April 14th, 2011 by Happy Hospitalist in Health Policy, Humor, True Stories
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This was a classic moment of comical clarity that only comes along once a week. As you may or may not know, starting in 2013, The Medicare National Bank has promised to take back 1% of all of a hospital’s total Medicare revenue (to increase in future years) if the hospital has a higher 30 day readmission rate for congestive heart failure, acute myocardial infarction or pneumonia than an as yet undefined acceptable 30 day rate of readmission.
What does this mean? It means if the government decides that 20% is an acceptable rate for congestive heart failure 30 day readmission, and the hospital has a readmission rate of 25%, the hospital will be told to return 1% of all Medicare revenue for the year, not just their heart failure revenue.
Let’s use some hypothetical numbers, shall we? If a hospital generates $250 million dollars in a year on 25,000 Medicare discharge diagnosis related groups (DRGs) but only 100 of those discharge DRGs (or $1,000,000) were heart failure in 2013, what would happen if 21 CHF patients returned for readmission (a 21% thirty day readmission rate) within 30 days for heart failure instead of allowable 20%? The hospital would have to return 2.5 million dollars (1% of their total revenue on all Medicare admissions).
That one patient that took them from 20% to 21% will cost them 2.5 million dollars. The hospital would generate one million dollars in CHF revenue for the year and pay back 2.5 million dollars in penalty. That’s a pretty hefty price to pay considering that hospital profit margins from Medicare have been negative, on average, for most of the last decade. Read more »
*This blog post was originally published at The Happy Hospitalist*
April 14th, 2011 by Mary Lynn McPherson, Pharm.D. in Health Tips
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When it comes to treating chronic pain such as arthritis or low back pain, it’s important to remember that what works for one patient may not work for the next patient. Some people are able to control their pain by taking a nonprescription medication such as acetaminophen (Tylenol), while others may need an opioid (also known as narcotics). Tablets or capsules containing the opioid hydrocodone plus acetaminophen (known as Vicodin or Lortab) are among the most commonly dispensed medications in the US. But remember: just because this medication is popular doesn’t make it the best pain reliever for everyone!
For example, a recent study showed the older adults who were prescribed a short-acting opioid such as hydrocodone or oxycodone (e.g., Percocet) were twice as likely to break a bone in the following year compared to those on a long-acting opioid or a different pain medication altogether. How can doctors tell which pain medication to prescribe to best treat your pain, without increasing the risk of side effects? People also frequently turn to their pharmacist for medication advice – how does the pharmacist know what to recommend for your pain?
It all starts with a careful description of your pain. Read more »
April 14th, 2011 by Steve Novella, M.D. in Opinion, Quackery Exposed
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Science is a philosophy, a technology, and an institution. It is a human endeavor- our collective attempt to understand the world around us, not something that exists solely in the abstract. All of these aspects of science have been progressing over the past decades and centuries, as we refine our concepts of what science is and how it works, as we develop better techniques, and organize and police scientific activities more effectively. The practice of science is not relentlessly progressive, however, and there are many regressive forces causing pockets of backsliding, and even aggressive campaigns against scientific progress.
So-called complementary and alternative medicine (CAM) is one such regressive force. It seeks to undermine the concepts, execution, and institutions of medical science in order to promote sectarian practices and ideological beliefs. Examples of this are legion, exposed within the pages of this blog alone. I would like to add another example to the pile – the recent defense of homeopathy by Dana Ullman in the Huffington Post (names which are already infamous among supporters of SBM). Read more »
*This blog post was originally published at Science-Based Medicine*
April 14th, 2011 by admin in Health Tips
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At a Harvard Medical School talk on migraine and food, a nutritionist from Harvard-affiliated Beth Israel Deaconess Medical Center delivered a message that people in the audience probably didn’t want to hear: “There are no specific dietary recommendations for migraine sufferers,” said Sandra Allonen. But she did have some advice to offer—and she emphasized that the connection between food and migraine is a very individual one.
Several foods have been associated with triggering migraine. None of them has been scientifically proven to cause migraines, explained Allonen, but many people report a link between eating these foods and getting a migraine. Possible migraine triggers include: Read more »
*This blog post was originally published at Harvard Health Blog*
April 14th, 2011 by StevenWilkinsMPH in Opinion
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I recently participated in a Twitter Chat about physician-patient communications. A common refrain from some of the providers in the group was that “there isn’t enough time” during the typical office visit for physicians to worry about communicating effectively. What’s up with that?
The goal of patient-centered communications is to engage the patient in their own health care. While most physicians endorse the concept of patient centered communications, many seem reluctant to employ such techniques in their own practice. Why? I suspect that many fear that too much patient involvement will increase the length of the visit.
Take the patient’s opening statement aka “patient agenda” in patient centered lingo. This is where the doctor asks the patient why they are there. The resulting patient narrative is an opportunity for the physician to obtain valuable information to help assess the patient. Patient centered advocates recommend that physicians use open-ended questions like “what brings you in today” to solicit the patient’s concerns and agenda. Active listening by the physician and paying attention to the patient’s emotional cues are also hallmarks of patient centered communications.
The reality is that regardless of how they are asked, patients are often not able to complete their opening statement. Read more »
*This blog post was originally published at Mind The Gap*
