April 14th, 2011 by DrWes in True Stories
No Comments »
It was 11:00 pm when the pager vibrated, then beeped: it was the ER, Hospital #3.
“This is Dr. Fisher returning your page?”
“Thank you Dr. Fisher, just a moment for Dr. Frigamafratz.”
A brief pause, then:
“Wes, I think we’ll need your services. Old guy, found down at the nursing home, brought in unconscious, pulse 25 – hooked him up to an external pacer, he’s back with us now.”
“I’m on my way.”
When I arrived, there was the usual cacophony of activity in the Emergency Room. Someone screaming in one corner. Intercom sounding. Ambulance en route to our location. Breathing treatments underway in Bay 5. Room 10 headed to the CT scanner. Has room 12 got a bed? By comparison my patient was easy: his disposition in the eyes of the ER staff had been made: he was on the Express Track to the EP lab.
There he was, chest twitching. Big forceful jerking. He was a big guy, uttering something with purpose but impossible to understand. Next to him, his wife, just arriving and removing her coat. “Is he going to be okay?”
My head scrambled for an answer. “He’s okay for now,” I think I replied. Read more »
*This blog post was originally published at Dr. Wes*
April 14th, 2011 by Happy Hospitalist in Health Policy, Humor, True Stories
No Comments »
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 10th, 2011 by DrWes in Humor, True Stories
1 Comment »
He must have been about eight at the time. I had made the mistake of watching doctor shows on TV with him and he had probably heard my wife and I describe the challenges of my doctor lifestyle at times over dinner. For the most part, he seemed oblivious and liked the things that most young boys at that age do: sports, jungle gyms, mud, and bicycles, but he had never seen his Dad at work.
So the day came when my wife was doing errands and stopped by the hospital with the kids to drop off my pager which I had inadvertently left at home. As timing would have it, I had just scrubbed in a case, so she was kind enough to bring the pager to the electrophysiology lab control room where the technicians could retrieve it for me. My son, realizing how close he was to my workplace asked within earshot of the technician, “Mom, could I see?” She looked at the technician, and he nodded agreement. Cautiously, they entered the control room just to wave “hi” briefly through the glass. Read more »
*This blog post was originally published at Dr. Wes*
April 2nd, 2011 by DrWes in Health Policy, Opinion
1 Comment »
Cardiologists in Connecticut are standing up to the lack of liability protection in the state’s new low-income health plan called SustiNet:
The SustiNet program would create large pools of people, including those who can’t currently afford health insurance, that would theoretically drive down premium costs by competing with the plans of private insurers. Among other cost savings, it would designate a single doctor or practice for each patient, to reduce emergency care use, and create new “best-use” procedures for a variety of ailments to reduce the number of tests doctors order.
But a key provision of the plan was that doctors, in return for following the new procedures and ordering fewer tests, would be protected from malpractice suits if the outcome of a case was not favorable for the patient. However, with backing from the Connecticut Trial Lawyers Association, that provision was removed from the SustiNet bill two weeks ago.
Cardiologists are considered a particularly important group for the new best-use procedures because they tend to order a battery of expensive tests when patients show signs of heart trouble. If specialists like them failed to participate in the SustiNet program, cutting medical costs could be more difficult.
On Tuesday, the Connecticut chapter of the American College of Cardiology withdrew its support for the bill and said that it would circulate an open letter to House Speaker Christopher G. Donovan and Gov. Dannel P. Malloy saying that it could not support the bill without the malpractice protection.
As screws continue to get tightened on doctors’ ability to order tests thanks to third-party oversight bodies, look for more physicians to play hardball about liability limits at both the state AND national levels.
Doctors are being forced to do do their part to control health care costs as a result of our increasingly government-controlled health care initiatives. It’s high time for the trial lawyers’ to do the same. And there’s already precedent to doing so: just look to the legal protections military doctors enjoy when caring for their members. While legal recourse still exists in the military, the challenge of suing the government on behalf of their employees thwarts frivolous claims.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
April 1st, 2011 by John Mandrola, M.D. in Health Tips, True Stories
2 Comments »
My neighbor Ed was a thin man all his life. He maintained an ideal body weight by combining regular physical activity with a modest intake of calories. He was a “young” seventy year-old who looked the picture of heart health.
Ed regularly read the newspaper while walking on his treadmill, he hit a golf ball straighter and longer than his peers, and he wore the same size jeans now than he did in college 50 years ago. What’s more, he bragged about his low blood pressure, normal cholesterol level and perfect blood chemistries. He took no pills. I think he went to his primary care doctor each year just to show off his health.
The morning he woke with crushing chest pressure and shortness of air stunned him. “This couldn’t be a heart attack?” he thought. An hour later, minutes after his urgent heart catheterization showed severe blockages in all three of the main coronary arteries, a sternal saw provided a heart surgeon access to his dying heart.
Ed did well. The story had a happy ending. He still looks the picture of health, but now there’s a scar on his chest and a few pill bottles in his medicine cabinet.
How can a human who exudes heart health go to bed well and wake up with severe heart disease? What’s missing? What could Ed have done differently? Could his doctors have measured anything—over and above the traditional risk measures—that might have suggested his obviously higher cardiac risk? Read more »
*This blog post was originally published at Dr John M*
