Government getting pissed because providers are beating it at its own game? When feds started pushing electronic medical records and threatening to penalize patient, a funny thing happened … the amount of money the feds spent on healthcare increased by billions of dollars. Now Kathleen Sebelius and Eric “Fast N Furious” Holder are warning that doctors that copying and pasting patient data between patient medical record entries should not occur because it risks medical errors and overpayments. They promise to “prosecute health care fraud” and will “consider future payment reductions as warranted.”
In other words, if you type or write the same thing over and over again, you’re fine, but if you cut and paste you are a prima facie criminal.
When people with no clue about the inner workings of the health care system attempt to create laws regulating the system, increased costs will result.
Medicare recently implemented a rule requiring that full hospital admissions must be reasonably expected to require a “two midnight” stay in the hospital, requiring physicians to certify the medical necessity of such care, and imposing more costs on patients if they do not stay two midnights. Do they really think that there will be less admits? All that is going to happen (and that is already happening) is more thorough documentation of a patient’s condition and comorbidities – which will increase billing levels further and will increase costs. Oh, and look for an increase in the number of new symptoms requiring extended hospital stays if a patient is stable to go home before the second midnight. What’s that, the patient’s pulse oximeter reading suddenly dropped? Let’s keep the patient on telemetry and do pulmonary function testing tomorrow? Whats that? The patient developed chest pain on the second night? Now they’ll have to be admitted another day for serial cardiac enzymes. Spending will go up not down because of this rule. Mark my words.
Oregon surgeon criminally charged and loses her license after patient dies from reaction to anesthetic in doctor’s office during a cosmetic procedure. Doctor faulted for not having equipment in the office to respond to medical emergencies, for performing a procedure in her office at night without staff support, and for failing to respond appropriately to a patient in distress. When another patient experienced dizziness and tachycardia after a cosmetic procedure, prosecutors alleged that the doctor put the patient at “substantial risk.”
State medical board hearings are becoming as serious as medical malpractice lawsuits.
Fascinating case report in the International Journal of Clinical Medicine. Patient suffers from Auto-Brewery Syndrome, otherwise known as Gut Fermentation Syndrome. 61 year old patient is constantly intoxicated without drinking alcohol – sometimes reaching levels of 400. Overgrowth of a certain fungus in the man’s intestine causes fermentation of excess carbohydrates into alcohol. After treating the patient with antifungals and temporarily putting him on a zero carb diet, then re-colonizing the gut with probiotics, the symptoms resolved.
Even more interesting is that the responsible fungus, Saccharomyces cerevisiae, is used to ferment beer and antibodies against it are markers for inflammatory bowel disease such as Crohn’s Disease and ulcerative colitis.
In addition, a related fungus, Saccharomyces boulardii, has been found effective in reducing symptoms of inflammatory bowel disease, irritable bowel syndrome, Clostridium difficile infections, and traveler’s diarrhea.
We have so much to learn about the microbiome in the gut and its effect on human health.
What happens when emergency physicians are routinely pressured to work overtime in high-stress and increasingly complex work environments? They leave. The UK’s NHS is concerned that there will be a staffing crisis in UK hospitals because fewer doctors are choosing to go into emergency medicine and more experienced doctors are leaving the country to practice elsewhere … which will increase the stress on the remaining physicians … which will cause more of them to leave … which will increase the crisis.
Who suffers? Patients.
But at least the care is free.
Interesting topic on Medscape discussion boards. Should a patient who attempted suicide be resuscitated in the emergency department? Or should the patient’s intent be honored?
Even more interesting is that much of the discussion focused upon liability associated with making the wrong decisions.
Another example of how human behavior is shaped by fear of liability.
Healthcare “superusers” are back in the news. This Kaiser article states that 1% of patients are responsible for 21% of all healthcare spending while 5% of patients are responsible for 50% of all healthcare spending. Reducing costs involves integrating their care.
What happens when relatives ask for information about an unconscious patient in the emergency department? Many times they get the “we can’t tell you anything due to HIPAA laws.” Such an assertion is not necessarily true. Disclosures in such situations are permissible, so staff can choose to do so based on their own discretion. But with increasing penalties for HIPAA violations under the HITECH Act, many practitioners choose not to take the chance. And don’t believe this attorney’s statement that “health care providers are only penalized when they act unreasonably.” Even incidental disclosures are subject to statutory penalties (see the HITECH Act link above) and the complaint of a HIPAA disclosure is easily enough to cause a hospital to terminate a healthcare provider’s job.
An example of what happens when we try to regulate (and or sue) our way to better health care.
According to this article in the American Journal of Emergency Medicine, more than one third of pulmonary emboli have a delayed diagnosis in the emergency department. Factors associated with misdiagnosis in patients admitted to the hospital included chronic pulmonary diseases such as asthma and COPD. Factors associated with misdiagnosis in patients sent home included fever, coughing up blood, and infiltrate on chest x-ray.
Wait times an issue in hospital emergency departments all over the world. Number of admitted patients waiting more than 24 hours to get a bed in Australian hospitals nearly triples in the past year.
An app to notify the emergency department about your symptoms before you arrive? I think this is a total waste of money. It is highly unlikely that there is going to be any ED “preparation” for a patient before the patient arrives. In many cases, the patients will be lucky if there is a bed available. And if forced to answer phone calls, all that will happen is that providers will be taken away from caring for other patients. While I think it may be an idea of limited utility, the docs who created the system and then sold it to Aetna are laughing all the way to the bank.
More on patients gone wild. St. Louis area’s St. Mary’s Hospital has had three attacks on emergency department nurses in two weeks. Two of the cases involved intoxicated patients.