WhiteCoat

Healthcare Update Satellite — 02-13-2014

More medical news from around the web on my other blog at DrWhiteCoat.com.

No more “putting it on my account.” Due to cuts in payments from Medicare and Medicaid and expenses for treating uninsured patients, Hutchinson Hospital in Kansas will require payment for emergency department services, radiology, and outpatient surgery services before services are rendered.
Emergency department patients will still get screened, but apparently won’t receive non-emergency treatment if a partial payment isn’t made.
Florida Hospital Memorial Medical Center has implemented the same type of system – along with several other hospitals in the area. Hat tip to Scott (@Bnet_bobcast) for the link.
While many people think that emergency departments have to provide patients with medical care, that misconception is only partially true. Federal EMTALA laws only require hospitals to provide care for “emergency” conditions, so chronic back pain, colds, toothaches, and rashes are unlikely to qualify. Many hospitals provide the care anyway, wanting to avoid accusations in the news of “refusing care,” but those winds are changing.
Look for prepayment of nonurgent medical care in the emergency department to become a widespread policy as the Unaffordable Insurance Act ratchets down payments to medical providers. You’ll have insurance, but fewer and fewer doctors will be willing to provide you with care.
Then look for the government to pass more unfunded mandates requiring medical providers to provide care free of charge. Wait. That would never happen … would it?

One of the wildest things I have heard of in a while. Gang busts into Brazilian emergency department and robs patients waiting in the waiting room. Taking “patients gone wild” to a whole new level. Another story about the incident here.

Six ways to avoid “unintentional” Medicare fraud. Usually fraud requires “intent”, but not when dealing with providing medical care to patients on the government’s dime.
The best way to avoid unintentional Medicare fraud is to stop accepting Medicare patients.

Another entry in the “that’s why they call it dope” chronicles. Brainiac in UK went home to visit his mother from college, got high on mephedrone, cut off his woo hoo, and then stabbed his mum.
I was disappointed to see that there wasn’t a comment section to the article.

Canadian “Robin Hood” doctor has license suspended for six months after exaggerating patient’s food allergies so patients could get extra diet allowances from the government – to the tune of $1.8 million over 4 years. In the process, Dr. Roland Wong made $60 per form he completed and earned $718,000 in 2008 alone. Hat tip to Mark for the story.

Study in NEJM shows promise in using an implantable upper airway stimulation device to help control sleep apnea. The abstract doesn’t describe the device, but a small picture on the site makes it appear that the device is similar to a pacemaker and has an electrode implanted under the jaw.

New study in Pediatrics: What’s better for treating children with asthma – oral prednisone/prednisolone or IM dexamethasone?

Hospitals in Ireland so busy and stressful that nurses are checking themselves in to be seen in the emergency department.

Irish patient dies of heart attack while waiting in a “dangerously overcrowded and understaffed” emergency department. Consultants warn that “The risk of our next untimely death remains high while the emergency department overcrowding continues.”
And this is the type of system that we want in the United States?

Not a medical post per se, but may become a bigger issue in the future. A Virginia Court of Appeals held that the rating site Yelp! was required to disclose the identity of “reviewers” who left bad reviews about a carpet cleaning business. The business alleged that the reviewers were not his customers and the court held that there was no “free speech” right to make false statements.
Will the same logic apply to those who anonymously rate physicians and hospitals using Press Ganey? It should.

2 Responses to “Healthcare Update Satellite — 02-13-2014”

  1. Fergus says:

    Regarding the healthcare in Ireland: I believe there are currently 50 public hospitals in the ROI.(no EMTALA type laws for private hospitals). With a population of 4.58 million, that’s about 90,000 people per ED. (High tech and specialty hospitals are private and may not offer emergency care and can require you to pay up front before being seen on admitted.) In the US, we have a population of about 313.9 million with about 60,000 per ED (excluding access and geographic issues).

    A Medical Card (means-tested as our Medicaid)entitles you to free GP services; in-patient and out-patient services in a public hospital; dental, optical and aural services and appliances; and maternity and infant care during pregnancy and for up to six weeks after birth. Prescribed drugs and medicines usually cost €1.50 per prescription item, up to a maximum total of €19.50 per month.

    Everyone else who’s entitled to public health care falls into Category 2. You will be charged to visit your family GP if you don’t have a GP Visit Card. This is means tested, and provides GP services for free, if your income is under a certain level. (This level is fixed at 50% higher than that required to qualify for a medical card.). If you wish to go to hospital, but are not referred by a GP, you must pay an initial hospital charge. This is currently set at €100 ($138) per day or visit. You will also have to pay for medicines and prescriptions, routine dental, optical or aural treatment.

    All retirees over 65, whether or not they have a Medical Card, are entitled to regular visits by a public health nurse and, if required, occupational therapy.

    Private Health Insurance is widely used in Ireland. About half of the Irish population is covered by private health insurance. The main benefits of private health insurance are semi-private and private hospital accommodation in-hospital consultant services additional cover including overseas, psychiatric, out-patient and expanded maternity benefits. At least one offers tiered services such as GP care or hospital only care. There has beenn abut a 5% drop in privately insured persons due attributed to a 40 per cent increase in the Government levy on private health insurance. Private healthcare costs are a leading contributor to the rise in the Irish CPI over the last year.

    Given my experiences in the US, the same things have happened here: patients die in waiting room, patients die inside the ED, and sometimes people die whether we are looking at them or not. Ireland, like Israel, provides a core policy which the majority of the population supplements with private insurance. Sorry but I fail to see how the state of care in Ireland is related to the future of care here in the US.

  2. ana says:

    “Irish patient dies of heart attack while waiting in a “dangerously overcrowded and understaffed” emergency department. Consultants warn that “The risk of our next untimely death remains high while the emergency department overcrowding continues.”
    And this is the type of system that we want in the United States?”

    Because patients dying of cancer or of simple diseases because they dn’t have insurance and can’t afford it is so much better.

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