Healthcare Policy Roundup June 9, 2009

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One way to get rid of your chest pain … threaten the nurses and hospital staff with a knife in the emergency department. Police will come and shoot you dead.

Quote from the director of Calgary’s three emergency departments: “We have huge numbers of very sick patients essentially left behind in hallways and on ambulance stretchers for long periods of time, and across the country, in every major Canadian city, in every large urban emergency room, you have patients who are deteriorating or having adverse events as a result of these delays to care.”

Canadian ED overcrowding isn’t due to non urgent patients clogging the EDs according to this study. Instead, the study author, a 25 year old master’s student, states that overcrowding is “rooted in insufficient physical and human resources and poor integration within and between hospitals.” Before the problem of ED overcrowding can be cured, he suggests “determin[ing]the purpose of EDs in order to best serve the patients, health care professionals, communities and the country.” Good advice.

Sutter Roseville Medical Center is at risk of losing federal funding after a patient “walked away from the emergency room … and hanged himself in a wooded area 500 yards away.” CMS alleged that the hospital did not adequately screen the patient under EMTALA. Part of me wonders whether this action is somehow related to Suter’s decision to close another emergency department in its system. I may be wrong, but I just get the impression that there’s more than meets the eye going on here.

Ten previously blogged about how his group had been surreptitiously ousted by hospital administration. This article shows that having a good relationship with hospital staff can save your job. When Mercy San Juan Medical Center tried to fire their current emergency docs and hire docs from California Emergency Physicians, the hospital staff got up in arms and the deal fell through.

One way to cut state Medicaid costs … address high utilizers. This New Hampshire editorial states that frequent “ER” users only represented 5% of the Medicaid population, but those users accounted for 41% of the total Medicaid “ER” visits in the state during 2006.

Another way to cut state Medicaid costs … stop providing services. North Carolina Medicaid recipients may soon feel the “bite” of budget deficits as state legislators propose to cut payments for dental visits by 50%. Think this through, folks. It’s not like people with cavities will just go away. Where do you think people with dental problems will end up? Receiving that nice inexpensive care in state emergency departments. I’ll bet that the state Medicaid costs will increase if they go this route.

Funding issues causing problems with access to Connecticut hospitals as well. Connecticut hospitals lost $156 million in the last quarter of 2008 and $200 million in the first quarter of 2009. The state is underfunding its Medicaid program and hospital emergency departments are “busier than ever,” with uninsured patients making up 45% of hospital emergency department visits. Some hospitals are now requesting payment in advance for elective procedures.

Want to reduce your risk of malpractice? Be nice.Developing a rapport with the patient — is any physician’s best protection from eventually being sued by that patient.” One thing I don’t get – was this doc so busy that he couldn’t take off his surgical mask before posing for a picture in the article? Or is a surgical mask hanging around the neck the new fashion statement for surgeons?

A House Subcommittee recently approved a bill that would limit the Feres Doctrine for armed service members. Currently, members of the military and their families cannot sue the military for negligent medical care – regardless of how egregious the care was. The Carmelo Rodriguez Military Medical Accountability Act was named after a sergeant in the military whose bleeding buttocks lesion was repeatedly misdiagnosed as being a wart or a birthmark. Sgt. Rodriguez died from metastatic melanoma. I agree that doctors should be responsible for egregious care, but if we turn the armed services court system into another civilian medical malpractice system, how many military docs will leave? Another point of view from Walter Olson at Point of Law here. Fast care, free care, quality care – pick any two.

Physician’s Reciprocal Insurers, a med mal carrier that insures 25% of New York’s physicians has one foot in bankruptcy court and the other foot on a banana peel. State mandated insurance premium rate freezes appear to be partly to blame. How could this happen if insurers are raking in the money and are really responsible for the medical malpractice crisis?

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  1. “How could this happen if insurers are raking in the money and are really responsible for the medical malpractice crisis?”

    Without knowing the investment decisions they’ve made, your sarcastic question will have to remain unanswered. The fact is, though, that medical malpractice is profitable over the long term. Or do you think Warren Buffet is in the habit of buying businesses whose profit model doesn’t work. Or maybe NY docs have been committing more malpractice? We don’t have enough information to reach a conclusion.

    “but if we turn the armed services court system into another civilian medical malpractice system, how many military docs will leave”

    Probably none, since the money wouldn’t come from their own pockets anyway. Doctors aren’t rushing out the door in civilian practice now, so why would it change in military practice?

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