The Health Care Blog – Page 669 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Tonsillectomy Confidential

Jan 14, 2012• 10

By Seth Roberts

In 2008, Rachael Hoffman-Dachelet’s eight-year-old son started having frequent sore throats. He’d run a fever, feel stiff and tired, and miss a few days of school. After six sore throats in a year, her pediatrician said This is crazy. I’m going to refer you to an ear nose and throat specialist. I think he’ll recommend a tonsillectomy (tonsil removal).

Rachael and her son saw the specialist, who did recommend a tonsillectomy. Tonsils are part of the lymphatic system, a network of tiny tubes and nodes all over the body. It is mostly a drainage system. Lymph drains into the tubes, which carry it to the heart, where it reenters the blood. En route to the heart, lymph passes through nodes. How can lymph move through the system if you remove part of it? Rachael asked the specialist. If there were any bad long-term consequences we’d know because so many tonsillectomies have been done, he said. The correct answer is that lymph does not pass through the tonsils. Rachael asked about the benefits of the surgery. Your son will miss a lot less school, he said.

Rachael teaches art at a Minnesota middle school. Her experience with doctors had made her skeptical of their predictions.

To decide for herself if a tonsillectomy was a good idea, she googled “pubmed tonsillectomy meta-analysis” and found a Cochrane Review about tonsillectomies and tonsillitis. There are thousands of Cochrane Reviews. Each tries to summarize the evidence about the effect of a treatment on a health problem (e.g., “Antibiotics for sore throats“). They are meant to be practical — to help everyone, including outsiders like Rachael, make treatment decisions (such as “should my son have a tonsillectomy?”). They are produced by the Cochrane Collaboration, a British non-profit, which says its reviews are “internationally recognised as the highest standard in evidence-based health care”.

Competition in Health Insurance: What Should Government Do?

Jan 13, 2012• 3

By John Graham

Many Americans complain that there is too little competition between health plans. To some degree, this is true. Few of us are allowed to choose our own health insurance. Instead, we take whatever our employers offer us.

However, we must not succumb to the natural temptation to call for more government intervention to reverse this problem. On the contrary, concentration among health plans has largely occurred subsequent to government action.

Signed in March 2010, ObamaCare has certainly had the opposite effect than that promoted by its advocates. The table below shows premiums in the small-group market in 2008 and 2010, for 37 states with available data.

Two Patients Coded

Jan 13, 2012• 1

By Paul Levy

My recent post on end-of-life care issues, “What if they had had to pay?,” generated a lot of comments in the blogosphere and beyond. One intensive care doctor sent me a particularly poignant note. It gives a good sense of what it is like on this person’s side of the bed. The note re-emphasizes the need for better end-of-life planning, for the sake of patients, families, and providers.

Here’s my day so far. This is my first day of a 7-day stretch in a tertiary ICU. The average census in this ICU is 10, but today we have had to surge to 15.

Let me stop right there. This is doctor (and nurse) shorthand for, “I expect to be very busy, very tired, and very stressed out. I am going to have to make some highly critical clinical judgments, sometimes with very little time to react. I don’t know anything about these patients beyond what is in the charts and what our care team sees and hears for themselves.”

Two patients today coded in our hospital. One family wants “everything” done, and seemed shocked to learn that I don’t think it is right to provide “everything.” The other family wished someone from the healthcare team had bothered to ask them what their 89 year old dad would really like to accomplish from his hospital stay before he tried to die. We decided to let him finish dying.

Continue reading…

Meet the iPAB!

Jan 13, 2012• 10

By D. Brad Wright

Contrary to the title, the IPAB is not a new Apple product. Rather, it is the “Independent Payment Advisory Board” created by the Affordable Care Act to solve the problem of ever-increasing Medicare spending.

In people’s worst nightmares, the IPAB is a death panel that will make decisions about how to ration health care for the elderly and disabled. Images of 15 people sitting in a room handing out death sentences flash through the minds of the anti-government crowd.

Nothing could be further from the truth, as the IPAB has no authority to limit benefits, increase beneficiaries’ out-of-pocket costs, or otherwise alter the Medicare program in any way that would “ration” care.

So what can the IPAB actually do to promote slower spending growth in Medicare?

They can suggest legislation, that’s what. Legislation that, for example, would reduce or alter the way in which payments are made to providers. It’s debatable if the recommendations from IPAB will work to actually control spending. What’s not up for debate is whether action will be taken, and that’s what I’m most pleased about.Continue reading…

A Constitutional Right not to Be Bankrupted

Jan 13, 2012• 6

By Frank Pasquale

Those challenging the ACA in court profess deep concern about government forcing citizens to buy insurance or pay a fine. The fundamental harm here is monetary; it’s about being required to purchase insurance, not to use it (or to get any medical care at all).

If the Court agrees with them, why can’t there be a parallel monetary right not to be bankrupted by health care costs? In the 1973 case San Antonio School District v. Rodriguez, the Supreme Court decided, by a 5-4 vote, that children did not have a constitutional right to education. But at that time, at least four justices thought the state was obliged to make a decent education available to all. Why can’t a future Court do the same for health care?

If the current Supreme Court were to declare the ACA unconstitutional, it would need to abandon several landmark precedents. That’s not a problem for the Roberts Court; it’s already jettisoned once-venerable holdings on campaign finance, equal protection, antitrust, and voting rights.

For many Americans in these tough economic times, rights to education, housing, health care, and food are a lot more meaningful than the right to be free of an insurance mandate. We the people can locate these ideals in a Constitution and a Declaration of Independence rich with grand and sweeping language. If the ACA’s opponents can use our nation’s founding texts to undermine the ACA, those who care about meeting basic human needs need to gear up to use them to do quite a bit more.

Bring Back the Public Option

Jan 13, 2012• 108

By Scott Carroll

The way health care is administered in the United States is unsustainable and in need of fundamental reengineering — right? During the 2008 presidential race, the country appeared to be in agreement on this point. But that all changed somewhere, somewhere after the election of a dark-skinned new president with a foreign-sounding name whom even proud Medicare card-carrying Americans were viscerally driven to deride as a socialist.

This was recently reported in The Hill: “The six largest investor-owned health insurance companies saw a 22 percent increase in combined net income in the third quarter, putting them on pace to break profit records for 2010.” The president was castigated by loud little crowds around the country for championing the overwhelmingly popular idea of a publicly funded, public health insurance alternative to challenge the partly publicly funded, private health insurance companies’ assertion that they simply cannot provide their services any cheaper. Rather than groundbreaking legislation, what we got was the president being caricatured on national television, in effigy, as The Joker — and health insurance executives laughed all the way to the bank.

Patients Rating Doctors: Let’s Pay Popular People More!

Jan 13, 2012• 2

By Doc Gurley

My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of his teeth, and was such a frequent victim of head trauma that depressions and scars ridged his balding skull.

Over the last week, our substance abuse counselor had daisy-chained together an impressive series of phone calls, blood tests, and clearance forms to line him up for one of our rarely-available detox beds.

Only 20 minutes to go.

But it was 20 minutes too long for him.

How Healthcare’s Embrace of Mobility has Turned Dangerous

Jan 11, 2012• 9

By Eric Lai

No industry has adopted mobility faster than healthcare.

Doctors love their devices. 81% of physicians have smartphones. They also love their apps. 38% of them use medical apps daily. One-third use smartphones or tablets to access electronic medical records today, with another 20% expecting to start using them this year.

For instance, 200 doctors and nurses at Charite Berlin, one of Europe’s largest hospitals, are piloting SAP’s new Electronic Medical Record app on iPad.

The app allows medical providers to trade their clipboards for (electronic) tablets, which present them a clean dashboard that lets them drill down into data such as medical history, medications (and allergies), X-rays and vital signs. It pulls that data down from a speedy SAP Hana in-memory database.

CES Mania Over at Health 2.0 News

Jan 11, 2012

If you’re not seeing all the news and views coming out of the Digital Health Summit at the huge CES show in Vegas–a big segment of the Health 2.0 team is there so you dont have to join the hour long cablines. There’s a series of fabulous articles on new products, a great newsbites roundup and an interview with the new Blueprint Health incubator launching in NYC this week. All a click away here—Matthew Holt