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Latest Posts

Does The U.S. Have Plans To Pay For Long-Term Care?

The Obama administration has dealt a mighty blow to one part of the health reform law by effectively killing off the CLASS Act, which was to be a baby step in the development of a national program to pay for long-term care.   The CLASS Act, short for Community Living Assistance Services and Support Act, was supposed to be a voluntary and federally backed insurance program for people to use to cover potential long-term care needs.  The idea was for Americans to pay premiums into the fund during their working years.  If they later became disabled and needed assistance, they would be entitled to a daily cash benefit of, say, $50 to buy services of a personal care attendant or make home improvements that would allow them to stay in their homes—the preference of most seniors.  Advocates of the CLASS Act even envisioned that some of the benefit could be used for nursing home care.

The program, though, was never popular with insurance companies and politicians who listened to them, and the Act barely made it into the final bill.  It ran into trouble from the beginning.  The Secretary of Health and Human Services, Kathleen Sebelius, was tasked with Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

The Secret To The Virginia Healthcare Decision

Unconstitutional? How can the mandate to buy health insurance be unconstitutional? It must be some kind of misguided resistance to progressivism. Or maybe it’s someone finally taking a stand against a power-grabbing government program.

But it’s actually about something else entirely. And if you don’t know what it is, you won’t understand why the Virginia court ruled the way it did. Here’s the secret:

The U.S. Constitution grants to the federal government certain powers. These are things like raising an army, controlling currency and establishing courts. It also gives it the power to regulate interstate commerce, through something called the “Commerce Clause.” Everything else is the domain of the states.

Notice that the Commerce Clause only gives the federal government power over interstate commerce. The word “interstate,” in 1789, was probably easy to understand. Since the original 13 states were more like little countries, than part of one big country, the idea of trading goods from one state to another was identifiable as a special kind of thing. Read more »

*This blog post was originally published at See First Blog*

Biotech And Life Sciences Grant Program: Only A Few Crumbs To Go Around?

crumbs Biotech Grant Program: Are a Few Crumbs Better Than No Crumbs At All?After assuming control of the House in the mid-term elections, Republicans vowed to eviscerate the Affordable Care Act, the health reform law signed by the “Big O” last March. Thank heavens, therefore, that the Boehners were too busy congratulating themselves to even notice those federal helicopters dumping $1 billion in cash on some needy biotech companies just as the election results were being tallied.

Yep, it happened. Federal disbursements in the form of grants and tax credits were made last week, as required by a provision in the reform law known as the Qualifying Therapeutic Discovery Project Program. According to the terms of this program, biotech and life sciences companies with less than 250 employees could apply for federal funds to cover research costs they had incurred in the last two years, so long as the research focused on the prevention, diagnosis, and treatment of chronic diseases. Read more »

*This blog post was originally published at Pizaazz*

Why Healthcare Reform Is Good For Medicare

You may have noticed, uncharacteristically for me, that I haven’t posted a blog in week. I thought it would be better to allow the readers to post their own reflections, and you did — with comments ranging for unabashed pride to skepticism to disdain for the law and the American College of Physician’s (ACP’s) role in bringing in about.

I respect the principled arguments made by those who believe that the legislation gives the government too much control or those who fear that it will add to the deficit and public debt, even though the Congressional Budget Office (CBO) says otherwise. But there is one claim made by some of the critics that sticks in my craw, which is that the legislation will result in “massive cuts” to Medicare. Here are the facts. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Price Variations In Healthcare Are Not Related to Quality

The Massachusetts health reform law, Part II – enacted in 2008 – laid the groundwork for cost control and quality improvement, as a follow-on to the initial legislation’s emphasis on achieving near-universal coverage.  The legislation authorized several studies — including a report published a few months back on global payment strategies — and set the stage for hearings on health care cost containment to be held before the state Division of Health Care Finance and Policy (DHCFP), which are scheduled to begin March 16, 2010.

Update 2/18/10: Paul Levy posted a series of questions DHCFP would like hospitals to answer at the hearings at Running a Hospital. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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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…

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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…

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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…

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