Healthcare Update Satellite — 11-04-2013


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72 year old Connecticut patient awarded $9.3 million after being hospitalized for UTI, then given overdose of Lovenox. She developed intra-abdominal bleeding and required several surgeries and blood transfusions to correct the problem. She also developed a large abscess at the site of a central line insertion. Attorneys for the patient say that it was “an understatement” to say that the standard of care was violated.

One of the ideas behind providing more patients with “insurance” (not with “health care,” mind you) is that the insured patients will be less likely to use the emergency department. Untrue. When few doctors take the patients’ insurance, often the patients’ only option is to go to the emergency department. In addition, the emergency department is free for Medicaid patients. The Cato Institute’s Michael Cannon was quoted in the article. I’ve argued with Michael Cannon about his opinions in the past, but this time he is right on the mark when he says “Nobody spends (other people’s) money as carefully as they do their own.” In other words, with no skin in the game, patients have no incentive to limit spending.
The policymakers in Washington have no idea about the economics and incentives of this perverse system they are creating.

October 2013 study in Pediatrics shows that 10% of 14-20 year old ED patients at the University of Michigan admit to nonprescription opioid or sedative use.
My jaw dropped when I read that 12% of these kids had been prescribed sedatives but then I realized that it was 12% of the 5% of kids who reported using sedatives … or about 0.6% of the total patient population. That’s still a lot but it’s better than 12%.

InQuickER still allowing patients to schedule appointments in the emergency department and bypass other patients waiting in the waiting room. At some point a smart plaintiff attorney is going to realize that an EMTALA claim against a hospital using this service is a slam dunk.

Our national health care plan sucks so much that doctors are refusing to accept patients with government “insurance.” That, dear readers, is the difference between health “care” and health “insurance”: Health insurance is a false promise of obtaining health care. Virginia Democrat Kathleen Murphy has a solution to the problem, though: Force doctors to accept Medicare and Medicaid patients.
Our government is getting awful comfortable “forcing” the private sector to engage in activities that go against acceptable business practices. Obamacare forces insurance companies to provide policy coverage that makes policies too expensive and that provides services many people neither want nor need. Then Obamacare forces insurance companies to offer policies to people regardless of their pre-existing conditions. But insurance means nothing without being able to provide the health care and that’s a business the government doesn’t want to be involved in. So now politicians are floating trial balloons about forcing doctors to treat patients. Hopefully, this idea gets shot down quickly and forcefully.

Too many nursing home patients being sent to emergency departments? A research letter to the editor of JAMA Internal Medicine shows that the number of visits for preventable causes increased 21% between and that the number of visits for non preventable causes increased 23% from 2001 to 2010. More than half of the “preventable” visits were due to either pneumonia or UTIs.

Saving money by cutting services. New York’s St. Luke’s Cornwall Hospital plans to close its emergency department between 10am and 10pm in order to save more than $1 million per year. Patients needing emergency care will be directed to another hospital 5 miles away.

More on saving money by cutting services. Massachusetts’ North Adams Regional Hospital proposing closure of its psychiatric facility. The hospital is having financial difficulties and reimbursement for care of psychiatric patients is notoriously low. The hospital’s director of finance says that “Unless change happens, [the next hearing]won’t be about closing one unit, it will be about closing all the units.”

Michael Jackson’s former physician Conrad Murray is out of jail, but will he ever be able to practice medicine again?



    • While I share your concern about the high proportion of American children who are on regular medication, I see a problem with the figures in the linked post:

      “Some of these children are certainly benefiting from long term medication. Optimal asthma control, for instance, can be life changing for a child. But over the broad range of approximately one hundred million children taking daily medication in this country…”

      Huh? Take into account the other claim made there, that

      “One in four children in the U.S. are on chronic medications!”

      and that means we reckon that four hundred million of the three hundred and seventeen million citizens of this country are children?


  1. We are already forced to accept Medicare. I’ve personally opted out of Medicare, but if a Medicare patient comes in, I am not only required to treat them but required to accept the Medicare payment as payment in full even though I am not a Medicare provider. There is no getting around it for ER docs, we are Medicare slaves.

    • Wow! Blast from the past! Good to see you’re still lurking. Welcome back.

      Kind of a nuance, but an important point regarding this comment. Technically, EMTALA requires that *hospitals* evaluate and stabilize any patient that comes to the ED (“the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department“).
      EMTALA only applies to ED physicians because we contractually agree to provide the services when we apply for medical staff privileges. So an “EMTALA violation” can occur against the hospital for failing to stabilize the patient, but there is no statutory requirement to treat or statutory penalty for failing to stabilize that is made against individual physicians. The only requirement imposed upon physicians is that if a physician agrees to be responsible for examination/treatment/transfer of a ED patient, the physician must not misrepresent the risks/benefits of transfer and must not misrepresent an individual’s condition. 42 USC 1395dd (d)(1)(B).

      So even though the practical outcome is the same, emergency physicians technically aren’t “forced” to see patients by law, but are required to evaluate and treat patients by virtue of their contracts to provide services at participating hospitals. Hospitals are “participating” when they accept money from the government. So if a hospital received no federal funds, it technically wouldn’t have to comply with EMTALA.

      The importance of the distinction is that now some legislators are looking to extend the duty to provide medical care from the business organization to the person. They are also looking to force private citizens to provide services that those private citizens would not otherwise provide.

      Hospitals are required to provide services to the government because the hospitals have become dependent upon the government money. Forcing physicians to provide services to the government and then “take what we decide to give you” as proposed by Ms. Murphy literally does result in slavery.

      • Imagine if we had LegalCare or PlumberCare or RestaurantCare, whereby lawyers, plumbers and restauranteurs who were private citizens could be forced by the government to provide goods and services “at cost” or below to those deemed by the Government to be deserving of those goods and services?

        The Obamaphone lady could front up to Le Bernardin whenever she felt in need of feeding and they’d have to give her the chef’s tasting menu (normally $140), send the bill to the government, and eventually (in two or three months’ time) receive whatever the government felt like paying… say, $5.00.

        And any restauranteurs who complained would be painted as greedy bastards (and probably racists, too) who want to see “disadvantaged” Americans suffer and die on the streets of starvation.

      • As ER docs, we see all who come in, that’s what we do. I’m fine with that. Just let me bill everyone what I feel my services are worth. Medicare fixes our rates so we can only charge a ridiculously low amount, even if we opt out. I’m not fine with that. I don’t want any Medicare money, just let me bill the patient directly. Why should the fact that a patient turns 65 years old make them eligible for my services at drastically reduced rates whether I agree or not? It’s un-American and unconstitutional.

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