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 13th, 2011 by BobDoherty in Health Policy, Opinion, Primary Care Wednesdays
No Comments »
When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems.
And who can blame them? Older internists have seen this all before, and the word has gone out from them to medical students and younger doctors not to trust policy prescriptions that promise to save primary care. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
April 13th, 2011 by Medgadget in News, Research
No Comments »
IBM and the Institute of Bioengineering and Nanotechnology in Shanghai have designed a new type of polymer that can detect and destroy antibiotic-resistant bacteria such as MRSA. The polymer nanostructures also prevent bacteria from developing drug resistance. Moreover, because of the mechanism by which the nanostructures work, they don’t affect circulating blood cells, and, unlike most traditional antimicrobial agents, the nanostructures are biodegradable, naturally eliminated from the body rather than remaining behind and accumulating in tissues.
From the Nature Chemistry abstract by Nederberg, et al.: Read more »
*This blog post was originally published at Medgadget*
April 9th, 2011 by Happy Hospitalist in Health Tips, Opinion
No Comments »
After eight years of hospitalist medicine and seeing inaccurate urinalysis results day after day, year after year, I’ve come to the conclusion that the straight cath vs clean catch debate is not a debate. If the urine didn’t come from a straight cath, I have zero faith in the accuracy of the results.
I know, I know. It takes time and effort for a nurse to perform the straight cath. It’s not comfortable for the patient to have a catheter inserted into their urethra. Plus, with bad nursing technique, one could introduce bacteria into the bladder when performing a straight cath urinalysis.
All that aside, if I’m a physician trying to make medical decisions based on accurate data, then having bad urine results that don’t represent the true picture is worse than not having any data at all. For example, here’s a classic case of what I have to deal with day in and day out when trying to make medical decisions on my patients. Below is a snap shot of three UA results obtained from Happy’s ER over two visits. I’m sure it’s the same no matter where you get your care in this country. The first two urinalysis results came from a clean catch sample of a horribly weak 89 year old female who presented with family complaints of “fever and weakness”, both days. Read more »
*This blog post was originally published at The Happy Hospitalist*
April 7th, 2011 by John Mandrola, M.D. in Research
No Comments »
For competitive cyclists, Sunday morning usually signifies a time for combining spirituality with calorie-burning. Whether we are immersed in the total focus of a hotly-contested bike race or meditating our way through a seemingly endless training ride, it’s a given that most cyclists use Sundays to churn out the kilo-joules.
This kind of Sunday-behavior differs significantly from many regular (normal) people, who like to sleep late, get up slowly, dress themselves nicely and amble off to church. It goes without saying that this kind of spiritual exercise doesn’t burn many calories. And it is also well known that worship and consuming high-calorie comfort food frequently go hand in hand.
In the hard-to-believe-that-people-study-this kind-of-thing category, comes a report that frequent churchgoing in young adulthood increases the risk of obesity in middle age. Really, I am not making this up. The story was reported prominently here, on the theHeart.org. Read more »
*This blog post was originally published at Dr John M*
