Cancer patients covered only by Medicare face problems getting chemotherapy …
Massachusetts Health Plan underfunded
Above the Fold
Average Time of Discharge: Why a Hospital is Not a Hilton
Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.”
But when did we turn into the Holiday Inn?
Let’s start by appreciating where this comes from. Many hospitals, including mine, tend to run full – given the huge fixed costs of operating a modern hospital, being full is probably the only way you can be profitable, just like the airlines. Queuing theory (don’t tell me you’ve forgotten your queuing theory!) tells us that, when you’re full, you should look for fundamental choke points and do your best to relieve them. There are PhDs working for McDonald’s whose lives are dedicated to figuring out how to avoid lines at lunchtime rush hour, and others working in aviation who model the best ways to load passengers onto planes (latest answer courtesy of a Fermi Lab astrophysicist: start in the back and load every third row, back to front, sequentially).
The main stenosis in hospitals occurs in the early afternoon: the morning’s OR cases are finishing, the ED is heating up, the clinics are sending over elective and urgent admissions, the respiratory therapists have done their weaning and “liberated” a few patients from vents… and everybody needs a floor bed. Now! But they’re all taken, since nobody’s gone home yet.
Gridlock. Bad for business.
How do you fix this? About a decade ago, some smart consultant (I can’t figure out who, but he or she must have had a terrific PowerPoint slide making this point since every hospital I know of picked up on it) came up with the solution: let’s measure and report the time of discharge by service, shining the holy light of transparency on service chiefs like me to get them cracking. And since everybody likes Goals, how about we set a guideline – “The Discharge Time on 5 South is 11 am” – and post it in every room and nurse’s station. Then it won’t be a shocker to the patients when we try to hustle grandma into the wheelchair and roll her out of her room before noon.
Prosecution in organ harvest case faces hurdles at trial
Although neither the prosecution nor defense has shown its entire case, the unusually long eight-day preliminary
hearing for transplant surgeon Hootan Roozrokh revealed considerable details about what happened during Ruben Navarro’s final hours and the hurdles both sides must overcome at trial.
San Luis Obispo County prosecutors jumped their final pretrial hurdle March 19, when a judge ruled that a jury would decide whether Roozrokh committed dependent adult abuse Feb. 3 and 4, 2006, at Sierra Vista Regional Medical Center in San Luis Obispo.
Never before in the United States has a transplant surgeon been tried criminally under similar circumstances, and the transplant and medical communities have followed the case closely. No trial date has been set, but if the preliminary hearing is any indication, the trial likely will be lengthy with many witnesses and substantial expert testimony.
Entering Unfamiliar Territory
If universal coverage mandates that employers provide health insurance or that people secure it themselves, it is highly likely that the majority will choose the lowest cost option, or “low premium” (aka HDHP or high deductible health plan). These plans enable consumers to open an associated financial account – HSAs. In addition to helping consumers plan their spending, savings and investment for current and future health needs, HSAs provide a triple tax free opportunity to save for retiree health.
Criminal charges filed against transplant surgeon
Prosecutors in a small town on California’s Central Coast are making history. For the first time in the United States, they brought criminal charges against a transplant surgeon, alleging he prescribed excessive amounts of medication in an attempt to hasten a disabled man’s death and harvest his organs. The case cleared its final pretrial hurdle Wednesday and will now go before a jury later this year.
San Francisco surgeon Hootan Roozrokh faces one felony charge of dependent adult abuse, for which the maximum punishment is four years in prison. Roozrokh, 34, has pleaded not guilty and his attorney, M. Gerald Schwartzbach said his client looks forward to clearing his name at trial.
The Roozrokh case has attracted much national attentionand raises worrisome questions about whether the transplant community is pressing too hard to increase the nation’s organ supply, thereby creating situations ripe for blurring ethical boundaries, such as this one.
A Detailed Analysis of Barack Obama’s Health Care Reform Plan
Thanks to a very high Google ranking this has been the most popular ever post on THCB. And it's an excellent analysis by Robert Laszewski. who writes The Health Policy and Marketplace Blog. However, it was written during the Democratic primaries in 2008 and is of course out of date. THCB suggests that you checkout a few other intriguing posts too.
For more recent posts on health care reform, try a smattering of these:
- Health Reform and Obama's Leadership by Rahul Parikh
- The Affordability Model by Robert Laszewski
- No Country for Old Men by Jeff Goldsmith
- Two Rules by Which to Judge a Health Reform Bill by Matthew Holt
- Ditching the Public Option by Robert Laszewski
- No Alternative: An Analysis of the GOP Plan by Harris Meyer
and of course enjoy Bob's analysis too!:
Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.
The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.
By contrast, the McCain Republican strategy for health care reform would first emphasize market reforms aimed at making the system affordable so more Americans can be part of the system and he claims that there would be no additional upfront cost.
Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”
The three parts are:
1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health
Obama claims that his health care reform plan will save the typical family up to $2,500 every year through:
* Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems.
* Improving prevention and management of chronic conditions.
* Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead.
* Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
* Making health insurance universal which will reduce spending on uncompensated care.
Will Obama be able to cut the typical family’s health care costs by $2,500 a year?
Well, yes and no.
A Doctor Grows in Brooklyn
Doctor Jay Parkinson became a media celebrity last year as word spread about his unconventional practice in Williamsburg, Brooklyn. Instead of maintaining a traditional office and paying support staff, Parkinson’s operation is entirely virtual and requires almost no overhead. (Unless you consider a Mac overhead.) Using his apartment as a base, He runs a web site loaded with Web 2.0 touches that allows patients to communicate with him easily and explains his services in plain English. After an initial in-person consultation, exchanges can be online and are conducted through either instant messaging or web chat.
“The healthcare industry is so stuck in 1994,” he says, “The only way they’ve used the Internet is to provide information. I look at the Internet as something that provides communication.”
Health 2.0: Weighing In With a Reality Check
Maybe you saw the article: “Health 2.0 Helps, But Personal Contact Remains Top Weight Loss Strategy.”
OK. I made up the headline. But the information comes from an article that provides food for thought for those of us who speak, blog and otherwise evangelize about the good things the Internet is bringing to
health care. Here’s one question to start with: is there a different ethical obligation for those promoting the efficacy of an online health intervention than for those promoting a site to help you find a great
hotel?
Mother-Power Online
4 in 5 moms go online at least once a month, according to My Mommy’s Online. The report is based on 2007 data from Simmons Consumer Research Survey published by eMarketer.
"Being a parent makes going online almost a necessity," according to eMarketer.
40% of all women who go online in the US are mothers with kids under 18. There are 35 million of them (including me).
Intriguingly, virtually all women who are pregnant (94%) use the Internet, and half of the mothers surveyed use the Internet more since having a child.
What do Moms do online?
94% visit portals
88% visit retailers
74% go for news and information
70% go for conversation.
BabyCenter found that 68% of moms regularly make purchases online. This makes sense: moms are busy people, shopping online is convenient and substitutes trips to the store.
Speaking of BabyCenter, it was arguably the most heavily shopped site in 2007 according to comScore (even though it is categorized the site as a media site).
In any case, BabyCenter reaches 78% of pregnant women and mothers of kids up to 24 months in the U.S.
The site also maintains a 60,000-mom panel for market research which is a rich mine for finding out What Moms Want. Since mothers are primary caregivers in the household, this is an important site for health.
Lessons From a Sad Error
I think many people have seen this sad story of a wrong-sided kidney removal in Minnesota. We all feel the pain for this poor patient. It is difficult for us non-physicians to understand how this happens, for the pathway to the error seems remarkably clear after the fact. But, we have to understand that the actual delivery of medical care contains multiple opportunities for mistakes, and even extremely competent and well meaning doctors and nurses can find themselves in shock afterwards when this kind of thing occurs.
Here are two emails I have received on the topic which both offer useful perspectives on the matter.
First, my buddy E-patient Dave writes:
I’ve caught a couple of errors on my radiology reports, and have had them corrected. Both VERY minor compared to this. Can there be any doubt that patients need to have access to their records, as PatientSite allows, and need to be aware of their need (and ability) to read them?
Second, from one of our senior surgeons to his colleagues:
As copied below, another high profile event, to remind us how easily error can occur. In this case the consent was wrong when done in the office, and it was the only document used to confirm sidedness at the time out. As you read the article, you will note this tragedy extends not only to the patient but to the entire team, as well as the institution.
I would remind you that we had our own "near miss" here at BIDMC, which was caught by the attending surgeon, and confirmed on reviewing the images. In our case, the patient had confirmed the wrong site to the nurses, residents and fellows involved, so patients are not infallible. To best avoid this we (multiple providers) must use multiple sources of information (including the patient, exam, imaging and documentation), and we must have all OR participants agree actively that the patient ID, procedure, side and site are correct. Also as highlighted by this case, the episode of surgical care and opportunity to err starts the first time we see the patient.
