May 11th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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In an ideal world ACOs should work. There is no evidence that untested and complex organizational structure of ACOs developed by Dr. Don Berwick (head of CMS) will improve quality of care and reduce costs.
ACOs are supposed to provide financial incentives to health care organizations to reduce costs and improve quality. There are too many defects in the ACOs infrastructure to improve the financial and medical outcomes.
At a conceptual level, the incentive for ACOs would be to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members would share the savings resulting from the increased coordination of care.
I have said over and over again that excessive administrative fees and ineffective management of chronic disease is the main source of waste in the healthcare system. ACOs do not deal with these main drivers of costs.
The only stakeholders who can demand that this waste be eliminated are consumers/patients. Patients must control their healthcare dollars. They will make sure there are competitive prices and will not permit duplication of services. Read more »
*This blog post was originally published at Repairing the Healthcare System*
May 10th, 2011 by Linda Burke-Galloway, M.D. in Health Tips
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If a pregnant woman finds herself scratching and itching during the third trimester, these symptoms should not be ignored. Each year, approximately 0.1 to 15% of pregnant women are affected by a liver disorder called Intrahepatic Cholestasis of Pregnancy or (ICP). ICP patients tend to develop symptoms of itchiness of their hands and feet that becomes progressively worse and then spreads all over their body. The itchiness usually worsens at night and if untreated can cause jaundice and several life-threatening complications to the unborn fetus. When a pregnant woman complaints of itchiness (pruritus) all over her body, the first order of business is to determine whether a rash is present. If a rash is absent, ICP should be suspected.
The liver is the largest gland in the body and in addition to filtering harmful substances such as alcohol it is also responsible for processing fats, carbohydrates and proteins. To process fat, the liver makes bile salts. In ICP, bile salts are increased which contributes to the symptoms of itchiness. Affected women will not only be plagued by pruritus but their unborn babies are at risk for stillbirth, preterm labor, fetal distress and abnormal heart rates. South American women and especially those from Chile have a greater risk of developing ICD as do women from South Asia and Sweden. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
May 10th, 2011 by BarbaraFicarraRN in Health Tips
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Thanks to Laura Landro for shining light on unsafe injections in her WSJ blog, “Unsafe Injection Practices Persist Despite Education Efforts.”
Landro writes:
“A new push is underway to eliminate unsafe injection practices, which remain a persistent safety problem despite years of efforts to educate clinicians about the risks of re-using needles, syringes and drug vials.
In the U.S., failure to follow safe practices in delivering intravenous medications and injections has resulted in more than 30 outbreaks of infectious disease including hepatitis C, and the notification of more than 125,000 patients about potential exposure just in the last decade, according to health-care purchasing alliance Premier Inc.”
As a registered nurse this is unthinkable. Learning to administer injections safely is “patient care 101.” There is no excuse for any health care professional to unsafely inject patients.
Patients in the hospital, ambulatory surgical centers or outpatient settings, should expect that their nurses, doctors and other clinicians are administering injections safely. Read more »
*This blog post was originally published at Health in 30*
May 9th, 2011 by DrWes in Health Policy, Research
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Quality measures. Patient satisfaction surveys. With our new health care reform law, these “performance measures” are the new black in health care.
Hospitals are currently spending, conservatively, tens of millions of dollars to bolster these “performance measures” in hopes of securing a refund of a mere 1% of payments that CMS will soon withhold from them in the name of “assuring” quality improvement.
But what if, nationwide, there wasn’t a big difference in these measures between hospitals? What happens then? Might payments then be made on political grounds?
Performance measures have been collected for some time now in anticipation of this new payment initiative by the government, so data exist to evaluate. In fact, Kaiser Health News was nice enough to aggregate the findings from our government’s Hospital Compare website for my review.
So I calculated the mean, median and standard deviation of the results of all of this data collected across 50 states and 2 territories and found very little difference in measures collected between states: Read more »
*This blog post was originally published at Dr. Wes*
May 3rd, 2011 by Happy Hospitalist in Opinion, True Stories
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America’s handicap bathroom definition has officially left the train depot for the next station. In America, we are entitled to life, liberty and the pursuit of happiness.
Oh yeah, and bariatric rated bathrooms. I snapped this picture of a bariatric rated “handicap bathroom” at the hospital Mrs Happy delivered Zachary
A part of me feels for folks who struggle through life outside their home in search of a toilet adequate enough to do their thing. Bathrooms and toilets simply aren’t made to hold the weight or size of 300, 400 or 500 pound people and neither are the hospital toilets.
Part of me wants to believe these bariatric rated bathrooms are for the oversized pregnant women on the floor. But the rational side in me knows otherwise. America is fat. And we have the bariatric rated handicap bathrooms to prove it.
*This blog post was originally published at The Happy Hospitalist*
