Nice article on how University of Michigan is decreasing medical malpractice expenses by disclosing errors and compensating patients before lawsuits are filed. Open claims have declined to 63 from 262. Lawsuits have declined to 0.75 per 100,000 patients per month from 2.13. Claim resolution time also has declined to 0.95 years from 1.36, costs to defend lawsuits have dropped to less than $1 million per year in 2009 from $2.2 million in 2001, and the amount needed for reserves has fallen to less than $16 million in 2009 from $72 million in 2001.
They seem to be on to something.
Nice article in the Atlantic about the decline of emergency care. Emergency department visits have increased by 44% while emergency departments have closed at a rate of 11%. In addition, 339 trauma centers have closed. A 10% increase in the number of African Americans treated correlated with a 41% increased risk of the emergency department closing.
Wisconsin hospital offers machine that dispenses prescription medications. Bad news is that patients need a credit or debit card to pay for the medications … no cash allowed. In addition, you have to visit the hospital’s own ED or acute care clinic – no other prescriptions work in the machine.
Interesting social experiment in New Zealand proves the obvious. Patients don’t use the the emergency department because they can’t afford to see a primary care physician – they use the emergency department because it is convenient. Patients were eligible to receive vouchers to obtain free appointments with primary care physicians for non-urgent complaints. Not one voucher has been handed out this year.
There was a wide belief that people used the emergency department because it was free, but the “clinical head” of the ED stated “that’s probably not as strong as a driver as you might think.”
Bullhokey. Institute a $20 co-pay for each emergency department visit and see how quickly ED patient volumes decrease.
More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com.
Annals study shows clinical signs that necessitate admission in patients with ALTE (when newborns appear to stop breathing): “obvious need for hospitalization (they used persistent hypoxia as one example of this), significant medical history, and more than one ALTE in 24 hours.
You know all of those hospitals that advertise their emergency department wait times? Now those ads may end up biting hospitals in the rear. Nevada patient chooses hospital based upon advertised average wait time of 17 minutes, then waits five and a half hours before getting treatment. Newspapers publish statements suggesting that the signs may be “false advertising.”
Will consumer fraud cases against hospitals based on these advertisements be too far behind.
Hospitals finding that they can cut costs by catering to emergency department “superusers”. For example, homeless patient Dennis Manners was treated in the emergency department 337 times in less than two years, amassing charges of more than $626,000. The hospital found him an apartment, assigned him a primary care doctor, and enrolled him in a drug treatment program.
I think that what the hospitals are doing is great, but why should this financial burden fall on the backs of private enterprises when government should be providing the services for its citizens?
More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com.
Diagnostic errors account for most paid claims in medical malpractice cases. Errors in diagnosis were the most common type of claim and also amounted to the highest proportion of total payments. The total inflation-adjusted amount of diagnosis-related payouts was $38.8 billion over 25 years.
Remember, these statistics represent just the payouts. On average, two of three medical malpractice lawsuits end in no payment to the plaintiff.
And we still wonder why doctors do so many “unnecessary” diagnostic tests?
Another missing bamblance. This one was from University of Alabama Birmingham ED ramp. The ambulance company executive said that it “wasn’t clear how or why someone took the vehicle.”
How – The driver obviously left the keys in it.
I agree with him on the “why” part.
Ex-boyfriend kidnaps patient from hospital room. Waited until she was called back to the treatment area from the waiting room, then stuck a gun in her ribs and made her leave.
I can’t make this stuff up.
Another application of federal EMTALA law. Everyone coming to the emergency department must be evaluated and treated – even if they just bombed the Boston Marathon.
Cases like this come up every once in a while and it is very difficult for the emergency department staff to set aside their feelings. Another story on the topic here
Surgical complications good for a hospital’s bottom line. With insured patients, hospitals made an extra $39,000 per patient who had post-surgical complications. Medicare patients with post surgical complications earned the hospital about $1750 more. Hospitals lost money on Medicaid and private pay patients with post-op complications.
Don’t believe people who try to draw the conclusion that “errors” and “complications” are the same thing – they aren’t.
Another article about Australian medical care. Patient goes to hospital complaining of the “worst headache of his life.” In many cases, that translates into doctor speak for “order a head CT scan to rule out bleeding”. The patient had a head CT nine days before going to the emergency department which showed the presence of an aneurysm. He was discharged from the emergency department and died the next day.
More arrests for oxycodone prescriptions. In this case, a physician wrote prescriptions for more than 500,000 pills over 2 years. The prescriptions were filled in New Jersey – even though they were written in New York. Other allegations surfaced as well.
The investigation was sparked by an overdose death where a prescription bottle bearing the doctor’s name was found at the scene.
“Sounds good my man, seeya soon, ill tw …” The University of Northern Colorado student sending this text message never got to finish it. He was driving while texting, drifted into oncoming traffic, jerked the steering wheel, and rolled his car. He died from the resulting injuries.
His parents published pictures of his phone with the message hoping that they can keep others from texting and driving. I hope that every parent prints this article and discusses it with their children.
What a great story. Six year old Long Island kid treated in emergency department raises $275 with a fundraiser and uses the money to buy coloring books for other emergency department children.
More than 25% of Oklahoma patients enrolled in Medicaid. Of those, about a quarter used the emergency department a total of 528,000 times at a cost of $170 million. Oklahoma is now trying to determine how to deal with the high utilizers – those who use the ED more than 15 times every 3 months.
Speaking about Oklahoma … Oklahoma Dentistry Board officials are deciding whether to pursue criminal charges against a dentist. Officials found rusty instruments, “potentially contaminated drug vials” and “improper use of a machine designed to sterilize tools” in the dentist’s office.
The Oklahoma Dentistry Board accused the dentist of re-inserting needles in drug vials after their initial use and using the same drug vials on multiple patients. This happens often in medicine. The dentistry board also stated that a sterilization machine hadn’t undergone monthly testing in six years. Concerning, but when the Board officials tested the machine was it not properly sterilizing equipment? They did test the machine, right? Were the rusty instruments used on patients? Where was the rust located – on the handles or on the surfaces that come into contact with patients?
In addition, the dentist allegedly allowed dental assistants to administer IV sedation when only dentists are allowed to perform such acts.
For each charge, the dentist could face up to four years in prison and a $10,000 fine.
Are the alleged actions above worth throwing someone in jail for 8 years over?
This case report is entirely bizarre. Patient gets awarded more than $800,000 after visit to doctor resulted in incorrect diagnosis of cancer when the patient really had pneumonia and caused patient to have amputation of her foot. A trial was held on the case four years ago with a verdict in favor of the doctor, but the judge declared a mistrial because Washington State jurors were referring to the plaintiff’s Japanese attorney as “Mr. Miyagi” and were making other racist comments against him.
Then, the article notes that the doctor had been disciplined by state regulators for making “erroneous diagnoses” and for prescribing methadone to drug-addicted patients. So now Washington State physicians’ licenses can be on the line for failing to perfectly diagnose patient symptoms and for prescribing medication for one of its intended uses.
I admit we don’t have all the information behind the license actions, but the article makes the Washington State Medical Board sound a little overeager to discipline physicians.
Australian patient held four days in emergency department waiting for psychiatric bed to open up. Shortage of beds creates high demand. Patient’s mother alleges that his condition worsened because of the long wait.
Not that anything like this could happen in the US. Oh wait. What a coincidence. LSU is closing their mental health emergency department, resulting in other hospital emergency departments having to care for “an additional 2,000 people who are a danger to themselves or others, who are desperately in need of stabilization and potential further hospitalization.”
When medical services are curtailed, the patients needing those services don’t just disappear.
Another medical issue with overweight patients: Intramuscular injections. An Epi-Pen may not work in patients who are obese since the distance through the subcutaneous fat to the muscle is greater than the length of the needle. This study showed that in more than 4 of 5 obese children, the subcutaneous fat layer was too thick for an IM injection one quarter of the way down the thigh. In nearly 1 of 5 obese children, the subcutaneous fat layer was too thick three quarters of the way down the thigh. In those patients, the study suggested injecting the calf.
I suppose the manufacturer could be forced to make autoinjectors with longer needles, but then non-obese patients would theoretically risk getting a bone marrow injection of epinephrine.
How good are emergency physicians at dispositioning psychiatric patients when compared to psychiatrists? Not horrible, not great.
95% of patients assessed as “definitely admit” were admitted by the psychiatrist. For other emergency department psychiatric patients, there was an 87-90% concordance rate.
Another nice article by Alicia Gallegos at AM News. Liability involving patients who overdose on medications is increasing. Families of suicidal patients who overdose on medications are blaming physicians who prescribe the medications … and winning.
According to the article, physicians are having also disciplinary actions taken against them if they prescribe medications to a “doctor shopper”.
This is getting ridiculous.
When pain patients complain that they are treated like “drug seekers,” this is part of the problem why.
Maybe the next step should be forcing all patients to sign a statement requiring them to list any doctors that have prescribed them medications, any medication that they have at home or have access to at home, and any medications or street drugs they are using or have used in the past 12 months. (more…)
The Veteran’s Administration intentionally changed and hid data to avoid providing costly yet critical medical care to soldiers from the Gulf War? A head VA epidemiologist alleges that more than two thousand veterans responding to a study felt like they would be “better off dead”. In 95% of those cases, the VA did nothing to assist those veterans with follow up care. In a subsequent study when the same epidemiologist attempted to ensure follow up care for potentially suicidal veterans, he allegedly had disciplinary actions instituted against him. If that’s true, I wonder how everyone else will be treated once they have medical insurance under the UnAffordable Care Act.
American College of Obstetricians and Gynecologists advises against using the da Vinci robots for hysterectomies. Robotic surgery adds about $2000 to the cost of surgery and “there is no good data proving that robotic hysterectomy is even as good as, let alone better than, existing and far less costly minimally invasive alternatives.”
I hope that other specialty societies have the integrity to make similar inquiries.
All those hospitals that spent millions of dollars on these machines to keep up with the Joneses may just be in for a big surprise.
You know all those things your hospital does to stop the spread of clostridium difficile infections? Yeah. They don’t work (.pdf file). 42% of hospitals implementing such policies noted decrease in c. difficile rates while 43% of facilities noted an increase in c.difficile rates.
Can’t wait to see the spin that the Joint Commission puts on this one.
More warnings about superbugs. MRSA is bad enough, but what happens when the organisms living in all of our intestines become resistant to antibiotics?
Patients gone wild returns. Minnesota goof screams profanities and disrupts medical care. Tied down in four point restraints until police arrive. Will likely be charged with disorderly conduct. Wow. If every patient that did this kind of thing was charged with disorderly conduct and whisked off to jail, our ED volumes would drop by a good percentage.
We’re watching you …California wants $10 million in funding to create a prescription-tracking database so that it can find doctors who overprescribe narcotics. Once the system was up and running, doctors and pharmacists would be REQUIRED to check it to look for signs of narcotic abuse. Of course, the definition of “signs of narcotic” abuse is purposely not included. That way the state could just attack at will any physicians who prescribe any narcotics. The database would be paid, in part, by raising physician licensing fees.
Interesting statistic. Top 25% of Medicare beneficiaries account for 85% of total Medicare spending. Prime targets for “death panels,” huh?
Seriously, though the article has several good points about how to improve the medical system, even though it is written by someone with no apparent experience in the medical system.
One point in which I disagree with the author is that “guidelines” should be used both as a shield and as a sword. We all saw what happened when NY Times reporter Jim Dwyermisused guidelines. In general, guidelines are situation specific and failure to follow them to the letter shouldn’t be considered malpractice.
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.
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).
