Hospitals

June 13, 2019

With seniors, special focus can be beneficial — in tough surgeries and more

Recognizing that seniors face different health challenges than younger folks could help doctors and hospitals better safeguard older patients who undergo complex and demanding surgery.

Paying heightened attention to age’s changes also can be beneficial to older adults in protecting themselves from damaging falls and getting retirees to keep moving to stay fitter — without getting hung up on a mistaken exercise measure.

A specialty group within the American College of Surgeons may be on a beneficial course in recommending new geriatric guidelines for older patients, a rising number of whom undergo extensive procedures that once were considered risky for those of an advanced age, the New York Times reported. This is a significant issue in surgical practice, the newspaper reported:

June 5, 2019

Hospitals raise legal concerns by lavishing pay and perks on staff doctors

by Patrick A. Malone

As hospitals boost their size and power to push their profits even higher, they’re also raising alarms with federal regulators over their too cozy relationships with doctors who are pulling down big pay from them now as part of their staffs.

Uncle Sam long has sought to ensure that the billions of tax dollars that get spent in the health care system don’t become medical spoils, riches that get passed around a select few through kick-back and self-referral schemes. These are barred by regulation, notably in Medicare- and Medicaid-funded care, and by the “Stark law.”

Jordan Rau of the Kaiser Health News service reported that a hospital in Wheeling, W. Va., has gotten regulators attention by lavishing pay and perks on specialists in its employ, including $1.2 million a year for a pain specialist and $770,000 annually and 12 weeks’ vacation for a cardiothoracic surgeon. The money is far higher than what such experts command in the area and it’s more surprising because the treatment areas these high-paid doctors work in are big financial losers for Wheeling Hospital.

June 3, 2019

As doctors warned UNC about heart surgery program, kids kept dying

by Patrick A. Malone

Although big hospitals may love to pat themselves on the back and boost their profits and professional standings by claiming to offer “comprehensive” services, children may suffer and die due to the reality versus the hubris of institutions’ excessive initiatives with specialized care.

Officials at the University of North Carolina blew past anguished warnings from their own pediatric cardiology staff of significant problems in the pediatric heart surgery program at the medical center’s children’s hospital, the New York Times reported. Brushing aside their concerns about a lack of resources within and to support the program, UNC declined to make public, as most similar specialty efforts do, key performance measures. They would show that the UNC pediatric heart surgery program had a higher death rate than “nearly all 82 institutions that do publicly report” this and other measures of patient care.

The newspaper, in a rare move, has internal tape recordings of doctors disputing among themselves whether dwindling resources, staff departures, and other problems meant that UNC should do what many of the specialists demanded — take a long hard look at what was going wrong, and, in the meantime, refer sick kids to other institutions to safeguard their care.

May 30, 2019

Congress and White House find a bipartisan target in medical bills and prices

by Patrick A. Malone

Doctors, hospitals, health insurers, and Big Pharma have become so abusive to patients with their billing and pricing that they may have accomplished what many consider a political impossibility ̶ angering Democrats and Republicans in Congress as well as the White House, pushing them all toward bipartisan legislation and executive actions.

Don’t bet on the exact outcome of the latest stirrings. They’re grist for a surge in coverage by the New York Times (click here), Washington Post (here), Wall Street Journal (here), Kaiser Health News (here), Modern Health Care (here), Stat (here), and Pro Publica (here). The stories point out that the partisan divide is too great for Congress and the White House to get near serious work on big health care-related issues like improving the Affordable Care Act.

So, instead, as the articles report, lawmakers are taking varying approaches to attack medical billing, particularly so-called surprise bills (out-of-pocket charges patients get hit with when they get medical services from providers outside their health insurance networks) and balance billing, when medical providers chase patients for charges above what they’ve already recouped from insurers. Health reporters have drilled down on stories about such billing outrages. Drug and hospitals prices also are big targets.

May 27, 2019

High court leaves it to Congress to restore service members’ basic rights

by Patrick A. Malone

The U.S. Supreme Court has left it up to Congress to decide if service members may pursue in the civil justice system claims that they have suffered harms while seeking medical services, a fundamental civil right now denied to military personnel.

Justices Clarence Thomas and Ruth Bader Ginsburg — who rarely agree on much — both wanted but were unsuccessful in getting their high court colleagues to revisit an inequitable, 69-year-old Supreme Court ruling involving the Federal Tort Claims Act. That act governs who can bring a claim for negligence at a military or other government health care facility.

Active duty military personnel cannot bring a medical negligence claim for care at a military facility. This is called the “Feres doctrine,” after the Supreme Court decision, Feres v. United States, 340 U.S. 135 (1950). Under the Feres doctrine, members of the United States armed forces are barred from making a claim against the United States for personal injury or death arising “incident to service.” Military medical treatment received by a service member, while on active duty, has been held by the courts to be “incident to service,” and, thus not actionable, even if that treatment was for a purely elective procedure, and even if the procedure was performed negligently.

May 24, 2019

Walmart sees a bigger picture with costly imaging: frequent misdiagnosis

by Patrick A. Malone

As Walmart tries to work with its 1 million-plus U.S. employees in controlling health care costs, the retailing giant has not only struck a blow for quality medical treatment, it also has raised key questions about a costly and booming specialization in health care: medical imaging.

Walmart decided to shake up this diagnostic field by telling its employees to pay more themselves or to first seek CT scans and MRIs at one of 800 imaging centers that a company-retained health care consulting firm has identified as providing high-quality care. Covera Health, a New York City-based health analytics company, “uses data to help spot facilities likely to provide accurate imaging for a wide variety of conditions, from cancer to torn knee ligaments,” Kaiser Health News Service reported.

KHN reporter Phil Galewitz said Walmart targeted improved imaging based on the giant retailers’ experiences already in funneling workers to select facilities its research has found to offer efficient, high-quality care in specific areas, such as organ transplantation, back and knee surgeries, and heart and cancer treatment.

May 21, 2019

Preventable hospital deaths’ terrible toll: at least 160,000 lives each year

by Patrick A. Malone

Although the fatalities have declined, preventable hospital deaths kill more than 160,000 Americans annually — four times as many lives as were lost to vehicle wrecks in 2017, more than twice the deaths attributable to opioids and drug overdoses that year, and more than the toll of stroke or Alzheimer’s disease.

The disturbing new report on hospital deaths comes from Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality and the Leapfrog Group, a national nonprofit founded by large employers and others concerned and focused on safety and quality in health care.

May 19, 2019

Terps draw new fire for staying mostly mum about a fatal viral outbreak

by Patrick A. Malone

Just as the nation grapples with the worst measles outbreak in a quarter century, the University of Maryland and public health officials are drawing fire for the way they handled the strange confluence of mold infections in dorms and the spread of an contagious virus among students on the College Park campus.

The university and its advisers tried to keep a lid on public information about the dual problems, leading students and parents to assail the school and to blame its sluggish response and silence for the death of an immune-compromised coed.

Her death late last year — following the fall heat-stroke fatality involving Jordan McNair, a 19-year-old football player — has renewed concerns that the university and its staff may lack the expertise, training, and sensitivity to protect vulnerable young people, the Washington Post reported as part of its investigation of the confused health scenario involving Olivia Shea Paregol.

May 16, 2019

Hospitals rip employer health plans with prices up to 3 times what Uncle Sam pays

by Patrick A. Malone

Big businesses, which beat on their employees to be more cost-conscious, efficient, and productive, may need to take a page out of their own books if they hope to better control the soaring health care costs that they’re also shoving off onto their workers.

That’s a key takeaway from new research by the independent, nonprofit RAND Corporation into prices paid in 25 states to 70 hospital systems by job-provided health insurers in 2017. They provide coverage for most Americans, more than 180 million of us, and RAND found that private employer-sponsored health plans paid hospitals on average twice or even three times as much as Uncle Sam did through the Medicare program for the same services at the same hospitals.

Hospitals bellyache about tight-fisted Medicare prices that Uncle Sam can negotiate due to big dollars and huge number of patients covered under its senior health care plan. Although hospitals call the government-negotiated prices too low and an unfair benchmark, they provide realistic insights into hospitals’ bottom-line charges in what is one of the biggest areas of Americans’ health care costs. As RAND researcher Christopher Whaley told Modern Healthcare, an industry-covering news organization:

May 10, 2019

Modern medicine may be great at making money but not at making sense

by Patrick A. Malone

Spending’s askew when billions go for unproven surgical robots while lack of affordable care leads thousands of poor, black, and brown patients to need diabetic amputations

If U.S. health care leaders look ahead to 2020 and wonder why their sector of the economy will be one of the key concerns of presidential candidates and voters, they can only blame themselves for allowing the public to conclude that the industry’s big money and big profit drives have gone haywire.

How unbalanced have the nation’s health care priorities become that, on the one hand, surgeons and hospitals keep pushing to spend billions of dollars more for robotic surgeries that doctors themselves are doubting, while, on the other hand, researchers blame economic and racial disparities for playing a big role in requiring tens of thousands of patients — especially those who are black and brown and poor — to undergo diabetic amputations?