April 12th, 2007 by Dr. Val Jones in True Stories
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I worked in a hospital that was so old that the bathroom doors in the patient rooms were not wide enough to accommodate a walker or certain kinds of wheelchairs. The hospital had resisted any upgrades, because the building codes stipulated that if any improvement was made, all of the necessary upgrades were required. The cost to fully comply with the new codes was enormous, and so in some twist of bureaucratic irony – nothing changed for decades upon decades.
One morning I entered one of my patient’s rooms to check on her. There she was, 4’11”, 85 years old, with a white bob and a thin frame, wearing nothing but a hospital gown tied only at the neck. She smiled brightly as she caught my eye. She was clutching her walker, attempting to exit her bathroom straight on. I watched her as she slowly inched towards the narrow door, bumped into it and then backed up to try again. She made several valiant efforts to get out of the bathroom, holding onto her walker for stability. (Though none of the attempts involved turning the walker sideways to fit through the door.) Trapped and befuddled she smiled at me good naturedly and concluded, “I think this hospital gown is too heavy.”
When I remember this patient, I imagine how so many people are trapped in the healthcare system that is old and poorly designed. They want to get through barriers to care, have inadequate resources, and a limited understanding of what’s actually blocking them from the help they need. If you feel that “your gown is too heavy,” I hope that Revolution Health can make things better for you… we want to empower you to understand the problem and get the help you need. Let us know how we can help!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 12th, 2007 by Dr. Val Jones in News
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I was reading a news story about how medical fraud is becoming more frequent in Australia. They attribute this to the recent transition to electronic record keeping, which makes it easier to file fraudulent claims. Although these tactics are old news in the US, I think it’s worth a little summary (from the article) here – stay on the lookout for overcharges and fraud! The best way to protect yourself is to review your bills with vigilance. It’s sad that it has come to this…
Fraudulent tactics
Supply companies:
* Upcoding of items and services where, for example, a medical supplier may deliver to the patient a manually propelled wheelchair but bill the patient’s health fund for a more expensive, motorized wheelchair, or where a routine follow-up doctor’s office visit might be billed as an initial or comprehensive visit.
* Billing for medical services or items that are in excess of the patient’s actual needs. These might include a medical supply company delivering and billing for 30 wound care kits per week for a nursing home patient who only requires one change of dressings per day, or conducting daily medical office visits when monthly office visits are adequate.
Providers:
* Duplicate claims, where a certain item or service is claimed twice. In this scheme, an exact copy of the claim need not be filed a second time. Rather, the provider usually changes part of the claim so the health insurer does not realize it is a duplicate.
* Unbundling, where bills are submitted in a fragmented fashion so as to maximize reimbursement for tests or procedures that are required to be billed together at a reduced cost.
* Kickbacks, when a healthcare provider or other person engages in an illegal kickback for the referral of a patient for healthcare services that may be paid for by Medicare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 10th, 2007 by Dr. Val Jones in Humor
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I’m doing my best to prepare my weekly round up of the best of Revolution’s expert blogs… but it’s taking a little longer than usual, so here’s a funny little excerpt from a Dave Barry calendar to tide you over…
In the 1950s, medical paperwork was simple: The doctor gave you a bill. That was it. Whereas today, if you get involved with the medical care system in any way, you will spend the rest of your life wading through baffling statements from insurance companies. I speak with authority here. At some point in the past, some member of my family apparently received medical care, and now every day, rain or shine, my employer’s insurance company sends me at least one letter, comically titled, EXPLANATION OF BENEFITS. It’s covered with numbers indicating my in-network, out-of-pocket deductible; my out-of-network, nondeductible pocketable; my semi-pocketed, nonworkable, indestructible Donald Duckable, and so on. What am I supposed to DO with this information?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 9th, 2007 by Dr. Val Jones in News
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In a recent study published in the British Medical Journal, researchers found that blood tests and a history of patient symptoms might be all that’s needed to diagnose the majority of individuals with celiac disease. Until now, a diagnosis required a biopsy of the intestinal wall.
It is estimated that celiac disease (caused by an autoimmune reaction to wheat gluten) remains undiagnosed in a whopping 85% of cases. This may be due to the fact that symptoms are often non-specific (diarrhea and constipation, fatigue, anemia, tooth enamel defects, weight loss, and dry skin are some of the symptoms).
The researchers report:
We devised and evaluated a clinical decision tool that used a combination of pre-endoscopy serological testing (for tissue transglutaminase antibodies) and assessment of symptoms to identify patients with coeliac disease. This decision tool might help increase the detection of coeliac disease in patients attending for gastroscopy without the need to perform routine duodenal biopsy.
As efforts are underway to increase awareness in the primary care community about the disease, it is good to know that diagnosis may no longer require an invasive test!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 8th, 2007 by Dr. Val Jones in News, Quackery Exposed
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The number one Google news item today is a report of a mouse study (published in Nature Medicine, but apparently still embargoed to the public as it is not listed on their website) that suggested that an herbal supplement could (in combination with antibiotics) “eradicate” urinary tract infections.
In usual fashion, the buzz preceded the science, and now we have thousands of people on the lookout for forskolin (a root extract of coleus) tablets from the local health food store. Do these have any possible merit?
A recent review of the literature about this herb was conducted by the good docs at Harvard, and turned up “no conclusive evidence for its [forskolin’s] use for any health condition.”
My friend Dr. Charles also read the reports of this “miraculous” new cure – which posits that recurrent urinary tract infections are caused by pockets of bacteria that hide inside bladder walls. Dr. Charles rightly points out that there are many different points of entry for bacteria, and that an herb which (and we don’t know that it even does this) relaxes bladder walls would surely not affect the alternate routes of entry, hence it cannot be curative in all cases.
So my friends, I’m sorry to say that there is little justification for enthusiasm yet. But we will follow the research with interest, in case human subjects do indeed show benefit in the future.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
