a seizure, I refused transport to the ER because what are they going to do? Watch me eat a lunch tray? Poke my finger for me? I can do that at home. The problem is fixed, so it’s no longer an emergency. It’s like calling an asthma attack an emergency even though a hit off an inhaler fixed the problem. Keep in mind that a shot of glucagon oftentimes will bring a blood sugar up to 250-400 very quickly.

      If you get the glucagon/D50 and you’re not coming around (still confused) or your blood sugar is persistently low or something and there’s no one to watch you, sure, a trip to the ER should be warranted. That’s more like an “unintentional overdose” of insulin though or, perhaps, another medical problem (eg. sepsis) that’s manifesting as/includes persistent hypoglycemia.

      • Teresa says:

        Well. I’m sure my diabetic friends will be able to tell me where their glucagon is when they are in a comas. And obviously, not being a diabetic, I’ll know exactly how to deal with that. In fact, this has been such an education that I am completely confident that when I find a friend unconscious, I’ll know exactly what the cause is and will just grab the glucagon and administer it.

      • Wendy says:

        reply to Teresa~I think the average “friend” wouldn’t be expected to to know how to deal but as a wife of a diabetic (since he was 5) I’ve had to learn. After many years of stability, we had a tough year partially due to med changes. After 3 911 calls in one year & me screwing up the glucagon (BS was so low it would register) we talked my hubby into being transported to the ED. And what did they do for him there~ they gave him a turkey sandwich, applesauce, & a cookie. Then a sugar check, then discharge. Now I’m ready. Better trained with the glucagon & unless they don’t respond quickly, we are staying home.

      • Teresa says:

        Wendy–Are you actually suggesting that the non-diabetic doesn’t know how to deal with a diabetic’s low blood sugar issue without some knowledge or training? You are complete refuting the notion that a diabetic coma is never an emergency.

  10. NurseBeth says:

    We had the staff mtg yesterday regarding the new “rules” for WA State medicaid pts. Basically, the state couldn’t resolve this issue of repeated non-emergent use of the ER, so now it’s on the hospitals. We have to demonstrate we have a plan to decrease the problem and encourage pts to use their PMDs instead of the ER. Oh but wait, those PMDs are paid like an HMO contract to see these pts, why aren’t *they* demonstrating the plan?

  11. SeaSpray says:

    I LOVE the story about the nurse who collapsed, was in cardiac arrest for 73 minutes and survived. I want to read her book. Her husband a cardiac nurse initiated CPR, paramedics arrived in 7 minutes and so on.

    That was a miracle.

    It must be so hard to have to give up and declare patients dead. What if they didn’t go 15 rounds? How do you know? How do you know the next round won’t do it? And they were stopping. Certainly understandable. And then her husband’s yelling not to give up and that he would do it himself seemed to jar her. Coincidence?

    Boy …you really have to wonder why things happen as they do sometimes.

    Thankfully …her husband was home with her when she collapsed.

    They never said why am active,healthy 28 yr old would go into cardiac arrest. ?

    And just what is the point in time the staff gives up in resuscitation? Is there a basic criteria, but staff tries harder on some people for whatever reason?

    I am guessing they went that many rounds because of her age, husband, young children and one of their employees.

    • Nurse K says:

      She got a defibrillator put in with no other mention of a cause, so they likely determined that it was just a “sh*t happens” situation (ie. no specific cause was determined). I think the two medical professionals in the story would have talked at length if there was some other cause like a rare heart defect, etc.

  12. Nurse K says:

    How does making the hospital eat the cost of repeat visitors deter individuals from abusing the ER? It’s not like you’re allowed to balance-bill Medicaid patients or whatever.

    Perhaps, if hospital administration knows it’s freebie care for non-emergent Medicaideurs after the 3rd visit, they’ll encourage ER docs to not coddle the frequent flyers with narcotics or anything other than a basic medical screening exam so they don’t find any particular benefit in showing up every other day.

  13. Matt says:

    How the healthcare budget in Canada gets worked out, allegedly:

    http://www.theatlantic.com/politics/archive/2011/04/those-wacky-canadians/237457/

  14. Matt says:

    One more – Krugman argument on containing costs and why the market isn’t the answer (don’t know I agree but worth considering):

    http://www.nytimes.com/2011/04/22/opinion/22krugman.html?_r=2&hp

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