WhiteCoat

Healthcare Update Satellite – 09-25-2013

See more health care news from around the web on my other blog at DrWhiteCoat.com

Man found dead in parking lot of Detroit’s Grand Valley State University had just used the university computers to query Dr. Google on “pain and tightness of the chest and sweating.”
Wonder what happens if the web site he landed on didn’t tell him to call 911?
Maybe Google, Esq.?

North Carolina woman busted for drug trafficking and felony possession of controlled substances after going to multiple physicians and being prescribed 1,286 doses of Xanax and 2,330 doses of oxycodone/hydrocodone between May 2012 and May 2013.

Think closely about those discharges against medical advice. A Canadian study of more than 1.9 million patient records shows that the 90 day mortality rate for patients leaving against medical advice was 2.5 times greater than for all patients combined.
Then again, I did a survey of two patients who left AMA and neither of them died in 90 days, so using Press Ganey statistical methods, the authors of this study must be all wrong.

The first day of Fall was also National Falls Awareness Day. The Executive Director of Elder Care Advocacy in Florida provides a nice letter to the editor listing some easy ways to minimize fall risks in elderly patients … including getting rid of throw rugs, avoiding slippers/sandals/[and flip flops], and placing non-slip mats in bathtubs and showers.

You can’t make this stuff up. Sadly, I’ve heard the same things said by patient before. Montana sheriff starts following a car that is swerving on the road. Pulls car over and finds out the the people were fighting and punching each other. Driver found in possession of oxycodone pill in wallet that he states girlfriend planted there. Girlfriend was confused and told officers that she believed someone was surreptitiously injecting her with drugs. Taken to hospital, then said girlfriend goes into emergency department bathroom and sets bathroom on fire in an attempt to “kill herself from smoke inhalation.”
This sheriff was probably kicking himself for ever pulling this car over.

Assuming that Obamacare is not defunded, if you want to get an idea of what you will have to pay to purchase insurance on the Unaffordable Insurance Act exchanges beginning next month, you can check out this Kaiser Family Foundation subsidy calculator.

In response to costs from the Unaffordable Insurance Act, Trader Joes cuts health care benefits for part-time workers, but will give those workers a $500 check to help defray the costs of finding another health care plan.

California mother taking methadone and other painkillers was charged with murder and child endangerment after her 9 month old child suffered fatal drug overdose from medications in mother’s breast milk. Child “Protective” Services knew about the issue and reportedly warned the mother to stop breast feeding, but the “safety plan” that CPS created reportedly wasn’t reviewed and approved for three months after a social worker created it and the CPS didn’t release the contents of the “safety plan” to the media.

More on antibiotic resistance with a hat tip to Instapundit. As more and more patients opt to have surgeries in ambulatory centers, the CDC is expecting the rate of antibiotic resistant infections in outpatient settings to increase. While “preventable infections” in hospitals have dropped by 20% in the past 4 years, allegedly due to institutional assistance, training and Medicare fines, ambulatory surgical centers are expected not to have the same resources that hospitals have in order to address these “preventable” events.
Unfortunately, the article doesn’t really say too much more about doctors’ offices or even ambulatory surgical centers for that matter.
One of the things that caught my eye, though, was the Medicare Factsheet (.pdf) contained within the article. Remember all of those conditions that were previously known as “Never Events”? They’re not called “never events” any more. They’re now just called “Hospital Acquired Conditions” and Medicare still isn’t paying for them if they happen in the hospitals. No payment for surgical site infections for bariatric surgery or for surgical site infections after certain orthopedic procedures. No payment for DVTs after hip replacement or knee replacement. No payment for vascular catheter-associated infections. Of course, we all saw how hospitals may be gaming the system by classifying a catheter related infection as something else, but that’s beside the point. When the CDC can tell a Senate panel that it is reducing central line associated infections by 44%, it can pat itself on the back — even though an NIH fact sheet has noted that the “number of sepsis cases per year has been on the rise in the United States.” So the CDC can congratulate itself because the reported incidence of bloodstream infections related to central lines has decreased while the overall incidence of bloodstream infections in general continues to climb.
Is that a good thing?
Personally, I think that the statistics are largely a combination of creative medical coding and getting the numbers that you pay for.

6 Responses to “Healthcare Update Satellite – 09-25-2013”

  1. RSDS says:

    According to the subsidy calculator for unaffordable care, an insurance policy will probably cost me 194.08% of my annual income. How am I supposed to pay that?

    I will not be eligible for subsidies in the exchanges because my income is below 100% of the federal poverty level.

  2. Ed says:

    If your income is that low, don’t you qualify for Medicaid?

  3. Mandy says:

    It’s because the provision in Constitutional Law Professor Barry O’s signature healthcare act which was supposed to take care of people like RSDS was… unconstitutional. He was counting on his decree that all states must expand their Medicaid coverage, but the Supreme Court ruled that that was not on, so there we are.

    People with incomes between 100 and 138 percent of the federal poverty level ($15,900 for a single person and $32,500 for a family this year) can get a tax subsidy to help them buy insurance on the exchanges. But because of the way Congress crafted the law, people with incomes below the poverty level are barred from receiving subsidies in the exchanges because they were supposed to be eligible for expanded Medicaid.

    In a perversity of Obamacare, this means that some of those with the lowest incomes will get no government help buying insurance. Someone who has an income that’s 99 percent of the poverty level cannot get financial assistance to purchase health insurance from an exchange, but someone whose income is 101 percent above can.

    So, that’s another 15-20 million Americans falling through the cracks.

    Of course, the author of the blog post I linked above, along with other Obamacare fanbois and fangirlz, blames those mean ol’ meanie Red States for not expanding their Medicaid rolls like Barry wanted them to (and mistakenly thought he could make them do). So it’s truly Barry’s and the Dems’ fault, because they were in such a hurry to pass the bill to see what was in it, that they didn’t get a chance to run it by a REAL Constitutional Law expert or even check it for loopholes. But there ya go.

    As one Republican legislator I know put it, though, “Medicaid is already a train wreck, and they’ve just set it on fire. Now they want to give us ‘free’ gasoline to pour on it to put it out.”

    P.S. I’m in love with the phrase “a perversity of Obamacare.” That’s a keeper.

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