Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

More germs found on desk tops than toilet seats

Microbiologist Charles Gerba has made a career out of scaring people with news of how dirty seemingly innocent surfaces can be.  Dr. Gerba has taken media on germ tours of kitchens, bathrooms, and offices, and now in his new research study he finds that office desks have 400x more bacterial colonies than toilet seats.  Moreover, he found that women’s desks generally have 4x more bacteria than men’s.  He attributes this to women having more makeup and food products in their desks, as well as having greater contact with small children.

Well, before we all become totally grossed out and paranoid, lets think for a minute about this.  If there are so many bacteria all around us (even on our desks) and we’re generally not sick, then I guess we shouldn’t all rush out to buy bleach and sanitizers.  Other studies suggest that sanitizers disrupt the natural ecosystem around us, creating resistant organisms that are harder to kill.

Personally, I think that precautions should be taken to reduce transmission of viruses and bacterial infections (especially in the hospital environment) but that it is unreasonable, and perhaps even harmful, to wage an indescriminate war on all bacteria everywhere.

If your loved ones are sick, minimize your exposure to their droplets, wash your hands frequently, and sanitize surfaces that they are in direct contact with.  Otherwise, if you’re feeling well, I wouldn’t worry too much about bleaching your desk surface.

As one microbiology lab says,

“Support bacteria.  It’s the only culture some people have.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Subway workers hand out condoms in NYC

A new initiative funded by the health department resulted in the distribution of 150,000 free condoms to unsuspecting subway riders in NYC. The condoms were colorfully labeled with a subway themed wrapper, and handed out by city workers and volunteers in all 5 boroughs.

Condoms are critical for the prevention of sexually transmitted diseases, but I wonder if the candy wrapper marketing and non-selective distribution methods are contributing to an over-sexualization of society?

Now, I know a lot of you will think I’m being prudish, but I worry about children being over-exposed to sexual content all the time.  What does it say to them that subway staff are handing them condoms?  Is it just me, or does anyone else think this is a bit much?

Go ahead, let me know!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Why I worry about a government-sponsored universal coverage system

Within the past few years the Centers for Medicare and Medicaid Services (CMS) chose to enforce a rule (casually known as the “75% rule”) that resulted in denial of services to many heart, lung, and cancer patients requiring rehabilitation therapies.

CMS was looking for a way to cut costs in rehabilitation facilities, and decided to create a rule whereby these facilities would lose their approval status if they admitted too many patients with certain conditions. The CMS arbitrarily decided that 75% of all patients admitted to inpatient rehabilitation facilities had to have one of 13 diagnoses, or else the rehab facility would not qualify for Medicare reimbursement. Many important diagnoses were not included in those 13, including cancer, heart and lung disease, and many types of orthopedic injuries.

What does this mean? It means that getting admitted to a rehabilitation facility is no longer based on need, but on diagnosis code. Because of the financial pressure exerted by CMS (Medicare is the primary payer for most facilities) these rehab centers cannot afford to be delisted. So they turn away patients in need, for patients who have the “right” diagnosis.

What has this rule done?

  1. Limited clinical decision making by doctors – a physician is no longer able to recommend patients for acute inpatient rehabilitation purely based on their need for it.
  2. Decreased choice for consumers – people recovering from heart attacks, cancer or COPD (to name a few) will generally not be offered the opportunity to be rehabilitated in an acute, inpatient setting.
  3. Reduced quality of care – rehabilitation facilities specializing in oncology or cardiopulmonary rehab will need to divest themselves of aggregated expertise. Since these centers would no longer qualify for Medicare funding, they can’t afford to remain centers of excellence in these fields of medicine. Instead, they will need to turn their attention to the 13 diagnoses that qualify for inpatient rehabilitation.
  4. Puts lives in danger – patients who are not admitted to acute rehab will be forced to recover in nursing homes (also known as “sub acute facilities”) that do not have the level of expertise to take care of them safely.

The 75% rule is one example of the kinds of decisions that a government sponsored universal healthcare system will make. When one payer (government or non-government) develops a monopoly, their decisions can single-handedly limit consumer choice, prevent physicians from exercising clinical judgment, and decrease quality and safety of care. What will Americans say when the decision to fund organ transplants for people over 65, for example, is denied across the board?

When medicine is no longer applied in a personalized (case by case) manner, and population-wide rules are in effect, we will face ethical dilemmas far surpassing those we already have. A system that serves the needs of many still fails the needs of some – and when we lose the flexibility to “bend the rules” for the exceptions we will lose the best of what American medicine has to offer.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Health insurance frustrations & awkward physician-patient interactions

This excerpt from the New Yorker (quoting a Dr. Parillo) captures physician frustration with the process of insurance reimbursements:

Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of their practice. “A patient calls to schedule an appointment, and right there things can fall apart,” she said. If patients don’t have insurance, you have to see if they qualify for a state assistance program like Medicaid. If they do have insurance, you have to find out whether the insurer lists you as a valid physician. You have to make sure the insurer covers the service the patient is seeing you for and find out the stipulations that are made on that service. You have to make sure the patient has the appropriate referral number from his primary-care physician. You also have to find out if the patient has any outstanding deductibles or a co-payment to make, because patients are supposed to bring the money when they see you. “Patients find this extremely upsetting,” Parillo said. “ ‘I have insurance! Why do I have to pay for anything! I didn’t bring any money!’ Suddenly, you have to be a financial counselor. At the same time, you feel terrible telling them not to come in unless they bring cash, check, or credit card. So you see them anyway, and now you’re going to lose twenty per cent, which is more than your margin, right off the bat.”

Simplifying the process of insurance billing (and promoting more affordable plans) are important goals in healthcare. I hope that Revolution’s efforts will make things easier for physicians and patients alike. Otherwise we wind up in the unacceptable situation described in this article:

“If it’s not an emergency and you can’t pay for it, you don’t get care.”

Do you think that retail clinics will make basic healthcare more affordable and accessible to patients who are uninsured or underinsured?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

US healthcare then and now: 1907-2007

We have met the enemy and he is us.

  • Walt Kelly

From an article published in JAMA on February 16, 1907:

It is strange that the hospitals and dispensaries of this country should be so shamelessly flooded with pseudo-charity patients, having no claim whatsoever to gratuitous service. It can be explained only on two hypotheses: First, the working of that innate trait of human nature which prompts to obtain something for nothing, and, second, the lack of good business discrimination on the part of the institutions whose benefits are thus abused.

This quote is almost 100 years old to the day. Does anyone see any similarities to today’s emergency department or medical practice?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »