WhiteCoat

Healthcare Update – 11-05-2012

What will the form for paying your new health care tax look like once 2014 rolls around? Americans for Tax Reform creates one possibility. If you are looking for a list of legislators who voted in favor of the Affordable Care Act on this day before election day, one list broken down by state is here.

Supreme Court ruling on Affordable Care Act allowing states to opt out of Medicaid expansion estimated to cost states an extra $53 billion in unfunded care. Six to ten million additional patients will remain uninsured because many states are reigning in Medicaid costs and are not expanding Medicaid services or coverage. In addition, many hospitals agreed to accept lower payments for Medicaid patients, expecting that there would be fewer uninsured patients with the expansion of Medicaid. Now those hospitals will likely eat the cost of treating the uninsured patients.
Another reason why our government needs to provide patients with health care rather than “insurance.”

How are NY City hospitals functioning after Hurricane Sandy aftermath? Struggling. Several hospitals are still closed. No emergency services being offered. No electricity. Backup generators failing because of flooding.
Similar story in Connecticut where Norwalk Hospital experienced “bedlam.”

Let’s see … Alcohol? Check. 17 ounce sodas? Check. Hmmmm. What’s next? I know! It’s time for government to regulate energy drinks. After all, it’s for our safety, you know.
Next up … coffee. Ooooh. Oooooh. What about water? People can die from drinking too much of that, too, you know.

Elderly Alabama woman dies after wheelchair rolls down hill and lands in ditch during nursing home fire drill.
Actually, the patient developed pneumonia after the incident, died three days later, and the cause of death still hadn’t been determined, but the wheelchair/death headline sure catches your eye.

More on being “sentenced to death” on the NHS’ Liverpool Pathway … in a story from the Telegraph this time. OK, OK, the story is from 2009, but I’m hoping that the Telegraph has more street cred than the Daily Mail with Steve and Stephen. Give us limeys the scoop – is the Liverpool Pathway real or is it a bunch of hype?

“Like wild bulls in a pen.” Bath salts are still dangerous. One emergency physician calls their effects on people worse than heroin, crack, PCP, or methamphetamines. One patient handcuffed to a gurney flailed his arms around “until he was bloody from his elbows to his wrist” and then he “snapped the metal railings in half.”

Speaking about drugs, here’s a story about a new hallucinogenic drug similar to LSD called “25-I” that reportedly packs quite a punch. One drop allegedly caused a seizure and death in a patient who used it at Voodoo Fest in New Orleans. Not that the patient may not have had other substances floating around in his system at the time, but still.

Delegating work to non-clinicians in order to shoehorn more patients into the system. In some cases, 77% of preventative care and 47% of chronic care would be delegated to “nonphysician team members.” Will it work?
Depends on several things. Biggest concern will be the payment model. Will docs accept being paid the same amount of money to care for the sickest of the sick patients? I doubt it.
Also, will physicians agree to accept the liability for the actions of the non-clinicians to whom they delegate patient care?
In a way, free market principles may come into play. If the “delegation” becomes widespread, will patients agree to hearing “the nurse practitioner tech assistant who took three online courses in advanced patient management will see you now” or will patients pay extra to see “physician team members”?

Paging Dr. Orwell. Dr. George Orwell to the nurse’s office, please. Pennsylvania school students to wear electronic tracking devices around their necks so that “researchers” can monitor how often they come into contact with each other during school days — and on a day off from school as well. This data will help them to determine “how children interact” and how the flu is spread among them.
I’m trying to determine what study question the tracking devices will answer. We know influenza is spread by air droplets and that the virus can live on surfaces such as doorknobs for up to six days. How will tracking devices account for surface-to-person spread of influenza as opposed to the person-to-person spread? Who cares. Let’s just monitor the children and see what information we get.
Up next … computerized toilet paper in student bathrooms so “researchers” can tell how well children wipe their buttocks and what effect that may have on disease.

Think that a medical triage hotline will reduce emergency department visits? Didn’t happen in Australia. Study there showed that fewer than 2% of ED visits came from the hotline and that in some cases the nurse hotline increased the number of patients going to the ED. Researchers

Janssen Pharmaceuticals announces Xarelto, an oral anticoagulant which has been approved – on a “priority review timeline” – for treatment of DVTs and pulmonary emboli. No need for routine blood monitoring like used for coumadin. Already approved for use in atrial fibrillation.
Look for coumadin to soon receive a black box warning for causing fatal arrhythmias in two Saharan aboriginals in 1977 that has now just come to light by diligent review from the FDA. Isn’t that how things work around here?

Dear Troopers and Deputies, when transporting patients to the emergency department for medical care, please secure your weapons. Another patient grabs a trooper’s gun while in the emergency department. Unfortunately, the patient killed himself. Fortunately, the patient didn’t shoot anyone else, first.

3 Responses to “Healthcare Update – 11-05-2012”

  1. steve says:

    RE: Liverpool Pathway

    Now that’s better , a more balanced link, without all the I stubbed my toe and they handed me the body bag junk.

    Have a glass of wine to celebrate, (checks the daily fail “a thousand thing that will give you cancer” scare list)…oops maybe not!

  2. GrumpyRN says:

    Re the LCP, please read this cut and pasted from “The Medical Registrar’s” page on Facebook. Yes, yes I know, that means nothing but the 8000+ likes and the comments says much, much more.

    Speaking to a dying patient’s relative, “…well Mr Doe, at this point I think the most important thing is to keep your mother comfortable. There is a care pathway we…”

    “Is that the Liverpool Pathway? I read about that in the papers.”

    Filling with apprehension, “Oh yes?”

    “Yeah, that Melanie Phillips in the Mail. God she talks a load of shit. I don’t know what she expects you to do, keep dying people alive just to watch them suffer? You do what you have to doctor, we trust you, not some publicity seeking hack writing for a fish and chip wrapper.”

    You can find it here from November 2nd;

    https://www.facebook.com/medicalreg?ref=stream

    Also see this;

    http://www.endoflifecareforadults.nhs.uk/assets/downloads/LCP_consensus_statement_24_09_12.pdf

    As you can see, it seems to be that those in the business of dying are pro-LCP.

    • DensityDuck says:

      As I’ve said elsewhere, the response to “death panels” should have been “hell yeah, we’re instituting death panels. Anyone who thinks we shouldn’t have them has never had to watch an elderly relative die in pain, by inches, while doctors are forced to pretend like there’s some use keeping them in a full-care hospital as opposed to giving them a morphine drip and a comfortable bed. We spend millions of dollars a year on giving old people a few more years of life, and bad years at that, because our system is set up to incentivize painful life over painless death. My grandfather had a stroke that melted his brain, but the DNR didn’t quite have the right signatures, so by God those doctors wer gonna keep his heart going no matter what, even if it cost fifty thousand dollars, even if they had to break two of his ribs doing chest compressions. You’re damn straight we’re advocating death panels.”

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