WhiteCoat

Healthcare Update Satellite — 08-28-2014

Good news is that the number of medical malpractice cases in Pennsylvania is decreasing. Bad news is that if you practice medicine in the Philadelphia area, you’ve got a big target painted on your back. Philadelphia accounts for only 12 percent of the state’s population yet in 2013, 40 percent of medical malpractice trials resulting in verdicts took place in the city. Philadelphia medical malpractice plaintiffs won 45% of trials, more than any other jurisdiction and significantly higher rate than the national average.
Looks like we’ve found another place to avoid when looking for your next place to practice medicine.

Regulating a longstanding practice out of existence. Remember going to your doctor’s office and seeing those walls full of pictures of babies that the doctor delivered? Yeah, that’s illegal. Violates HIPAA.

Travelers from Liberia still being transferred via commercial flights to Delhi and Mumbai. A few with fevers were quarantined … after they arrived … while the others were required to be tracked daily by local authorities for the following month.
Meanwhile, most major airlines are suspending service to the “crisis zones.”

With the ebola hysteria comes hysterical actions. Woman on a Delta Airlines flight in Florida was kicked off the airplane because she “looked tired and drowsy.” Staff stated that if she did not get off the flight, they would call the authorities. Delta gave her a $20 voucher for tea and soup, then let her on the next flight. Because tea, soup, and an hour wait in the lovely airport atmosphere are more than enough to kill any potential communicable diseases that cause people to look tired and drowsy.

Study in Journal for Healthcare Quality shows that diagnostic errors double the odds of malpractice payout totaling $1 million or more. There were 6,130 such “catastrophic payouts” between 2004 and 2010 and those payments amounted to .05% of the total health care expenditures each year. Years of practice and number of prior paid claims had no bearing on the odds of a catastrophic payout.
However, failure to order diagnostic testing absolutely contributes to diagnostic errors. Kind of flies in the face of the whole “lets cut back on testing” mantra, doesn’t it?

Obamacare mandates having an effect even on Major League Baseball. Cubs grounds crew hours cut to keep them under 130 hours per month so that they don’t meet “full time worker” criteria and get insurance coverage under Obamacare. During rain delay at a recent Cubs game, the understaffed grounds crew wasn’t able to get the tarp properly positioned on the infield – leading the umpires to call the game off due to poor infield conditions.

Neat idea in Singapore to curb non-urgent emergency department care. Hospital and local primary care physicians teamed together to create a “GP First” scheme. If a patient goes to their primary care physician for a problem and then has to be referred to the emergency department, they get $50 off of the $108 emergency department bill. So far, the hospital has seen a decrease in non-urgent cases by 10-12%. The resulting decrease in patient volume also caused about a 20% decrease in emergency department wait times.
Now why wouldn’t such a plan work in the US?

Flying drone delays medical helicopter’s landing at Ohio’s Miami Valley Hospital. What are we going to ban after this incident?
Once we had a guy taking pictures/video with his phone who wouldn’t get away from the helipad in the hospital parking lot while the chopper was landing. Security literally had to tackle him and drag him away.

Louisiana pays extra $18 million to keep Baton Rouge General’s emergency department open. The hospital emergency department is seeing an additional 400 uninsured patients per month with numbers of uninsured psychiatric visits up 60% and number of uninsured surgery patients up 70%. After Louisiana State closed its Earl K Long Medical center in an attempt to privatize charity hospital care, the patients had to find other care. Now Baton Rouge General is losing $1 million per month. Another story on the topic here.
I’ve been saying this for years. When hospitals close, the patients going to those hospitals don’t just disappear. They seek care elsewhere. The costs of providing uncompensated and poorly compensated (Medicaid and “Obamacare”) care at the remaining open hospitals then compounds on itself until the next hospital closes under the weight uncompensated care. Every hospital that closes causes a decrease in access and decrease in available medical care.
Wait. Wasn’t that what the “Affordable” CARE Act was created to solve?
Louisiana better write at least double that $18 million into its yearly budget. It’s trying to cure a hemorrhage by using a Bandaid and we all know how well that will work out.

Another hospital shooting near Philadelphia. Man pulls gun in hospital room then kills wife and shoots himself. Fourth hospital shooting in the Philadelphia area this year. Wait. Isn’t this the same place that has such the high rate of successful malpractice cases? Another reason to consider whether you really want to practice medicine in the Philadelphia area.

Joan Rivers goes into cardiac arrest during throat surgery and is brought to the Mt. Siani emergency department. Reportedly stable. Good job, team!
I can’t wait to hear all of the jokes about this incident.

12 Responses to “Healthcare Update Satellite — 08-28-2014”

  1. Nicole says:

    With regard to the Singapore idea, I would suggest that this won’t work here because many of the people who use the ED for non-emergent issues aren’t paying out of pocket for anything.

  2. ErDoc1 says:

    “…an attempt to privatize charity hospital care…”

    Wow – that phrase certainly puts the moron in oxymoron!

  3. ErDoc1 says:

    “Philadelphia accounts for only 12 percent of the state’s population yet in 2013, 40 percent of medical malpractice trials resulting in verdicts took place in the city. Philadelphia medical malpractice plaintiffs won 45% of trials, more than any other jurisdiction and significantly higher rate than the national average.”

    The ONLY possible explanation for this is that Philadelphia attracts negligent doctors, right?

    • matt says:

      Probably not. The question is probably how many patients are seen in Philadelphia v. the rest of the state. Lies, damn lies, and statistics and all.

      Of course, none of this really tells us whether the quality of care has improved, but if you’re an insurer I’m sure these are interesting numbers.

  4. ErDoc1 says:

    If the guy killed his wife (patient) and himself (next of kin), who will sue the hospital? Somebody HAS to sue, right? Surely those nearby suffered hearing damage or emotional trauma from the gunshots. Maybe a class action suit?

  5. Ted says:

    Blaming Louisiana’s health care woes on Obamacare isn’t very good journalism. Bobby Jindal (Louisiana’s governor) is as anti-Obamacare as they come, and has gone to pretty great lengths to keep Obamacare out of Louisiana. http://www.huffingtonpost.com/2013/11/08/bobby-jindal-obama_n_4242584.html

    • Ted, Instead of having to shore up a failing emergency care system with limited state budget dollars, Louisiana, with 287,000 uninsured, could have expanded Medicaid – per Obamacare, which would bring $15.8 Billion into the state and $8 Billion in to hospitals in Louisiana over 10 years (in federal tax dollars), save the state lots of money even after covering the costs to increase the Medicaid rolls, AND improve the state’s budget situation, AND create thousands of jobs. It really is a ‘no brainer’, which may explain Jindal’s decision.
      http://www.urban.org/publications/413192.html

  6. Howard Rubinstein says:

    It’s a real shame that you make light of a victim of cardiac arrest, whether it be Joan Rivers or a non-celebrity. A very poor example of the compassionate emergency physician.

    • WhiteCoat says:

      Telling the team that cared for Joan Rivers that they did a good job and then saying that I can’t wait to hear the jokes about the incident = “making light” of a victim of cardiac arrest? Riiiiight.
      What’s next? You going to complain to the keeper of the Internets that I’m “rude” and give me a bad reader satisfaction score?

  7. RE: “If a patient goes to their primary care physician for a problem and then has to be referred to the emergency department, they get $50 off of the $108 emergency department bill. Now why wouldn’t such a plan work in the US?”

    Because one person with chest pressure wanting to save $50 would make an appt to see their primary care physician, and if they were lucky enough to get a same day appointment, they would delay their door to open coronary artery time by 3 hours, resulting in chronic CHF, and the cost for caring for this patient for the next two years would exceed the savings associated with 5000 people who might, in retrospect, not have needed to go to the ED.
    Or, they might get a next day appointment with their PCP and drop dead before they every got to the ED.
    Not that it might actually save the health plan some money.

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