February 5th, 2011 by Veronica Sikka, M.D., Ph.D. in Health Policy, Opinion
Tags: Dr. Veronica Sikka, Dumping Patients, ED, Emergency Department, Emergency Medical Treatment and Active Labor Act, Emergency Medicine, Emergency Room, EMTALA, ER, General Medicine, Health Affairs, Healthcare reform, Healthcare Solutions, Internal Medicine, National Health Service, New U.S. Healthcare System, NHS, Patients With No Health Insurance, PCP, Primary Care Physician, Retail Clinics, Triage, Urgent Care Centers, Virginia Commonwealth University Medical Center
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In 1986, when Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals and ambulance services were mandated by law to stabilize anyone needing emergency healthcare services regardless of citizenship, legal status, and/or insurance status.
This was instituted at the time to prevent the prevalent practice of “dumping” — refusing to treat patients because of insufficient insurance or transferring or discharging patients on the basis of anticipating high diagnosis and treatment costs. While the implications of this law are indeed very noble in providing undifferentiated care to all patients based solely on healthcare needs and not financial status, it has unfortunately led to many patients presenting to the emergency department (ED) for primary care issues.
The misconception is that the care in the ED is similar if not better (because of increased access to consult services and imaging) and quicker than waiting to see your primary care physician (PCP). A 2010 study published in Health Affairs found that 14 percent to 27 percent of visits to hospital EDs are nonemergent, such as minor infections, strains, fractures, and lacerations. The study found that all of these cases could have been appropriately triaged in urgent care centers or retails clinics.
England has a model that may be a potential solution. The healthcare goal of the National Health Services (NHS) is to “treat the right patients in the right place at the right time.” The NHS employs nurses and paramedics to handle 999 (their equivalent of our 911) triage calls with more appropriate triaging of patients based on acuity. Read more »
February 5th, 2011 by Felasfa Wodajo, M.D. in Opinion, Research
Tags: Behavior Modifications, Blood Sugar Control, CDC, Centers For Disease Control and Prevention, Chronic Conditions, Diabetes Epidemic, Diabetes Mine, Diabetology, Dr. Bruce Bode, Dr. Felasfa Wodajo, Endocrinology, Health and Smartphones, Health Apps, Healthcare and Internet Technology, Healthcare Cost Drivers, iBG Star, iMedicalApps, iPhone Glucometer App, Living With Diabetes, Managing Diabetes, Medical Technology, mHealth, Mobile Health Technology, On-The-Go Chronic Disease Management, Potential Healthcare Cost Savings, Real-Time Disease Management, Reducing Negative Health Effects, Research2Guidance
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The cost of managing chronic diseases is the largest portion of healthcare expenditures in developed countries. For example, the prevalence of adult acquired diabetes has been rising in the United States, in concert with increasing rates obesity. The CDC has termed it an “epidemic,” especially in light of the massive costs incurred by the healthcare system due to diabetes.
The deleterious health effects of many chronic conditions can be diminished by behavior modifications. While few would underestimate the difficulty of having patients lose weight or exercise more, good management of blood sugar in diabetes is both objectively measurable and strongly correlated with reduced end-organ damage.
This is among the reasons why Research2Guidance has recently nominated diabetes as the condition most likely to be most targeted by mobile medical software and devices (mHealth). This finding is part of their recently published Global Mobile Health Market Report 2010-2015. This is the same report that also predicted that, in the future, medical apps are likely to be distributed by physicians and healthcare institutions.
This time Research2Guidance is highlighting the portion of the survey where they looked into where mobile devices have the most potential to affect health outcomes. While other chronic conditions such as hypertension and obesity have larger populations, the market researchers felt diabetes had the largest market potential due to the huge cost saving potential, the demographic and geographic overlap between smartphone users and people with diabetes, and the real potential to improve blood sugar management using mobile devices. Read more »
*This blog post was originally published at iMedicalApps*
February 3rd, 2011 by GarySchwitzer in Better Health Network, Opinion
Tags: Child Safety, Children's Health, Empty Cradles, Gary Schwitzer, Global Crisis, Global Health, HealthNewsReview.org, Infant Care, Infant Mortality, Infant Safety, Marty Kaiser, Maternal-Child Health, Milwaukee Journal-Sentinel, Pediatrics, Premature Death, Protecting Children, Public Health, Sudden Infant Death, U.S. Infant Mortality Rate
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I have gushed praise for the Milwaukee Journal Sentinel for a long time. (Disclosure: I cut my teeth in journalism as a Journal Company employee way back in 1973. No ties since 1976.) As a mid-market newspaper facing all of the same hurdles as other newspapers, it consistently demonstrates tenacity and creativity in tackling vital healthcare issues in this country. The latest: A project called “Empty Cradles: Confronting Our Infant Mortality Crisis.”
While there is a great health/medicine/science team in place at the Journal Sentinel, I believe that much of the credit goes to the top — to editor Marty Kaiser, who clearly understands that healthcare issues are among the most important his paper can report on in serving public needs. Kaiser writes:
“The Journal Sentinel today takes on an issue we have too long ignored — the death of children before their first birthday. Infant mortality is a crisis not just of public health, but of ethics and morality. The rate at which infants die in our city is unacceptable. In 2011 we will examine the problem and point to solutions.”
The project is off to a great start, taking a global picture and focusing it locally. Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
February 3rd, 2011 by BobDoherty in Health Policy, Opinion
Tags: 30 Million Newly-Insured Patients, ACA, ACP Advocate, Affordable Care Act, American College Of Physicians, Bob Doherty, Fate of Americans' Health, Florida, Future of American Healthcare, Government Health Insurance, Government-run Healthcare, Healthcare Coverage For All, Healthcare Policy, Healthcare Politics, Healthcare Reform Law, medicaid, Medicare, New U.S. Healthcare System, New York Times, U.S. Supreme Court, Unconstitutional, Wall Street Journal Health Blog, WSJ
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A Florida’s judge’s ruling that the Accountable Care Act (ACA) is unconstitutional doesn’t resolve the underlying constitutional issue (which will ultimately have to be decided by the U.S. Supreme Court) but it has introduced new uncertainty for the $2.3 trillion health care industry, and emboldened the law’s critics to push even harder for repeal (not that they weren’t trying already).
The Wall Street Journal’s (WSJ) health blog reports that “states and companies that are supposed to be implementing the law trying to figure out what to do next. The WSJ reports that the 26 states that are parties to the suit are considering whether to ask the Supreme Court to take up the case now, before it has fully wended its way through the legal system. The New York Times (NYT) quotes the governor of Florida as saying that until the fate of the law is clear, “we’re not going to spend a lot of time and money” to implement it. Other states, even if part of the suit, will move ahead,” the NYT says. The WSJ also reports that most health care companies plan to “stay the course” and continue to plan for the law’s implementation. Meanwhile, the Obama administration says that the judge’s ruling will have no effect on the implementation of the law or the requirement that states (including those who brought the suit) comply with its mandates and claims that most constitutional experts agree with the administration.
Now, I am not a lawyer, so I don’t have any expertise on the legal arguments over the ACA’s constitutionality. For those of you who want to hear more about the constitutional questions from people who might actually know what they are talking about, I recommend this Health Care Blog post from attorney Mark Hall, a critic of the Florida judge’s ruling. He notes that “at least half of the relevant part of the opinion is devoted to discussing what Hamilton, Madison, Jefferson and other Founding Fathers would have thought about the individual mandate” (Judge Vinson concluded that they would not have approved of it) but “the same Founders wrote a Constitution that allowed the federal government to take property from unwilling sellers and passive owners, when needed to construct highways, bridges and canals.” The Washington Post’s Ezra Klein — a supporter of the Affordable Care Act — has posted an excellent overview of what legal experts are saying about the ruling, pro and con, including a link to a posting that argues Judge Vinson ruled correctly. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
February 2nd, 2011 by Mary Knudson in Health Tips, Opinion
Tags: AHA, American Heart Association, Cardiology, Cardiopulmonology, Dietary Guidelines, Dietary Recommendations, FDA, Food and Drug Administration, Gastroenterology, Heart Disease, Heart Health, HHS, High Blood Pressure, Hypertension, Institute of Medicine, IOM, Kidney Disease, Mary Knudson, Nephrology, Patient Empowerment, Patient Involvement, Preventive Health, Salt Consumption, Sodium Intake, Stroke, U.S. Department of Agriculture, U.S. Department of Health and Human Services, USDA
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I confess to loving Campbell’s tomato bisque soup. I mix it with 1 percent-fat milk and it’s hot and delicious and comforting, but one of the worst food choices I could make because one cup contains more sodium than I should have in a day. Knowing this, I have already relegated it to an occasional treat. But by the end of this blog post I will do more.
We are overdosing on sodium and it is killing us. We need to cut the sodium we eat daily by more than half. The guidelines keep coming. The U.S. government has handed out dietary guidelines telling Americans who are over 50, all African Americans, people with high blood pressure, diabetes, or chronic kidney disease to have no more than 1,500 milligrams (mg) — or two thirds of a teaspoon — of sodium daily. That’s the majority of us — 69 percent. Five years ago the government said that this group would benefit from the lower sodium and now it made this its recommendation. The other 31 percent of the country can have up to 2,300 mg a day, say the guidelines from the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS).
Or should they? The American Heart Association (AHA) recommends that all Americans lower sodium to less than 1,500 mg a day. Excessive sodium, mostly found in salt, is bad for us because it causes high blood pressure which often leads to heart disease, stroke, and kidney disease and can also cause gastric problems. People with heart failure are taught to restrict salt because water follows salt into the blood and causes swelling of the ankles, legs, and abdomen and lung congestion that makes it difficult to breathe.
I saw one recommendation by an individual on the Internet to just drink a lot of water to flush the sodium out of your body rather than worry about eating foods that have less sodium. BAD idea, especially for people with heart problems who need to restrict fluids to help prevent fluid accumulation in their bodies. The salt will draw the water to it.
But cutting our salt consumption by half is quite a tall order for an individual consumer because Americans have been conditioned from childhood to love salt and we on average consume 3,436 mg — nearly one and a half teaspoons — a day. Sodium is pervasive in our food supply. We get most of our sodium from processed foods and restaurant and takeout food, sometime in unexpected places. Read more »
*This blog post was originally published at HeartSense*
