June 22nd, 2011 by Happy Hospitalist in Health Policy, Opinion
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Are government entities required to pay the hospital bills of incarcerated prisoners? This is a scenario that happens quite often. Jailed patients are admitted onto the hospitalist service through the ER for anything from patients faking seizures in the ER to chest pain to drug overdoses. When patients are under the custody of the city, state or federal system, those entities are required to pay for necessary acute health care services. I don’t know, maybe it has something to do with a prisoner’s constitutional right. You lose your right to vote, but not to get a liver transplant.
So what happens? Jailed patients get admitted and guards, sometimes, one, two or three at a time, are required to be at the patient’s bedside 24 hours a day. If the patient needs to transport to the radiology department, sometimes this must be arranged with the guards ahead of time to allow extra staffing for the transport.
As you can tell, having a jailed patient is expensive, not only for the cost of the incurred hospital expenses but also the extra labor costs of having additional guards in the patient’s room 24 hours a day. So what’s a city to do? Read more »
*This blog post was originally published at The Happy Hospitalist*
June 10th, 2011 by Happy Hospitalist in Health Policy
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Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.
One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care.
There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either they do or they don’t succeed. Either they survive the coming Armageddon of hospital funding or they don’t. The hospitals least able to reduce their expenses in a market of decreasing payment will fold and other hospitals will become too big to fail. You want to be too big to fail. That’s the goal. If you can survive the coming tsunami, you will be saved and bailed out when you are the only one left standing. That is what history has taught us.
So, how can hospital costs be reduced? One way is to Read more »
*This blog post was originally published at The Happy Hospitalist*
June 1st, 2011 by Happy Hospitalist in Humor
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I’ve discovered the perfect tool to improve doctor-nurse communication skills. Let’s see. Hundreds of nurses. Dozens of floors. Day shifts. Night shifts. This pin pretty much sums it up. Any questions?
*This blog post was originally published at The Happy Hospitalist*
May 26th, 2011 by Happy Hospitalist in News, Opinion
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Chantix lawsuits here we come. I’ve been prescribing Chantix and helping fill out forms for free Chantix for my patients for several years now. Chantix is one medicine used to help get patients to quit smoking right now. In fact, I even had a case presentation of a woman I warned to quit smoking for good or face a lifetime of being cross eyed.
Does Chantix help to quit smoking? Yes it does. It helps to take the cravings away in folks who use it. If you smoke, you should want to quit, based on my discussions with a tobacco farming insider. If nothing has helped, Chantix might be your last hope. As a hospitalist, I always offer Chantix therapy as part of my smoking lecture (that I bill out as smoking cessation CPT 99406 or 99407)
With the average cost of cigarettes going through the roof, the percentage of Americans who smoke has come down. For those still hanging on, taking Chantix to help quit seems like a perfect opportunity to put down the cancer sticks forever. Until the nicotine vaccine becomes widely available I just don’t think we have that many other options available.
But now it seems like Chantix lawsuits may be the next greatest get rich scheme for smokers every where. On May 19th, 2011 the FDA responded to a report from the QuarterWatch: 2010 Quarter 3 Institute of Safe Medication Practices report regarding the safety profile of Chantix . You can view the Chantix information on this pdf file starting on page 14. Pfizer sent the FDA information on several thousand Chantix adverse drug events (ADEs) resubmitted to the FDA’a Adverse Events Reporting System in July 2010 at the FDA’s request. These events reportedly had been previously submitted in a form that did not allow for a comprehensive evaluation.
These included 150 completed suicides dating back to 2007 along with hundreds of incidents of psychosis, depression and attempted suicide. In the third quarter of 2010, varenicline had 1,055 serious adverse drug events reported, more than any other drug the ISMP montitors and Chantix ranked first with twice as many deaths reported related to Chantix exposure.
Pfizer said they were unable to repond to the findings of the ISMP because of their possible involvement in future legal cases. Here is the FDA response statement to the ISMP QuarterWatch report:
In 2006, the Pfizer product, Chantix (varenicline), was FDA-approved as a smoking cessation aid. Soon after marketing, FDA became aware through its postmarketing surveillance system, the Adverse Events Reporting System or AERS, of the potential for serious neuropsychiatric events in patients taking Chantix. Subsequently, FDA began communicating about these potential risks with health professionals and patients. A list of previous safety communications can be found on the Chantix Information page.
Amid continuing adverse event reports, in July 2009, the FDA required that Pfizer update the Chantix label with the most restrictive safety labeling – a boxed warning – describing the risk for neuropsychiatric events. This warning was directly related to the association of Chantix with suicidal thoughts and aggressive behavior. In addition, in 2008, FDA required a mandatory medication guide for patients describing this risk.
In July 2010, Pfizer, at the request of FDA, resubmitted a large number of adverse event reports that were initially sent to the Agency in a way that did not allow for comprehensive evaluation. Although this resubmission included thousands of reports of potential adverse events, these events were spread out over a number of years, and had been reported to the agency periodically in summary safety reports. These reports confirm what we already knew about Chantix and would not have changed the Agency’s position on the drug’s risks and benefits, given that the data in these reports were consistent with those that led to the 2009 labeling change. At this point, based on the data, FDA does not have any new safety concerns with Chantix, though those that have been established remain under active review.
The Agency takes seriously the adverse events associated with all drugs, including Chantix. FDA continues to monitor for serious and unexpected events associated with Chantix. FDA has initiated additional postmarket safety activities. Specifically, it has required the manufacturer of Chantix to conduct a large, comparative, postmarket clinical trial assessing the safety of Chantix among other smoking cessation aids. FDA has also initiated two observational safety studies on Chantix, one with the Veterans Administration and one with the Department of Defense.
Last year, FDA became aware that a few manufacturers were submitting adverse events reports to FDA through improper channels. At that time, FDA clarified its instructions to drug manufacturers, including Pfizer, to submit adverse event reports through a channel that would allow for the adverse event reports to be entered into FDA’s Adverse Event Reporting System, a database of postmarketing adverse event reports that allows for review by the Agency’s safety staff. These instructions were clarified and put on the FDA website for AERS Electronic Submissions2.
FDA will continue to monitor the postmarket safety of Chantix and will communicate any new information as it becomes available. The Agency remains committed to monitoring the safety of drugs as they are used in the postmarket, real-world setting.
Chantix lawsuits, here we come. I think all hospitalists should be aware of these significant findings. Should we stop prescribing the drug? I think I’m done with it. I’d rather have my patients die a slow and painful death filled with morbid disability spread over many years than to have one claim I tried to knock them off with a little bloodless surgery.
Pick your poison, I guess. There’s always cold turkey available too.
*This blog post was originally published at The Happy Hospitalist*
May 22nd, 2011 by Happy Hospitalist in Health Tips, News
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Here’s how we used to find a difficult vein. If a floor nurse could not get an IV in, they asked one of their colleagues to try. If their colleague could not find the impossible-to-locate vein, they contacted an ICU nurse. If the ICU nurse couldn’t get one, sometimes an ER nurse or a flight nurse would try. If they still couldn’t get an IV, then I would be paged to ask if they could get an order for an anesthesiologist to try. And if the anesthesiologist couldn’t figure out how to find a difficult vein, we got a PICC line with the PICC nurse or with the radiologist or I placed a central line if the patient could not wait for a PICC line.
That’s how we used to find a difficult IV.
How do we find one now? If you’re on the floor, you use one of these cheaper vein lights to find the difficult vein and place your IV. However, if you work in Happy’s ER, now you have a $6,000 Star Trek looking vein finder for those dehydrated nursing home patients and cracked out meth heads. Read more »
*This blog post was originally published at The Happy Hospitalist*
