July 16th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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A non English-speaking husband and wife went to a rural ER because the wife had chest pain. The ER staff was unable to understand their language and did not have an interpreter. Since the husband was trying to explain his wife’s chest pain to the doctors, they thought he also had chest pain. Both patients were admitted to rule out MI (a heart attack). They stayed overnight and both had a full, negative cardiac workup. The husband complied with the workup, figuring he was getting free care and a place to stay next to his wife. His wife’s symptoms resolved on their own. (via Rural Doctoring)
Did you know that there are medical diagnosis codes for almost everything under the sun? Yes, even an “accident involving a spacecraft injuring the occupant of the spacecraft.” (via KevinMD)
A hospital pharmacy cancelled a surgeon’s order of antibiotics after a young patient survived a ruptured appendix (with pus in the abdomen). They were adhering to a new protocol that required all antibiotics to be discontinued 24 hours after any surgery. If the surgeon hadn’t noticed the inappropriate application of this new rule, his patient could have become septic and died. This is just another example of the oversimplification of medicine that is becoming more and more common these days. (via Buckeye Surgeon)
The ACP Internist blog posts a weekly “Medical News of the Obvious.” Here are two goodies:
Parents of twins report more anxiety and sleeping difficulties in the year after birth than parents of single children, according to a study presented at the 24th annual meeting of the European Society of Human Reproduction and Embryology (via Science Daily). I wonder why?
This study, courtesy of the Washington Post, finds that auto deaths decline as gas prices rise because– ta da!– there are fewer people on the road to kill or be killed. And that is especially the case for those subgroups (like teenagers) who don’t have as much money to burn on gassin’ up.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 14th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I had the chance to speak with John Rother, Executive Vice President of Policy and Strategy for the AARP about the intersection of online health, information technology (IT), and the baby boomer generation. Find out what America’s most powerful boomer organization thinks about the future of healthcare in this country.
*Listen to the podcast*
Dr. Val: Recent studies suggest that Americans age 50 and older are more Internet savvy than ever before. How are AARP members using the Internet to manage their health?
Rother: People over the age of 50 are the fastest growing set of online users, and healthcare is the major reason why they’re going online. They’re looking for health related news, help with diagnosis, and finding appropriate healthcare providers.
Dr. Val: What role can online community play in encouraging people to engage in healthy lifestyles that may prevent chronic disease?
Rother: Our experience is that online communities can be extremely helpful in several ways. First, it provides emotional support for people who have a shared experience, whether it’s as a caregiver, or being recently diagnosed with a disease or condition. Second, people seem to feel more comfortable asking questions of others with their condition than they do their own physicians. And third, online communities can reinforce needed behavior change. Whether it’s weight loss, exercise, or quitting smoking – online communities can be just as effective in encouraging behavior change as a face-to-face community.
Dr. Val: Tell me a little bit about the communities on the AARP website.
Rother: Currently our communities are organized around medical topics, but in the future I think the communities will become more geographical. An online community designed to serve the needs of people in a given location can facilitate information sharing about how to navigate a particular hospital system, for example, instead of just general information about coping with a disease or condition.
Dr. Val: Intel just announced that it has FDA approval for its “Intel Health Guide.” The unit enables caregivers to provide their patients with more-personalized care at home, while also empowering patients to take a more-active role in their own care. What do you think of this technology?
Rother: I think information technology is going to have all kinds of beneficial applications for people with health challenges. Personal health records and this Intel Health Guide are very well suited to the needs of individuals with chronic health conditions, and I expect to see more Internet based tools developed to help people to make appropriate decisions and change their behavior.
General information is helpful, but personalized information is the key. The more these technologies allow you to have your own individual information at your fingertips and allow that to be the basis for recommendations and decision support, the more powerful it’s going to be. This is all very promising technology – the next question is, can people afford it and will the people who need it be able to use it?
Dr. Val: In your opinion, what role does health IT have in reducing healthcare costs and improving access to care?
Rother: Health IT can support almost every aspect of healthcare. It can decrease costs by reducing duplication. Many people with chronic conditions see different doctors – and if you have to go through the same set of X-rays or CT scans every time you see a different doctor, that can get very expensive. A good, common medical record system is critical in reducing costs and improving care.
IT can also reduce the cost of health insurance, in the way that online car insurance has reduced car insurance premiums. If we reform our health insurance market, this could offer substantial savings to individuals.
People often use the Emergency Department inappropriately – for minor issues instead of true emergencies. A good decision support system that helps people to figure out when they need to go the ER could be helpful in reducing costs.
Dr. Val: What are the AARP’s major health-oriented initiatives?
Rother: The AARP is very focused on healthcare because our members tell us that it’s their top priority. The cost, quality, safety and accessibility of healthcare are important to us, so we are involved in a broad spectrum of initiatives.
First of all, extending coverage to all Americans, regardless of their age or health condition, is a top priority for the AARP. Second, In terms of health quality, it varies quite broadly among hospitals in the US. If we could get everyone to copy the best hospital practices, we’d have a much more manageable problem.
Dr. Val: What needs to happen to America’s healthcare system in order for it to serve the needs of baby boomers on its limited budget?
Rother: We spend almost 2.5 trillion dollars for healthcare in the United States, so I don’t think of it as a limited budget, but quite an expansive budget. There is enough money in the system to fully respond to the needs of the population. It’s just that we’re not organized very well and the system has become fragmented.
The healthcare system needs to be organized in a more person-centered way, and we need it to shift from a focus on acute care to a chronic care model. We need a different system of health delivery – one that relies more on nurses and other physician extenders. People need to join support groups to modify their behaviors and risk factors and rely on IT to help them make appropriate decisions.
So you put that all together and you have a pretty big agenda for change. I don’t know if we can achieve this all at once, or if it will occupy us for several years. The upcoming election gives us the opportunity to do this at the Federal level, though there are many private sector initiatives that are currently making important contributions.
Dr. Val: Can you give me an example of someone in the private sector who’s making an important contribution to improving healthcare?
Rother: The AARP just met with the leadership of the Mayo Clinic, one of the most outstanding medical institutions in the country. They provide excellent care at a cost that is less than most other parts of the healthcare system – and with improved outcomes. We asked them about their secret to success.
Mayo has an electronic medical record and all their patients have their information online. The physicians are on salary, so there’s no incentive to order unnecessary tests or procedures, and Mayo has an ethic of patient-centered care, with a long history of attracting the best people and rewarding them.
If Mayo can do it, why can’t everyone else? The AARP believes that the potential is there for most communities to have excellent care – we must emulate the care delivery of institutions like the Mayo Clinic, and put in place payment and information systems that will coordinate care management better. It’s a big job and will take some investment, but we have many opportunities to do a better job than we’re doing today.
*Listen to the podcast*
*Learn more about preventing chronic disease*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 11th, 2008 by Dr. Val Jones in News
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Intel just received FDA approval for their new in-home monitoring devices. The press release notes:
The Intel Health Guide enables caregivers to provide their patients with more personalized care at home, while also engaging and empowering patients to take a more active and positive role in their own care.
Intel said the interactive guide integrates vital sign collection, patient reminders, multimedia educational content and feedback and communications tools such as videoconferencing and e-mail. It can connect to specific models of wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters and weight scales.
Now this is a good idea – imagine how much pain and suffering we can alleviate by intervening in illnesses before they become acute? For example, when a patient with CHF begins to decompensate, physicians can intervene before the patient experiences severe shortness of breath and requires a hospital admission via the ER. What about catching a hyperglycemic episode early on? What about a hypertensive emergency that has no symptoms until very late in the game?
Avoiding the hospital can reduce exposure to infections, medical errors, insomnia, stress, and disorientation. Early intervention in disease keeps people out of the ER, and saves money and resources – while improving quality of life for the patients. The data gathering tools not only empower patients to be as independent as possible for as long as possible, but they empower physicians to care for their patients more effectively.
Unlike services that are aimed at replacing physicians, this one is designed to make them more efficient and effective. One day I imagine that a primary care physician will be able to keep an eye on her patients on one web page – with input from all the terminals combined into a dashboard. Alerts can be set at customized levels for different patients, and with a glance of an eye the physician will be able to see which patients may need help.
This is a brave new world of real-time health communication, and with technologies like this one, we may be able to bridge the gap between growing care needs and decreasing care resources while actually improving quality to boot.
Personal, affordable, telemedicine for the chronically ill. Bravo, Intel.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 7th, 2008 by Dr. Val Jones in Health Policy
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This is one of the worst ideas I’ve heard of in a long time – “secret shoppers” in the ER (h/t KevinMD and Dr. Wes). In an attempt to assess hospital quality, patients with fake complaints are sent to the ER unannounced to see how they will be triaged and treated. In one case, a woman complained of stroke-like symptoms (headache, slurred speech, and difficulty moving the left side of her body). She underwent a head CT (which was normal) and then signed out of the hospital against medical advice.
Let me tell you why this “secret shopper” idea is so bad:
1. The woman was exposed to unnecessary brain radiation via the CT scan – this risk is acceptable if a patient’s life is in danger, but why would a normal person wish to be exposed to additional radiation? I smell a law suit in her future…
2. The woman’s triage experience could not possibly represent the average stroke patient experience because she could not replicate the signs of a stroke and (if she tried) any good ER doc or neurologist would know that she was faking. A patient faking the symptoms of a stroke would likely be treated differently than a patient with objective signs.
3. Wait times are dangerously high in ERs across the country. Bumping legitimate patients with “secret shoppers” is unethical and downright dangerous.
4. If hospital staff know that some of their patients will be fake, this could result in mistrust of symptoms or stories and a backlash against real patients who might be confused with secret shoppers.
The ER secret shopper movement was clearly conceived by people who don’t understand the complexity of healthcare, and are applying reductionist principles that will cause unanticipated consequences. Physical harm to the shoppers, longer wait times for real patients, further mistrust by the medical community, and inaccurate quality assessments are only the beginning. I hope the AMA voices their disapproval of this practice.
Quality is better assessed by an average of real patient experience, along with data comparing treatment protocols with medical records. Fake patients have no place in the ER.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 1st, 2008 by Dr. Val Jones in Expert Interviews
3 Comments »
Some 600,000 physicians are facing a 10.6% cut in Medicare payments beginning July 1.
Congress failed to pass a measure to block a steep reduction in the Medicare physician payment rate before adjourning for a weeklong July 4 recess. That failure allows a 10.6 percent cut to take effect on July 1 that could end up limiting or denying care to millions of Medicare beneficiaries. [
AAFP News Now]
I reached out to Dr. Nancy Nielsen, the President of the American Medical Association, for comment. [Listen to the podcast]
Dr. Val: How will the Medicare cuts affect seniors in this country?
Dr. Nielsen: Because the 10.6% cuts to all physicians who see Medicare patients goes into effect today, we are really on the brink of a meltdown. Physicians say that a cut of this size will force them to make terrible choices, just to keep their practices open. In a recent survey, 60% of physicians said that the cuts would cause them to limit the number of new Medicare patients that they treat. This is the last thing we need at a time when baby boomers are aging into Medicare. It’s not why any of us went into medicine – to shut doors and turn patients away. So this is really, really painful.
Dr. Val: What do you say to those who claim that doctors are simply protecting their own salaries when opposing this cut?
Dr. Nielsen: We’re really not hearing that argument because people understand that this is about whether or not payments keep up with the costs of rendering care. At least 50% – 65% of income that comes into a physician’s office is spent on overhead. That includes rent, liability insurance, staff salaries, equipment and supplies. None of the manufacturers of hospital gowns or exam table paper are cutting the cost of those supplies to us by 10%.
When you’re spending up to two thirds of your income on overhead, you simply can’t tolerate payments that haven’t kept up.
Dr. Val: What can patients do to protect themselves from being denied access to medical care?
Dr. Nielsen: Patients need to understand that this issue is about them. We physicians embarked on careers in medicine to serve them, and we’re hoping that Medicare beneficiaries and military families will reach out to the senators who did not vote with us and tell them that this is a critical issue that needs to be fixed. The AMA has a Patient Action Network available online or by calling a toll free number: 1-888-434-6200. Individuals should contact us to take a stand against these cuts. Patient groups have been very supportive – the AARP and representatives from the disabled community and assisted living were with us pleading with the Senate to block the Medicare cuts.
Dr. Val: What is the AMA doing to protect access to healthcare?
Dr. Nielsen: The Medicare crisis is an access issue. It is the insurance that seniors depend on and that our country has promised them. We do not want a Medicare meltdown. The responsibility for this crisis lies with the Senate. We are hoping that the Senate will come back from vacation and do the right thing.
Last year the AMA embarked on an unprecedented campaign to encourage all Americans to put pressure on politicians to find a way to cover the uninsured. This is the other major access initiative that we’re promoting.
Dr. Val: What do you make of the “concierge medicine” movement where doctors — who are fed up with insurance — simply stop accepting it?
Dr. Nielsen: It’s a symptom of doctors becoming frustrated with bureaucratic red tape and payment problems. Many don’t feel that they have enough time to spend with their patients, and can’t afford to practice the kind of medicine they want to with insurance-based payments. Concierge practice is not a big movement, but there are some good physicians who have made that choice. We’re hoping that more physicians are not forced to stop taking insurance, but those who choose this route report being very happy, and so are their patients. The problem is that for patients who cannot afford concierge medicine, it’s not a solution at all.
Dr. Val: What would you like to say to the American public today about the Medicare cut crisis?
Dr. Nielsen: We need your help and we need it immediately. Please call your senators over the long weekend and plead with them to do the right thing and help us avoid a Medicare meltdown – a crisis that is not in anybody’s best interest.
[Listen to the podcast]This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
