Articles Posted in Hospitals

mal200x267In the battles between lawyers and doctors over malpractice lawsuits filed by patients harmed while seeking medical services, it may be worth heeding economists’ prescription for caregivers: Physicians, heal thy selves.

Aaron Carroll, a pediatrician and health policy expert at Indiana University, has written in the “Upshot” column of the New York Times that research shows that so-called tort “reforms”—including current initiatives on medical malpractice by the Republican-controlled Congress—may be misguided.

That’s because advocates committed to greater patient safety and improved care may find more impressive results on the medical not the legal side of “reforms,” Carroll argues. He points to persuasive data from Florida and Texas hospitals and how they fare with lawsuits and their rankings with Patient Safety Indicators (PSIs).

end-of-life-800-300x198Many hospitals and doctors rightly have campaigned to get more patients to provide information in advance about their end-of-life care choices, but doesn’t that mean that the choices when made should be respected? And if they’re not, what role do the courts have?

Paula Span, a New York Times columnist who writes on aging issues, reports that a growing number of patients and families have sued hospitals, doctors, and nurses for disregarding or overriding advance directives. There are various kinds of these legal documents. But they often become part of patients’ medical records, directing caregivers, for example, that an individual does not want extreme measures taken to resuscitate them or to sustain their lives.

This can go against deep traditions in medicine, especially for caregivers accustomed to crisis responses in difficult, exigent circumstances. They think of themselves as life changers and life savers. At the same time, patients have insisted that their rights and choices demand respect. Many physicians and hospitals have recognized and encouraged this, as has the U.S. health care system more generally, for example, via Medicare.

codes-300x220Hospital care accounts for a third of the nation’s $3 trillion in annual spending for medical services. And not only are these charges increasing—and driving up health costs—they’re infuriating patients and their families. Who can make heads or tails of hospital bills? And if consumers do, will they discover billing practices that only anger them more?

Elizabeth Rosenthal, a seasoned journalist, accomplished medical correspondent, and a non-practicing doctor, has created a stir with “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.” It’s her new best-seller, and was excerpted recently in the New York Times Magazine.

The book and magazine story delve, in part, into the sausage-making aspects of medical billing. These systems have enslaved American health care. They turn on bulky, balky coding systems that provide a short-hand summary for every therapy that patients receive from providers—physicians and hospitals. In turn, payers—patients, insurers, and Uncle Sam—rely on the codes to determine fees they will fork over for services and materials. In between are platoons of coders and billing experts for payers and providers, warring over ever number and the money they represent.

popularOcareRepublicans in Congress are heading home to their districts for a spring break. Will they hear again from angry constituents—but this time from zealous supporters angry that they failed to fulfill their seven-year promise to repeal and replace the Affordable Care Act aka Obamacare?

Maybe, maybe not. It seems the House GOP, especially, has remedied one of President Obama’s notable shortcomings: Republicans have churned through the ACA so thoroughly and publicly that they have convinced Americans that Obamacare’s pretty good.

It’s polling more strongly than ever, hitting a peak 55 percent approval rating. Americans say they want politicians to improve the existing ACA, not replace it with the failed American Health Care Act, aka Trumpcare.

howard-300x231It may be easy to forget. But hospitals not that long ago refused to care for black Americans. If they did so, they kept them separate and far from white patients, shunning African Americans in separate wards in “freezing attics or damp basements.” Blood transfusions were taboo. The medicine was dismal and unequal, with black patients sometimes resorting to becoming test subjects to get any kind of treatment.

The nation’s capital also contributed its own notable example of a once-thriving such spot: Freedman’s in Northwest DC, which opened in 1862 and “stood out for the medical care it offered freed slaves and became an incubator for some of the country’s brightest African American physicians.”

But that venerable haven, known now as Howard University Hospital, has fallen far, the Washington Post says. Howard’s care, still for predominantly black and now poor patients, is unequal and lagging, the paper’s investigation found:

vox-300x255Now that the blitzkrieg assault on Obamacare is over, the battle to repeal and replace the Affordable Care Act hasn’t gone totally up in smoke. It just has fallen, for now, into lots of still critical bits and pieces.

Keep your eye on:

Medicaid

Tom_Price_official_Transition_portrait-240x300Doctors should hold the prime role in the nation’s medical policy making, Tom Price, the orthopedist who is the Trump Administration’s top health expert, has insisted. But will the U.S. Health and Human Services Secretary heed top experts in his field, writing in some of medicine’s leading journals, that he and GOP partisans lack real evidence for their assault on patients’ rights to seek legal redress when injured by medical care?

Experts from the Stanford University’s medical and law schools have just written in The New England Journal of Medicine that “this an odd time for [Price and] Congress to be considering malpractice reform.” Why? As they noted:

Malpractice environments are currently stable: the incidence of paid claims has shrunk by half in the past decade, indemnity-payment levels have declined or plateaued, and many physicians pay less for liability insurance than they did a decade ago. Price has claimed that defensive medicine is responsible for a quarter of U.S. health care spending — about $650 billion — but the best estimates are closer to $50 billion. So is a push for liability reform at this moment inappropriate? We don’t think so.”

Donald_Trump-1-225x300A GOP assault on American health care has been turned aside, for now. But major questions have been exposed that will need answering if we as a country are ever to come together over health care. Do we recognize that health care—comprising 17.5 percent of the Gross Domestic Product and trillions of dollars in spending annually— has become so costly, complicated, and critical that each of us, at some point in our lives, must have some assistance from all the rest of the collective us?

In short: Do we believe that health care is a right?

All other civilized countries answered that question long ago in the affirmative and have implemented systems that guarantee everyone living within their borders (or even visitors from places like the USA) a basic package of health care.  But we here in the United States still struggle with the world’s most expensive health care system that delivers care to a smaller percentage of its residents than anywhere else and that gets worse outcomes than most other advanced countries.

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