March 24th, 2007 by Dr. Val Jones in News
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In my last blog post I was describing how adversity can be used for good, and as I was reading the medical news this morning I found another great example. While gardening, a British man was bitten on the neck by a spider. Now, the report doesn’t say exactly what type of spider this was, but judging from the outcome it was probably not a black widow or brown recluse. I’m assuming that the insect was some sort of common garden spider, though it must have had “fangs.” (Imagine my sister recoiling in horror here.)
As it turned out, the spider bit the man right next to a growth on his neck that he hadn’t noticed before. When he went to the doctor’s office to have the bite inspected, they found the growth and decided to biopsy it. The growth was cancerous, and the medical team was able to remove it before it had spread anywhere.
The little spider inadvertently saved a man from cancer. As he weaves his web, nestled between the coarse, hairy leaves of turnip plants, this tiny creature may never understand his contribution to humanity. Small actions can have a positive ripple effect, and a seemingly bad experience can save a life.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 17th, 2007 by Dr. Val Jones in Health Policy, Opinion
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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?
- 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.
- 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.
- 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.
- 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.
February 14th, 2007 by Dr. Val Jones in Opinion
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One of my readers recently asked for some examples of how price transparency might improve his lot. A great question! The people who stand to benefit the most from price transparency are the uninsured and those with high deductible health savings accounts. Price transparency is globally valuable because it allows people to understand the true cost of healthcare, making them more informed consumers. It also promotes accountability of hospitals, healthcare providers, and insurance companies.
Naughty Hospitals
Arbitrary fees:
“The cost for a total hip replacement in the greater Seattle area varied between $13,996 at one local hospital and $46,758 at another. Furthermore, there wasn’t necessarily any correlation between the cost of the procedure and the hospital’s quality or experience doing it. …Why would anyone pay a higher price for lower quality and potentially more complications, especially when it concerns your health?”
Where does a non-profit put its profits? Dr. Feld knows where:
“We are unable to know the hospital’s actual overhead. If we did, we could to find out what the hospital’s actual costs are. We could then calculate the hospital’s profit. These numbers are totally opaque.
Most hospitals are non profit hospitals. They can not post a profit at the end of the year. Therefore, they have to pour the extra money into something. Executive salaries and capital expenditures are a prime avenue for getting rid of their profit. A key question is how is the hospital’s overhead calculated? Maybe reducing costs to the consumer would be a good idea?”
“Predatory hospital billing:”
Over the past year, aggressive billing practices have been exposed at a number of hospitals in the United States. Despite the fact that a widower had paid $16,000 of his late wife’s bill of $18,740, some 20 years after the incurrence of the bill a teaching hospital held a lien on his home for $40,000 in interest. Many years earlier the hospital had seized his bank account, and now the 77-year-old man was destitute. Only tremendous publicity caused the hospital to back down. In California, a patient was forced into bankruptcy in 2000 by a for-profit hospital from a day-and-a-half stay in the hospital that did not include any surgery but totaled $48,000 in hospital bills. These have become common stories as hospitals aggressively market, bill, collect, and foreclose, just like any other corporation. The uninsured are facing the brunt of the hospital industry’s billing practices.
Naughty Outpatient Facilities
“Mr. Smith needs to get an MRI. He has a high deductible HSA, with a $2000 deductible, much of which he has not yet spent. So he will likely have to pay for 100% of this service himself. Without access to cost information by facility, he would simply go to a convenient, local facility and might pay up to $1300 for this single test. If he had access to health care cost information on the web, he could look up the cost of his service across different facilities and choose to go to the one that only charges $450 – a very meaningful difference for Mr. Smith.”
“More than 3 million people have already signed up for HSAs, and 29 million are projected to do so by 2010. Forty percent of the people who bought HSAs have family incomes below $50,000. More than a third of those who bought HSAs on their own had previously been uninsured.”
Naughty Doctors
What happens when 2 procedures have been shown (through careful research) to have equal efficacy, but one is reimbursed at a much higher rate? Docs will choose to perform the more expensive one, of course.
“Prostate cancer patients’ biggest concerns — after cure — are the possible side effects of surgery, including urinary incontinence and sexual impotency. Data on these side effects from robotically assisted prostatectomy were sketchy at best, and no evidence was available to indicate that any surgical method emerged as better than another for these side effects… Open radical prostatectomy costs $487 less a case than non-robotic laparoscopy and $1,726 less than robot-assisted prostatectomy.”
Naughty Insurance Companies
Insurance companies don’t want to make their pricing public because they don’t want their competition to know how much (or how little) they’re compensating physicians. Therefore, consumers are prevented from seeing costs as well – which can hinder their ability to make informed decisions about their care.
I bet others can think of some excellent reasons why price transparency is beneficial to consumers. Care to contribute?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 24th, 2007 by Dr. Val Jones in Announcements, Opinion
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On New Year’s Eve when many people are drinking champagne and worrying about who they should kiss at midnight, Dr. Brian Fennerty, Section Chief of Gastroenterology at Oregon Health & Science University is fighting to keep patients alive in the Intensive Care Unit. Severe internal bleeding has put these patients’ lives in jeopardy, and Dr. Fennerty stays with them all night, ordering blood transfusions and tamponading their bleeding.
Dr. Jack Cook, US Navy veteran and former submarine commander, is under a mountain of medical charts. At 67, he is spearheading the transition from paper records to an electronic medical records system for his group practice of primary care physicians in Virginia. He wants his patients to have the opportunity to experience chart portability – something he believes might save their lives in cases where they are brought to the ER in an unconscious state. Although this project will take his group 2 years to complete, and cost untold hours in lost wages (with no clear reimbursal benefit for his practice) he is making the investment for his patients’ sakes.
In the middle of a teleconference, Dr. Iffath Hoskins, Chair of Ob/Gyn at Lutheran Medical Center in Brooklyn, excuses herself to perform an emergency C-section on a young woman with a complicated pregnancy. Against all odds she saves both mother and baby, and reschedules the teleconference for late that evening so she can complete her interview on time for a feature article at Revolution Health.
Just returning from Africa, Dr. Leo Lagasse, Vice Chairman of Ob/Gyn at Cedars-Sinai Medical Center, is preparing for his next mission’s trip with medical residents and faculty. His non-profit organization, Medicine for Humanity, has been behind countless trips to Afghanistan, Kenya, and Eritrya – serving impoverished women with medical problems. Dr. Lagasse takes time out to explain to me the link between smoking and cervical cancer for an article I’m preparing.
Dr. Charlie Smith is spending the afternoon with his son Jordan in Arkansas. Jordan was accidentally shot in the chest by a child with a BB gun, tearing a hole in his heart that caused him to go into cardiac arrest. He was rushed to the hospital where surgeons resorted to cardiac massage to keep him alive – he survived the ordeal, but his brain never fully recovered from the temporary lack of oxygen. He was rendered permanently bed-bound, and raised at home by his loving parents. Dr. Smith created a company called eDocAmerica to allow him to work from home and spend more time with Jordan. eDocAmerica is devoted to answering consumer medical questions via email.
At Harlem Hospital, Dr. Olajide Williams works tirelessly to raise awareness of stroke symptoms in a high risk inner city population. He organizes outreach through musical youth initiatives, lectures nationally to narrow the racial gap in quality care, and declines all prestigious medical recruitment offers. He is steadfast in his devotion to his community – no matter what the cost. Dr. Williams spends part of his weekends preparing blog entries for Revolution Health.
These are only a handful of the wonderful physicians associated with Revolution Health. I hope you’ll enjoy getting to know them through their blogs, articles, and future contributions. They are here for you… to support your need for credible information, to answer your questions, and to help guide you towards optimum health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 22nd, 2007 by Dr. Val Jones in News
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I’d never really thought about this issue until I read a study from the American Family Physician where some hardy souls sifted through the world literature for the answer to this very question. Their conclusion was that one out of every 220 women experiencing post coital bleeding has invasive cervical cancer.
The general prevalence of cervical cancer (in the US) is about 10 in 100,000.
So, if you’re experiencing bleeding after sexual intercourse, you should follow up with your Ob/Gyn to determine the cause. Also, regular pap smears are important in sexually active women as most cases of cervical cancer have no symptoms at all.
(How common is post-coital bleeding? About 1% of women report this problem.)
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
