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Medicare Only Covers Some Medications During A Hospital Stay

One of the worst parts of my job over the years has been to tell patients I was going to bring them into the hospital as an observation status because they did not have any criteria for full inpatient status.  There is a huge difference in how CMS pays for hospital care (excluding critical access hospitals) between inpatient versus observation.

Observation is considered outpatient.  Medicare will pay for observation hospital services for up to 48 hours to allow physicians a chance to observe the patient and determine if they need to have an inpatient hospital admission.  Observation was never intended to be used as a holding pit  to help social workers arrange for a nursing home transfer during normal business working hours because it can’t be arranged, on either end, at 10 pm on a Friday night.
What used to be a moral family obligation to care for loved ones too weak to care for themselves has now been relinquished to the role of hospitals and hospitalists.  And we all pay for it.  Families have abandoned their loved ones for good.  It’s really quite sad.  Bringing patients into the hospital for the purpose of arranging a nursing home transfer is, in my opinion, a form of Medicare fraud, since these patients have no intention of being fully admitted.

But it’s paid for and will always be paid for, except when Read more »

*This blog post was originally published at The Happy Hospitalist*

The State Of Drug-Seeking In America: Nothing Should Hurt

101-homepage-merthiolate

This might sting a little…

When I was a child, I was often painted orange with Merthiolate.  My grandmother, like every good grandmother, kept a bottle handy at all times.  Merthiolate was an antiseptic, containing Mercury, that was marketed for cuts and scrapes.

A fall on the gravel, a slide on the pavement, a run through the briar patch and you’d be sitting on the kitchen table while grandma colored you orange with the magical elixir, which incidentally burned like fire!

On a recent emergency department shift, we were colluding about the general state of drug-seeking in America, which has been enabled by our ‘nothing should hurt’ ideology.   One of my dear friends, Nurse Nancy, had a realization; an epiphany, really. Read more »

*This blog post was originally published at edwinleap.com*

Reducing The Use Of CT Scans In Children

Well, this is satisfying. Over the years, in our ER we have mirrored the nationwide trend and have significantly increased the utilization of CT scans across the board. The reasons are manifold. Some cite malpractice risks, and indeed in our large group we have had one lawsuit for a pediatric head injury and another for a missed appendicitis which probably did contribute. But, in my opinion, there have been many other drivers of the increased use. For one, CTs have gotten way, way better over the last 15 years, which quite simply has made them a better diagnostic tool. They’ve also gotten way faster. As the facilities have invested in CT scanners, they have increased their capacity and increased their staffing, so the barriers to their use have rapidly diminished. I am so old that I remember when ordering a CT involved calling a radiologist and getting their approval! No more of that, I can tell you.

But a couple of years ago, we really started paying attention (perhaps belatedly) to Read more »

*This blog post was originally published at Movin' Meat*

Battling With The Insurance Company

A few months back, while we were on vacation in Washington, D.C., my 17-year-old son Noah sustained an injury at 1:00 a.m. I was asleep, but this is usually a few hours earlier than he typically retires. In our hotel room’s bathroom, he dropped a glass and then managed to step in the wrong place. A sharp shard sliced through the soft skin between his great and second toes. Blood was spurting wildly and he woke me up with a shout. He was spooked.

We gastroenterologists are experienced at stanching bleeding, although I was uncertain how to do so without some kind of scope in my hand. I reflected on my ACLS training, which is a comprehensive 2 hour course that my partners and I take every 2 years. In between those sessions, I neither think about nor practice any advanced life saving procedures. It doesn’t seem rational that a community gastroenterologist should be schooled in temporary pacemakers, when most of us haven’t interpreted an EKG in decades.

I still remember the fundamentals of life support, the famed A, B, Cs, standing for airway, breathing and circulation. I decided to apply this to the hemorrhage at hand.

Airway: the windpipe was open and functioning

Breathing: the kid was breathing

Circulation: BINGO!

After going through this brief but critical checklist, I now knew where to focus. Read more »

*This blog post was originally published at MD Whistleblower*

Study Shows That Medicare Pays More For Patients Cared For By Hospitalists

Association of Hospitalist Care With Medical Utilization After Discharge:  Evidence of Cost Shift From a Cohort Study.

That’s the title of the latest medical study making the viral rounds.  I had an opportunity to read the study in full.  I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours.  Now, that’s amazing.  Thanks Judy for a job well done.  You deserve a raise.

Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.

In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher.  These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.

OK fair enough.  Let’s come to that conclusion.  Let’s say Read more »

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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