October 12th, 2009 by GruntDoc in Better Health Network, News
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EMS/ED frequent fliers are both a bane and (supposedly) another cost of doing business for EMS systems. Maybe not.
My city of Fort Worth is trying to do something about it, proactively and correctly (emphasis mine):
MedStar program sends paramedic to homes of some repeat callers before they dial 911 | Fort Wor…
FORT WORTH — Last year, MedStar was called more than 800 times by 21 people.
Those “frequent fliers” weren’t necessarily facing life-threatening emergencies. Some may have needed primary care but didn’t have a regular doctor or transportation. Read more »
*This blog post was originally published at GruntDoc*
October 8th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
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I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.
The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.
Insurer side
Insurance companies have to maximize their revenue because they answer to their boards. They are in no rush to fix claims systems that make copious errors and delay payments to providers. There are hundreds of claims processing software programs out there. Some are acceptable, some are useless. None are really good or efficient. And there is the human error factor. A careless mistake by an apathetic claims processor can create payment problems that could literally last for years. Read more »
*This blog post was originally published at KevinMD.com*
October 7th, 2009 by Happy Hospitalist in Better Health Network, Health Policy, Opinion
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Some put the figure for defensive medicine at 10% of medical expenses a year. That’s $250 billion dollars. Others claim it to be 2-3% per year or about $60 billion dollars a year.
Now ask any physician what it is. I’d say it’s closer to 30% a year. That’s $750 billion dollars a year. Why? Because I know what is going through the minds of physicians when they put the pen to the paper. In America, we strive to exclude the long tail diagnosis. Why? Because getting sued for 67 million dollars because you treated a torn aorta when all the evidence pointed to an emergent MI has a way of making doctors evaluate the possible, instead of focusing on the probable.
Defensive medicine is not about losing a lawsuit. It’s about getting sued and the lack of boundaries that protect a physician from having bad outcomes with competent medicine, even if that competent medicine was the wrong medicine for the wrong patient at the wrong time, a fact known only after the fact when a bad outcome occurs. Read more »
*This blog post was originally published at A Happy Hospitalist*
October 6th, 2009 by DrWes in Better Health Network, Health Policy, News
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I just finished our first day at the Principle Investigator Meeting for the launch of the Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial in Philadelphia today. The trial is a 3000-patient patient trial performed at 140 centers around the world and jointly sponsored by the National Heart, Lung, and Blood Institute (NHLBI), a component of the National Institutes of Health (NIH), and industry (St. Jude Medical and Biosense Webster).
The trial will randomize 3000 previously untreated or incompletely treated patients at high risk of cardiovascular complications in the trial to two arms: 1500 patients to catheter ablation as primary therapy of atrial fibrillation and the other 1500 patients to conventional medical therapy with rate control or rhythm control strategies to determine if catheter ablation is superior to medical therapy at reducing total mortality (the primary endpoint). Secondary endpoints of a composite endpoint of mortality, disabling stroke, serious bleeding, or cardiac arrest will also be studied.
If done properly, this study stands to be a landmark trial for the field of cardiac electrophysiology and has huge ramifications for the treatment of patients with atrial fibrillation. Also, it doesn’t take a lot of rocket science to know that the government will be looking closely at the results of this trial to determine which treatment strategy will receive government funding. Read more »
*This blog post was originally published at Dr. Wes*
September 28th, 2009 by Happy Hospitalist in Better Health Network, Opinion
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I have blogged extensively about why standard of care is an irresponsible measure of the threshold for determining negligence in medical care. Most recently, I blogged about it
here and
here. Imagine for a moment what capitalism would be like if your investment adviser was sued every time your investment value went down. Imagine what life would be like if they risked civil liability every time a bad outcome occurred. What if no laws were broken? What if an after the fact determination of negligence was based on a bad outcome?
Read more »
*This blog post was originally published at A Happy Hospitalist*
