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Repealing Healthcare Reform To Gain Campaign Ammunition

Repealing healthcare reform has become a way of stockpiling ammunition for the campaign trail. The Republican-led House has scheduled a repeal of healthcare reform for Wednesday, Jan. 12, and they’d garner as allies some but not all 13 Democrats that voted against healthcare reform to begin with. The House’s quixotic vote would then promptly die in the Democrat-held Senate.

But recording votes on repeal would put pressure on already vulnerable lawmakers, as well as give a quick boost to incoming ones. A Gallup poll shows 46 percent of Americans want healthcare reform to be repealed, 40 percent don’t want repeal.

Unfortunately, not only can’t the law be passed, it would add $230 billion to the federal debt by 2021, according to the Congressional Budget Office. House Speaker John Boehner said, “I don’t think anyone in this town believes that repealing Obamacare is going to increase the deficit,” although Republicans have already exempted a repeal of the healthcare law from new rules prohibiting legislation from adding to the federal debt. (Politico, Kansas City Star, [Aurora, Ill.] Beacon-News, USA Today, CNN)

*This blog post was originally published at ACP Internist*

How Will Today’s Elections Affect Healthcare Reform?

All eyes are on today’s mid-term elections and how they’ll play out across the country. The results are likely to affect the recently enacted healthcare reform legislation, Politico reports. Although repealing the legislation would be difficult, Republicans may be able to challenge its implementation if they gain control of the House. Attempts to modify the law could require a delicate balance since, as noted by the Washington Post‘s Ezra Klein, some of its provisions, such as coverage for dependents age 26 and younger, are individually popular.

Reuters has published a Q&A on what the election results could mean for the healthcare reform law. The Wall Street Journal is asking readers to weigh in on whether the legislation is affecting their votes. (Politico, Washington Post, Reuters, Wall Street Journal)

*This blog post was originally published at ACP Internist*

“Gagging Orders” For Doctors?

From the article “Millions spent on doctor ‘gagging orders’ by NHS, investigation finds” in the “Health & Families” section of The Independent in London:

Hospital doctors who quit their jobs are being routinely forced to sign “gagging orders” despite legislation designed to protect NHS whistleblowers, it is revealed today.

Millions of pounds of taxpayers’ money are being spent on contracts that deter doctors from speaking out about incompetence and mistakes in patient care.

Wow. I’m not being snarky here — I really have no idea: Does this happen in the U.S?

*This blog post was originally published at GruntDoc*

Public Service: Does Having An Opinion Disqualify You?

Many conservatives are up-in-arms about President Obama’s decision to appoint Don Berwick, a pediatrician and renowned expert in quality improvement and patient safety, to lead the Center for Medicare and Medicaid Services (CMS). They object to Dr. Berwick’s views on a range of issues, and to Obama’s decision to use his office’s authority to appoint Dr. Berwick while the Senate was out on a short Independence Day holiday recess. As a “recess appointment,” Dr. Berwick was able to take office without Senate hearings and confirmation, but he can only serve through the end of the 111th Congress — that is, until the end of 2011 — unless ratified by the Senate.

Berwick, though, also has many supporters. Maggie Mahar articulates the “pro” viewpoint on Dr. Berwick’s appointment in a recent Health Beat post. She observes that two former CMS administrators who served in Republican administrations have commented positively about Dr. Berwick’s qualifications. Read more »

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

Dr. Don Berwick’s “Patient-Centered” Medicine

There’s been a bit of buzz in the health blogs over President Obama’s decision last week to use the mechanism of a recess appointment to be the director of the Centers for Medicare and Medicaid Services (CMS).

Recess appointments, for those who may not be aware, allow a President to put a nominee in place when Congress is in recess in order to have him in place without the messy process of having him approved by the Senate. True, the Senate still has to approve a recess appointment by the end of its term, or the seat goes vacant again, but it’s an excellent way to avoid having nasty confirmation fights during election years. Of course, both parties do it, and the reaction of pundits, bloggers, and politicians tend to fall strictly along partisan lines.

If you support the President, then a recess appointment is a way to get around the obstructionism of the other party. If you don’t support the President, it’s a horrific abuse of Presidential power. And so it goes. Either way, I don’t really care much about the politics of how such officials are appointed so much as who is being appointed.

The man who was appointed last week to head CMS is Donald Berwick, M.D., CEO of the Institute for Healthcare Improvement. His being placed in charge of CMS will likely have profound consequences not just for how the recent health care/insurance reform law is implemented, but for how the government applies science-based medicine to the administration of the this massive bill. Read more »

*This blog post was originally published at Science-Based Medicine*

Latest Interviews

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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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…

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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.

***

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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