Health care takes some good steps forward

harlanYes, there can be progressive steps in health care—and with all the controversy and change going on in the sector it’s worth spotlighting some of these:

Patients should get access to own health records, researchers say

  • Three researchers—Dr. Harlan Krumholz of Yale Medical School (photo right), Connecticut lawyer Jennifer L. Cox, and Yale student Austin W. Jaspers—deserve credit for publishing a pointed opinion piece in the JAMA Internal Medicine detailing the costs and needless obstacles patients confront when they want copies of their own health records. As Krumholz told Reuters of the study’s message about excessive records fees charged by doctors and hospitals:  “Higher costs are a higher barrier for people to get their own information. Without that information it is not possible to correct errors in the record, get informed second opinions, donate your data to research – or share with others what is happening with your care.”  That’s spot on, doctor, as I have written recently and in my book,  The Life You Save: Nine Steps to Getting the Best Medical Care, and Avoiding the Worst. Uncle Sam has stepped in and tried to make it easier and more affordable for patients to get their own records, which Krumholz and company point out should be even more available now that they are digitized (he’s working on software to help, too). But states aren’t doing enough to help, except for Kentucky, which requires a free first copy on request, he and his colleagues say. My firm’s site contains information that may be helpful to those struggling to get their records. Here’s hoping that doctors, hospitals, and other caregiving facilities read the Jaspers, Cox, and Krumholz viewpoint, and, because it appears in one of their publications and Krumholz is a physician-researcher of growing influence, they heed it more.

USA-Football-300x158Finally, safety changes in rules for youth football

More protections for nursing home residents but …

  • Because I see in my practice the terrible harms that occur in nursing homes due to neglect and abuse, I’m pleased to see any glimmers of improvement in this challenging part of health care. As Paula Span has pointed out in her New York Times “The New Old Age,” Uncle Sam is pushing forward with some good seeming regulations to better protect residents. Wielding the powers of the considerable funding they provide to nursing homes, officials with Medicare and Medicaid last fall started rolling out new rules affecting 15,600 institutions and the care of 1.5 million older and disabled Americans. Span says the latest rules seek to ensure patients can choose who they will or won’t see. They force homes to take more responsibility for securing residents  personal belongings, and in ensuring their staff get better training in caring for those with dementia and in averting elder abuse. The rules try to curb patients getting bounced around from nursing homes to hospitals but not back—a kind of “dumping,” in which institutions try to off-load problem residents by insisting they need medical services at hospital but then refusing to take them back once they get them. Uncle Sam also has stepped up grievance procedures for patients. But, sadly, industry leaders have resisted, for now, regulators’ efforts to block nursing homes from hiding behind a dubious legal shield. They do this by requiring stressed out patients and familes to sign away legal rights and to submit disputes they have with nursing homes to arbitration, instead. I’ve written about ending compulsory arbitration, and it is a step that’s badly needed so nursing homes can’t push significant problems involving negligence, elder abuse, sexual harassment, and even wrongful death, out of public view and the civil courts, and into a private system for hire. It’s also discouraging that Span reports that nursing homes, again for now, have talked regulators into skipping rules that would “incorporate specific staff ratios or minimum hours of care in the new regulations, or to require nursing homes to have registered nurses on site around the clock. (Current rules require R.N.s only for eight hours.) Instead, homes must develop assessments of their resources and residents’ needs and hire accordingly.” We inch forward but must stay atop our lawmakers and regulators to do right by seniors.

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