WhiteCoat

Healthcare Update – 03-04-2013

Drunks caught on security camera beating each other in a Turkish emergency department waiting room. Best part of the video is when one dope pulls off his belt to start hitting people and his pants fall down. Then he waddles about swinging his belt like a little kid with a load in his diapers.

Another bamblance theft from the emergency department. If you don’t know why it’s called a bamblance, you need to listen to the video below (strong language alert). This latest ambulance theft occurred at University of Michigan. Many of the commenters to the article suggested that the patient was going to a different emergency department due to the wait times.

FDA stifling pharmaceutical innovation through excess regulation. You don’t say. Scary that the average time and cost involved in developing a single drug approved by the FDA is 12 years and $1.2 billion.

How much will you be charged for your emergency department visit. This study in PLOS-ONE gives you a good idea of what you should be charged. Keep in mind, though, that the numbers are “median” values, meaning half of patients got charged more than those numbers and half of patients were charged less than those numbers. The range of charges was ridiculous. For a UTI, the lowest charge was $50 while the highest charge was $73,002. That doesn’t mean some poor patients actually paid $73,000 for a Bactrim prescription, only that insurance was billed that much (which is still a crime).

Yet another way for government to cut healthcare costs: Pay for services, then go back years later and allege that those services were provided inappropriately. Demand reimbursement and penalties. Publish news articles about how horrible the providers were and how patient’s lives were in jeopardy. Then show how federal agency intervention is the only means to help patients.
In this article, nursing homes had patients on two whole anti-psychotic drugs and one depression medication and didn’t even have tons of paperwork to show how the drugs were being monitored! Gasp! Another patient had paperwork for the government, but the paperwork showed that he kept getting physical and occupational therapy even though all the therapy goals had been met. What “poor nursing home care.”
Too bad we can’t compare private hospital performance to VA hospital performance on the HospitalCompare web site. Data for government institutions is blocked. Wonder why that is?
One of the biggest impediments to the government providing health care to the general public is that it would be crushed under the weight of its own paperwork and regulations.

Obama administration creates statistics showing that its policies have decreased the hospital readmission rates by a little more than one percentage point. A CMS official says that the news is “exciting” and that we are seeing “a fundamental, structural change.” Penalties work!
Read into the article a little further and you’ll see that the penalties amount to a whopping $1 per Medicare patient for one hospital. You’ll also see that the government is penalizing 2,217 hospitals which is a little less than half of all the non-federal government hospitals in the United States. In other words, whether or not hospitals will receive penalties pretty much becomes a coin-flip.
I’d like to see how many of those non-readmissions were classified that way simply because the hospitals admitted the patients as “observation” stays – meaning that more of the costs were shifted to the patients and that the number crunchers still met their goals. Doubt you’ll hear that sound byte from the administration, though.

Interesting findings. When admitted patients receive “clot-buster” thrombolytics for acute strokes, they had more complications and higher death rates than patients who came to the hospital and received thrombolytics on arrival. Even when the study was adjusted for age and baseline clinical characteristics, in-hospital patients still had worse outcomes and more complications.

What will some of the other effects of the UnAffordable Care Act be? Silent exodus of physicians from the workforce. More employed physicians that punch clocks and work 9-5. Hospitals monopolizing medical care in certain regions. Some patients maintaining insurance, though … for now.

When Greek pharmacies stopped paying for their shipments, eventually the pharmaceutical companies stopped sending the medications. Greece owes pharmaceutical companies almost $2 billion Euros. In addition, due to the low price of medications in Greece, some of the wholesalers are selling medications to other countries to make a profit.
Now there is panic among the population because many medications are in short supply.
But I’m pretty sure that the Greeks have national healthcare insurance, right?

A little late, but worth repeating. Medscape publishes warning about physicians being liable for any bills sent to the government in the physician’s name. Note that the original federal OIG Alert regarding this issue was posted in February 2012.

Would you trust your own hospital for medical care? More than one third of 101,000 doctors, nurses, and paramedics surveyed in Great Britain wouldn’t recommend their own hospital to family or friends. In addition, one third of survey respondents had witnessed medical blunders or near misses at least once in the previous month.
Notice how contempt in the comments is directed toward the government? By providing “insurance” instead of health care to patients, the government in this country is able to redirect that contempt.

EPIC – one of the many electronic health record software companies – goes to hospital administrators and demands that they force a physician blogger to remove pictures of EPIC’s user interface from a snarky post about the software. Dickweeds.
First of all, anyone with half a brain can do a search for EPIC EMR screenshots and come up with dozens of pictures of your bloated EMR. Trust me, your EMR isn’t that good and it takes way too much time away from me being able to provide care to my patients. Oh, and talk about alarm fatigue.
Looks like I’ll have to prepare an educational article about EPIC now — including screen shots. Maybe I’ll call it EPIC FAIL. And I have no problem filing a SLAPP suit for inappropriate letters from attorneys.

16 Responses to “Healthcare Update – 03-04-2013”

  1. njfmd says:

    Re the Turkish ED fight: almost had to watch it twice to realize there was a fight. Looked like a normal day in when I worked in Camden NJ Hospital (now closed) in the early 90s. Only missing the broken bottle weapons and women joining in.

  2. DefendUSA says:

    WC…”dickweeds” is one of my favorite words for slanderous idiots! :)

  3. RuthieH says:

    Ok my Texas raising is coming out in this comment…”I ’bout fell outa my chair laughin’” listening to the “bamblance” clip. It was HElarious!
    (Pardon the spelling folks. It just doesn’t have the same “umph” spelled correctly. :-)

  4. mickcgorman says:

    Re Greek healthcare, they have a partial “national health” service with the rest being funded by various social insurance funds. Your point is what?? the problem is that Greece has no money! it wouldn’t matter what healthcare system they had as the whole country is broke! It appears that you are more interested in money than in the health of patients? have you thought of becoming a banker or stockbroker?

    • WhiteCoat says:

      My point is that the “national health” service for which people are clamoring in this country is not the panacea that many would hope for.
      Unfortunately, the system that is going into effect in this country is even one step removed from that. We get “insurance” and then have to try to find someone willing to provide health care for that insurance.

      Regarding national finances … have you looked at the balance sheet in the US? 16 trillion in debt. Shutting down government services because it can’t spend an extra $85 billion. That 24 billion Euro debt for Greece is budget dust to the US.

      Nice strawman argument with the allegations that I care more about money than the health of patients, though. That would be like me asserting that you didn’t care about your country’s economy because you didn’t agree to accept 20 cents on the dollar for your job.

      • mickcgorman says:

        The Greek population is 10,815,197 against the US population of 300,000,000+ so although the relative debt is still larger in the US the Greek debt is hardly “budget dust”
        Your pursuit of money is admirable, after all you have to support your family plus you have an obligation to your nation in the form of tax, it is just the tone of most of your arguments leans towards money over people?
        I get the point that the health system being proposed is flawed but you won’t get a better one by “throwing the baby out with the bath water” take it and use it as a starting point for something better, we all have a responsibility to help less fortunate people than ourselves even if we are exploited on the way by “scroungers, the workshy, illegal immigrants and the feckless”
        We don’t deny people access to banks and drug stores because criminals rob them!

      • DefendUSA says:

        Mick–
        It is not for the gov’t to redistribute my tax dollars to give to people who REFUSE to work for what they need.

        As a result of ObamaCare, I, a working,taxpaying citizen cannot afford health insurance!! I have been priced out of the market so others can have insurance, but not I. My premium doubled since this passed. I simply cannot afford it.

        It is not my responsibility to care for the less fortunate in the way you suggest and it doesn’t mean that WC is all about the money. Don’t be so obtuse. Logically, this will decrease care and access, but it appears you refuse to understand that concept.

      • mickcgorman says:

        @DefendUSA
        Of course it is your responsibility to care for less fortunate people than yourself! otherwise what is the point of YOU? People above you in status/ financial means subsidise you. You can’t afford your own Army, Navy, Airforce, road mending crews, teachers, park rangers etc. We all depend on each other otherwise the world doesn’t work, haven’t you noticed the American dream going down the toilet? People who refuse to work but who are able are to be despised but they are a tiny minority despite what Fox news tells you, many more are genuinely unable to work, what should we do with these people? If you say it is not your problem then I say F**k you. One day it will be your turn to be in need.

  5. Joe says:

    Epic is a suck ass program. I learned the CPRS program in one month. I am in my third year of Epic and still use expletives for it every day. Only reason they have done well is by buying of congress with lobbyists. Fucking racket.

  6. This post brought some smiles this am…the $73,000 UTI? I would love to see how those charges were brought to that level–I have to assume their was some gold chelation therapy involved! And the Bamblance bit was something else…have a great day.

    • WhiteCoat says:

      Jim! Long time no read.
      It’s like Norm just walked through the door at Cheers!
      I see you’re up and blogging again. That’s great. Keep it up!

    • Art Fougner MD says:

      The pricing article might have made an even stronger point had the monies collected been looked at, breaking down collections by payer. Remember that charges are only part of the story.

  7. Jason says:

    As far as EMRs go, think of it this way: it is not which one is best, but which one sucks the least. If you look at it that way, it makes a bit more sense (if no more palatable).

  8. Long Time E.D. Doc says:

    Meditech vs. EPIC in the ongoing battle of which EMR sucks more?

    • Joe says:

      Having used both I say EPIC sucks worse by far. It’s not an intuitive program. But hey, the coders love it and that is what is important right?

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