Articles Posted in Clinical guidelines

countylahospicegrafic-300x139With coronavirus infections and deaths rising anew in worrisome fashion from coast to coast, matters could not get worse with the nation’s long-term care, right? Guess again. Profit-mongering and “audacious, widespread fraud” apparently has run amok in hospice care in the Golden State.

Because California, alas, too often serves as a trend-setting locale, patients, their loved ones, clinicians, regulators, and politicians may wish to take heed of an investigation published by the Los Angeles Times. The newspaper reported that too many older, sick, and injured patients have been gulled into signing up for unneeded and undelivered services meant for folks at the end of their lives:

“[M]any [hospice patients] are unwitting recruits [of] unscrupulous providers who bill Medicare for hospice services and equipment for ‘terminally ill’ patients who aren’t dying. Intense competition for new patients — who generate $154 to $1,432 a day each in Medicare payments — has spawned a cottage industry of illegal practices, including kickbacks to crooked doctors and recruiters who zero in on prospective patients at retirement homes and other venues … The exponential boom in providers has transformed end-of-life care that was once the realm of charities and religious groups into a multibillion-dollar business dominated by profit-driven operators. Nowhere has that growth been more explosive, and its harmful side effects more evident, than in Los Angeles County. The county’s hospices have multiplied sixfold in the last decade and now account for more than half of the state’s roughly 1,200 Medicare-certified providers, according to a Times analysis of federal health care data.”

mckinseylogo-300x169Heaps of ignominy are not in short order for parties that played sketchy roles in fostering the nation’s deadly opioid abuse and drug overdose crisis. The stain has spread now to one of corporate America’s most-favored advisors — the giant McKinsey consulting group.

The firm has issued a rare public mea culpa for its work with Purdue Pharmaceuticals, a family-run drug maker that has gained notoriety, even among Big Pharma companies, for how it hyped its powerful painkiller OxyContin. The relentless push to sell that drug, officials have asserted, provided a ghastly template for peddling opioids, triggering abuse, addiction, debilitation, and death for hundreds of thousands of Americans in recent times.

Purdue was a McKinsey client, and the consultants now are re-examining their advice to the drug maker on how to fire up OxyContin sales and whether these suggestions fell short of the firm’s own standards. The New York Times, to its credit, dug into records to detail the consultants’ unacceptable conduct, reporting:

coverwithkareem-300x211A growing body of research is better explaining why the novel coronavirus has taken such a terrible toll on communities of color and especially black Americans. The evidence underscores the urgency for the nation to address racial injustice and inequities, particularly in health care.

As the New York Times reported, experts analyzing mountains of data are seeing that “there is no innate vulnerability to the virus among black and Hispanic Americans … Instead, these groups are more often exposed because of social and environmental factors.” The newspaper found this in talking to experts about their multiple, often sizable studies:

“The[ir] new findings do not contradict an enormous body of research showing that black and Hispanic Americans are more likely to be affected by the pandemic, compared with white people. The coronavirus is more prevalent in minority communities, and infections, illnesses and deaths have occurred in these groups in disproportionate numbers … [But among] many other vulnerabilities, black and Hispanic communities and households tend to be more crowded; many people work jobs requiring frequent contact with others and rely on public transportation. Access to health care is poorer than among white Americans, and rates of underlying conditions are much higher. ‘To me, these results make it clear that the disparities in mortality that we see are even more appalling,’ said Jon Zelner, an epidemiologist at the University of Michigan who led one of the new studies.”

covidnrsnghomenovdeaths-300x149While untold Americans tried to do right by older and more vulnerable friends and family members by taking extra precautions and even canceling Thanksgiving gatherings, the nation crossed a ghastly threshold for the aged, sick, and injured in late November: The coronavirus has killed at least 100,000 residents and staff in nursing homes and other long-term care facilities.

The number of deaths is likely under-reported in federal and other data sources, as several states lag in providing information about problems in the facilities. The deaths of those institutionalized also is spiking as Covid-19 cases have, too, from coast-to-coast. “Community spread” poses grave risks to those in institutions.

If these figures are not already bleak, the Wall Street Journal reported that its research finds that there also are “more than 670,000 probable and confirmed Covid-19 cases in long-term care, affecting both residents and staff members.”

With the pandemic  tearing through the United States and overwhelming U.S. health care system,  we pause from the grim news to tally  some of the nation’s blessings in this time.

We can be thankful for the courage, fortitude, dedication, and skill of an army of health workers of all kinds. They have put themselves and their loved ones at formidable risk and strain to treat patients under unprecedented duress. They have dealt with fear and uncertainty, giving little quarter, and approaching their own breaking points. Some health workers have themselves fallen ill, with some dying. Their sacrifices cannot be forgotten, and we need to give sustained and extra support to health workers as the pandemic enters its next perilous phase.

docofficegoogle-300x188A federal criminal case concluded with felony convictions for a Virginia gynecologist. But the questions are only now beginning as to how a doctor could have caused so many women so much harm for so long without other clinicians, hospitals, administrators, insurers, and regulators stepping in to stop him.

As the Washington Post reported, jurors took 2½ days to convict Dr. Javaid Perwaiz on 52 counts in what prosecutors alleged was his years of defrauding insurance companies by performing life-altering hysterectomies and other unneeded surgeries on women patients. He is scheduled to be sentenced in March, facing a maximum sentence of 465 years imprisonment.

His conduct, condemned and proven by prosecutors in a trial that ran for weeks, included “performing diagnostic procedures with broken equipment and scaring patients into surgery by falsely claiming they had cancer,” the newspaper reported, adding:

docnotes-300x154Millions of Americans may be finding that their doctors routinely refer to them with terms like SOB and BS. But patients will be better off with this knowledge, once they learn how to translate medical abbreviations.

The Associated Press reported that hospitals and health care systems nationwide quietly are complying with deadlines, and, under a 2016 federal law, are opening up convenient, fast access to patients to not only view and access their electronic health records but also physicians’ notes about their care. As the AP wrote:

“If you already use a patient portal such as MyChart to email your doctor or schedule an appointment, you may soon see new options allowing you to view your doctor’s notes and see your test results as soon as they are available. You may get an email explaining where to look, how to share access with a caregiver and how to keep other eyes off your information. Many people won’t notice a change. About 15% of health care systems already are letting patients read doctor notes online without charge. That means about 53 million patients already have access to their doctor’s notes.”

magicshrooms-150x150Voters in the nation’s capital joined with peers across the country to nudge forward a further reconsideration of mind-affecting substances popularized in the Sixties but made illicit thereafter.

Support ran strong for a District of Columbia ballot initiative directing local law enforcement to make among its lowest priorities the prosecution of those who use or sell certain hallucinogenic plants and fungi — aka magic mushrooms and psilocybin, the Washington Post reported.

Those substances also appeared to be headed to legalization in an Oregon vote, which also would “decriminalize the possession of all illegal drugs,” the Wall Street Journal reported.

colorscreen-300x168An important federal advisory group has joined with medical specialists in recommending a change in the age at which patients should start screening for colorectal cancer, to age 45 and not the current 50 years old.

Earlier detection of bowel issues could save lives, the U.S. Protective Services Task Force (USPSTF) has decided, with the influential medical group issuing a draft screening guidance and posting it online for public and expert comment.

Clinicians have reported for a while now that they are seeing more cases of colorectal cancers in younger patients, and their treatment might have better outcomes if it could be started earlier, too. As the New York Times reported:

casesurgecovidoct-300x175Numbers can tell a persuasive story, but will even overpowering figures shock Americans into taking the steps needed to deal with the coronavirus cases surging across the country?

By many metrics, it is counter-factual to contend, as President Trump insists, that the nation is “rounding the corner” on the Covid-19 pandemic and “the country is learning to live with it” — as opposed to getting sick and dying from it. Let’s take a look at a bunch of the metrics:

The United States’ new coronavirus case count exceeded 70,000 in a day for the first time since July.

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