WhiteCoat

Healthcare Update — 05-30-2011

Happy Memorial Day! Please take a few moments to remember all of our servicemen and servicewomen who have sacrificed for us and our country.

More medical news stories from around the web on the Satellite Edition of this week’s update over at ER Stories.net.

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Amazing story from one of the emergency physicians working when a tornado hit the hospital in Joplin, Missouri.

Failure to properly take medications results in extra $258 billion in medical costs each year according to CVS Caremark study. “If 35% of patients in a group of 100,000 don’t take their medications as directed, there will be 16 heart attacks, five strokes and seven deaths.” Now I wonder how many of those patients weren’t taking their medications as prescribed because CVS Caremark didn’t send them to the patients in a timely fashion … or because CVS Caremark waited to send the patient prescriptions until the doctor rejected some change in medications that CVS Caremark wanted to make.

Romneycare’s “insurance for all” mandate increased costs in Massachusetts by $4.2 billion and increased emergency department visits.

Obstetrician allegedly delays delivery of woman in labor. Father videotaping delivery catches doctor saying “Holy shit!” when child presents in breech position. Child develops cerebral palsy. Jury finds physician liable for $58 million – which is probably more than most community hospitals are worth.

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According to a survey of 1,700 emergency physicians, the main reason that more than half of emergency physicians order all of the tests that they do is because of a fear of lawsuits. Nearly half of survey respondents believed that this fear was the largest obstacle to cutting costs in the emergency department. “We have to err on the side of the test.” Suing our way to better healthcare is costing us a lot of money.

Federal court upholds medical malpractice damage caps in Florida.

Poignant story from one patient in an emergency department watching another patient in the emergency department die.

Right idea, wrong approach. Massachusetts lawmaker proposes bill requiring insurers to reimburse hospitals at a per-diem rate for any patients held in emergency departments longer than 24 hours while waiting for inpatient psychiatric placement. Insurers would be required to assist hospitals in finding available psychiatric beds.
If you’re a hospital administrator and this bill becomes law, wouldn’t you want to keep psychiatric patients in the emergency department as long as possible?
Better idea would be a bill to require fair payments to psychiatric hospitals for accepting and treating such patients, then diminishing payments for each hour on average that patients wait to be transferred to the facility. Hit a given threshold and the hospitals receive no reimbursement. Hit another threshold and the hospitals begin paying penalties to the state.
Reward access and penalize obstructionism.

More free market medicine. UNICEF decides to disclose what pharmaceutical companies are charging for vaccines. See price lists at this link. Patients and physicians should be upset about this data. The wholesale costs Mrs. WhiteCoat pays for her vaccines are in some cases 60 times more than those paid by UNICEF. Many times, insurance companies don’t even reimburse her for the costs of purchasing the medication, so she stops giving them.

When the priority for administrators in Spokane, Washington’s Sacred Heart Medical Center emergency department is “#1 profit, #2 productivity, #3 patient care,” one long-time emergency physician calls it quits. Another news story about the same topic shows additional issues at play, though. At least half of the patients coming to the emergency department are poor or uninsured. The hospital was subsidizing the care provided to those patients. In its latest contract with the physicians, the hospital dramatically reduced that subsidy. One evening, physicians were given an ultimatum to sign a contract that amounted to roughly a 30% cut in pay by 8AM the next day or the hospital would remove all local physicians and replace them with a national contract management group. Several physicians decided to leave. Time will tell whether the staffing cuts at the hospital will affect medical care.

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6 Responses to “Healthcare Update — 05-30-2011”

  1. EM Resident says:

    That Sacred Heart story is a sad reflection of the corporate approach to medicine. Sacred Heart sits on $28 million a year profits yet still had the nads to give the EM docs an ultimatum like that. Its CEOs like Elaine Couture that make me sick about the future of patient care.

  2. Rhia says:

    Regarding the psychiatric patients, that would not work in my state because anyone in this state taken to a general hospital must be transferred to a psychiatric facility or released within 24 hours.

  3. ThorMD says:

    I’m not sure your plan to get MA psych unit to accept patients would work any better. If I ran a pscyh unit had a bed open up, and there were 20 potential patients waiting at various ED’s, I would accept the one who had been waiting the shortest amount of time so I would get the least penalty.

    The big problem is not enough beds and the state continuing to limit the number of beds that are allowed. Trying to incentivize insurance companies to “help find a bed” is a dumb idea since the staff is already incentivized to “find a bed”. There are no beds to find.

    We once had a kid wait 10 days in our ER for a bed. What a disgrace. Waits of 4-5 days were not uncommon. During that time it’s an incredible drain on ED resources (one-to-one sitter), tying up a bed for ZERO compensation. No hospital administrator in their right mind would want to keep these patients longer as the cost of the sitter/lost revenue for the bed being tied up is far more than any piddly reimbursement they would get.

  4. Matt says:

    “Suing our way to better healthcare is costing us a lot of money.”

    Another day, another physician survey blaming lawsuits for their actions. This just in: another physician survey concludes physicians should be paid more! Another: Teenagers think curfews suck! This argument would hold more water, WC, if healthcare costs actually declined when we gave you the relief they requested. Turns out they don’t. Facts have to drive the conclusions.

  5. Ben S says:

    I’m assuming the incredulity regarding those vaccine prices is to comparing them versus costs in the US? Is there a breakdown on doses per vaccine? 2.53 billion plus another 400 million is mentioned on the overview. How’s that compare to doses per hospital (or purchaser) in the US?

    And the further question, if cost on our doses were lowered, would that raise the UNICEF costs? (That is, are we subsidizing worldwide vaccination?)

  6. “Now I wonder how many of those patients weren’t taking their medications as prescribed because CVS Caremark didn’t send them to the patients in a timely fashion … or because CVS Caremark waited to send the patient prescriptions until the doctor rejected some change in medications that CVS Caremark wanted to make.”

    You forgot to add – or perhaps because they would be charged more if they used another community pharmacy instead of CVS/Caremark’s own pharmacies or mail order service.

    – or perhaps they’re reporting these statistics only now because CVS/Caremark see’s an opportunity to predominate any possible future MTM business?

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