December 2nd, 2009 by Richard Cooper, M.D. in Better Health Network, Health Policy, Opinion
Tags: Geographic Variations, Hospital Readmission Rates, Medicare, MedPAC, Poverty, Readmissions, Safety Net Hospitals
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According to MedPAC, 18% of hospitalizations among Medicare beneficiaries resulted in readmission within 30 days, accounting for $15 billion in spending. Since treatable chronic illnesses are responsible for many such hospitalizations, it is assumed that they represent failures of the health care system. MedPAC claims that 84% of readmissions are potentially preventable. However, as will become evident, most readmissions reflect differences in co-morbidities, poverty and other social determinants, all of which deserve attention, including better transition care, but few of which are under the control of hospitals. Nonetheless, health care reform assumes that regulators can accurately adjust for such risks and estimate the “excess.”
Both the House and Senate bills include reductions in payments to hospitals with “excess” readmissions. Payment would be reduced 20% for “excess” readmissions within seven days and 10% within fifteen days. Hospitals with 30-day risk-adjusted readmission rates above the 75th percentile would incur penalties of 10-20%, scaled to the time to readmission. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
December 2nd, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
Tags: Cold Weather, Foot Warmer, Hand Warmer, Iron, Iron Oxide, Vermiculite, wilderness medicine
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Ski season is upon us. There is no greater relief on a frigid winter day than warming cold, painful fingers and toes. In a recent issue of Wilderness and Environmental Medicine (2009;20:33-38), William Sands, Ph.D. and colleagues authored an article entitled, “Comparison of Commercially Available Disposable Chemical Hand and Foot Warmers.” The objective of their study was to characterize the thermal behaviors of 14 commercially available hand and foot warmers.
The warmers were studied in pairs in a laboratory setting, not in frigid conditions. Each warmer was monitored with a rapidly-responding thermister to determine its external temperature. One of each pair of warmers was placed in a boot or glove. Temperature was recorded until the heat output of the devices ceased and the temperature was determined to be identical to ambient temperature.
The results were quite interesting. There was variability both within and between manufacturers and types of warmers. Some of the devices exceeded packaging claims, while others fell short. The greater the mass of the warmer, the longer the duration of heat production. Read more »
This post, Do Hand and Foot Warmers Work?, was originally published on
Healthine.com by Paul Auerbach, M.D..
December 2nd, 2009 by DrRob in Better Health Network, Humor
Tags: Break Up, Dear John, Flu, Influenza, Internal Medicine, Letter, Primary Care, Vaccine
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Dear Influenza Vaccine:
I am sorry to be so formal, but using your pet name, “flu shot”, doesn’t seem appropriate in a letter like this. I am also sorry to be writing this letter; I don’t want you to be hurt and I don’t want others to think bad of you.
I just don’t love you any more and want out of our relationship.
Don’t get me wrong; I still think you save lives. You are strong, noble, and deserving of appreciation. You give to my patients what I seek to give them: a longer life with less sickness, and you do so without much cost. I will never think badly of you in that way. I even want to continue meeting with you every year. I don’t want to lose touch.
But things have gotten hard for me. You give so much to others, yet you make my life so very hard. I never know how many people will want you, and yet I have to order you six months or more in advance. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
December 2nd, 2009 by Happy Hospitalist in Better Health Network, Health Policy, Opinion, True Stories
Tags: CMS, Incentives, Pay For Performance, PQRI, Quality
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It’s official. Happy has now earned his CMS physician pay for performance PQRI Bonus for 2008, a direct deposit into Happy’s bank account. PQRI stands for Physician Quality Reporting Initiative. How much was my PQRI Medicare pay for performance bonus for calendar year 2008? A $2,500 check written out directly to Happy by the Medicare National Bank. CMS gives a wonderful overview of the history of PQRI . PQRI is the Medicare pay for performance program for physicians that was initiated by Congressional mandate in the latter half of 2007. Doctors have an opportunity to earn back 2% of their gross Medicare collections (which the government calls a bonus but which I call legalized theft) by submitting a grotesque amount of quality performance paper work to the Medicare National Bank. It’s one giant PQRI guideline game.
PQRI reporting is currently voluntary, but legislation in future years will certainly mandate reductions in payment for not submitting data, all but making this program a punitive standard. Many physicians failed to meet the requirements to get paid under CMS pay for performance program guidelines in the latter half of 2007, the first year for PQRI measures. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
December 1st, 2009 by KevinMD in Better Health Network, Opinion
Tags: Flu Shots, H1N1, Influence, Influenza, media, Swine Flu, Vocal Minority
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My position on the H1N1 flu vaccine is clear: everyone should get it.
But not every physician shares that sentiment. The Washington Post reports that there are a minority who are unconvinced of the vaccine’s safety and believe the H1N1 pandemic is over-hyped.
Worse, they aren’t vaccinating their patients. And when you’re talking about pediatricians, that can mean trouble for their patients; children who are most susceptible to the damage caused by H1N1. Read more »
*This blog post was originally published at KevinMD.com*
