Hospitals

February 13, 2020

A top U.S. health official can’t get his. Which is why we need records reforms.

Federal regulators may be on the brink of not only protecting but also advancing patients access and use of a key component of their care: their electronic health records. Or will bureaucrats fold up in the face of a muscle campaign by corporate interests and hospitals?

To its credit, the giant Health and Human Services agency has emphasized that it is moving forward in its announced plans to prepare new regulations on so-called EHRs, pressing patients’ rights and newer, and potentially more nimble tech firms’ abilities to make the information in the records more accessible and helpful.

But Epic, the giant software company that has installed electronic systems in hospitals and health systems nationwide — often for billions of dollars — is leading resistance to the new rules. It has convinced dozens of institutions and groups, some sizable, to lobby officials to oppose this federal intervention.

February 11, 2020

Crucial doctor-patient relationships showing distressing signs of fraying

by Patrick A. Malone

Although health policy experts and doctors themselves may sing the praises of primary care providers — medical generalists who are supposed to be the first and important caregivers for most patients — recent studies suggest that yet another idealized aspect of the U.S. health care system has cost- and access-driven problems.

Patients, to start with, are driving a concerning trend in which they in increasing numbers are declining to tap the services of family doctors and other so-called PCPs.

Doctors in this field, as well as others, say that patients may be turning to online consultations, urgent care centers in drug stores and shopping malls, or more costly visits to highly credentialed specialists due to the spiking pressure on frontline MDs to maximize revenues by minimizing their “face time.” Physicians describe how “bean counting” executives in health systems may require them to see more than a dozen patients a day, while also handling all the bureaucracy, consultation, research this requires — or face sizable pay cuts for their “inefficiency.”

February 9, 2020

As coronavirus pummels China, concern rises about U.S. health care supplies

by Patrick A. Malone

The toll of the coronavirus outbreak in China keeps worsening, with the infections exceeding tens of thousands and the deaths spiking toward 1,000, also claiming the first American and Japanese lives of people in the disease epicenter of Wuhan.

The illness’ most significant harms continue to afflict China, particularly its central province of Hubei and regional capital Wuhan.

But the infection has raised global alarms, in part because its death toll, for example, has far exceeded in China the fatalities recorded with the 2003 disease incident involving Severe Acute Respiratory Syndrome, or SARS. That infection killed hundreds in China.

February 6, 2020

With U.S. health care costs sky-high, why gouge programs to help vulnerable?

by Patrick A. Malone

If rigorous research drove policy making in a more optimal fashion than it now apparently does, how might politicians and regulators react to findings like these:

The well-respected Commonwealth Fund has revisited earlier studies, finding anew that the United States “spends more on health care as a share of the economy — nearly twice as much as the average [industrialized Western European] country — yet has the lowest life expectancy and highest suicide rates among the 11 nations. The U.S. has the highest chronic disease burden and an obesity rate that is two times higher than the average [in comparable Western industrialized and European countries.] Americans had fewer physician visits than peers in most countries, which may be related to a low supply of physicians in the U.S. Americans use some expensive technologies, such as MRIs, and specialized procedures, such as hip replacements, more often than our peers. Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.”

Even while spending more than any other nation on health care and getting poorer outcomes, which Americans bear the heaviest burdens of the system’s costs? Here’s what researchers at the nonpartisan and independent RAND Corporation have found in a newly published study:

January 28, 2020

California, Big Blues, and hospitals join the attack on sky-high drug prices

by Patrick A. Malone

Big Pharma, with its relentless price gouging, may finally have poked in the eye the wrong people. But even as patients wait to see if hospitals, and now states and insurers, can beat down skyrocketing drug prices, isn’t it past time for more public shaming for doctors who persist in writing excessive, dubious, and downright risky prescriptions?

Although the Trump Administration and Republicans in Congress have failed to deliver on repeated promises to attack excessive costs for prescription drugs, the state of California and now leading insurers are following some hospitals in tackling the problem.

Calif. Gov. Gavin Newsom (shown, above right), in unveiling his state budget, told lawmakers that he wants the Golden State to consider contracting with generic drug makers to produce products that would cost less and be sold under a California label. As the Los Angeles Times described the still-to-be fleshed out gubernatorial plan:

January 26, 2020

A cause for global concern: an exploding viral outbreak in central China

by Patrick A. Malone

The Year of the Rat has dawned in Asia in most inauspicious fashion, with public health officials grappling with an exploding viral outbreak centered in China.

Tens of millions of Chinese have been locked down in what officials are saying may be one of the largest health quarantines of its kinds, occurring during Asia’s major New Year holiday. Authorities in Beijing report dozens of deaths and hundreds of cases of what officials have called a novel coronavirus (officially, for now, the 2019-nCoV).

It has sickened or killed most of its victims in central China, in and around the city of Wuhan. The afflicted suffer a pneumonia-like illness, and medical scientists say that advances in genetics have allowed them to study the virus with unprecedented speed and accuracy.

January 14, 2020

Here’s a cause for anger and despair: We’re all forced to pay $8,000 ‘health tax’

by Patrick A. Malone

Even as economic inequity and inequality fuel a nationwide plague of “deaths of despair,” a runaway and inefficient health system hits Americans hard in their pocketbooks, in effect imposing an $8,000 annual tax on every household, a pair of leading economists say.

The crushing cost of the U.S. health system, exceeding $1 trillion a year, forces all Americans to pay this “tribute,” as if it were going to a foreign power, except this is a toll on themselves that we tolerate and allow, say Anne Case and Angus Deaton. The Princeton economists have reached this conclusion, as part of their research for their upcoming book, “Deaths of Despair and the Future of Capitalism.”

Case told economists at a San Diego conference: “A few people are getting very rich at the expense of the rest of us.”

January 8, 2020

Hospital mergers and acquisitions aren’t great for patients’ care, study finds

by Patrick A. Malone

Big hospitals keep getting bigger. But, contrary to what the suit-wearing MBAs may claim, the rising number of institutional mergers and acquisitions isn’t necessarily better for patients and their care.

At hospitals subjected to corporate wheeling and dealing, the quality of care got worse, or, at best, it stayed the same and didn’t improve, a new study in the New England Journal of Medicine reported.

Researchers scrutinized federal data “from 2007 through 2016 on performance on four measures of quality of care … and data on hospital mergers and acquisitions occurring from 2009 through 2013,” they said. These measures, the Wall Street Journal reported, included: patient satisfaction; deaths within a month of entering the hospital; return trips to the hospital within a month of leaving; and how often some heart, pneumonia, and surgery patients got recommended care. They looked at 246 hospitals involved in M&A activity, controlling their findings with data from 1,986 institutions not similarly affected.

January 3, 2020

A patient’s painful and powerful reminder of harms inflicted by drug diversions

by Patrick A. Malone

Hospitals, clinics, and other health care settings — and those who staff them — aren’t immune to the ravages of the opioid crisis and its related abuse of prescription and illicit drugs. For patients, their caregivers’ addictions can have serious consequences, including a less-discussed nightmare: diversions of their drugs.

Lauren Lollini, a psychotherapist and a patient-safety advocate, has penned a powerful and scary Op-Ed for Stat, a health and medical news site. She describes how, while undergoing a relatively routine kidney stone removal at a respected Denver hospital, she was infected with hepatitis C — a draining and chronic liver disease that is blood-borne and is often associated with drug abusers. Lollini, however, had been healthy and did not use drugs. So, how did she get so sick? As she explained:

“[An investigation by the] Centers for Disease Control and Prevention, showed that I and at least 18 others had been infected with hepatitis C by Kristen Parker, a technician at Rose Medical Center who had tested positive for the disease before she was hired. She stole patients’ fentanyl-filled syringes off medication trays, injected herself with the painkiller, then refilled the syringes with saline. In the summer of 2009 — about three months after I learned I had hepatitis C — Parker was arrested in one of the biggest hospital drug diversion incidents to date. In 2010, she was sentenced to 30 years in prison.”

December 18, 2019

When those medical bill slips and errors add up, honestly, isn’t it just fraud?

by Patrick A. Malone

If department stores, car mechanics, or restaurants billed their customers in the same way that hospitals and doctors do, prosecutors might have their hands full. That’s because what patients now accept in sheepish fashion as simple “errors” or misstatements or curious charges on their medical bills more correctly ought to be called something else: fraud.

That’s the reluctant but tough view now taken by Elisabeth Rosenthal, an editor, journalist, and onetime practicing doctor.

She has written an Op-Ed for the New York Times, her former employer, in which she recounted how she long has reported on health care costs and economics, including in her much-praised book, “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.” She said she has listened to too many patient complaints, as well as experienced problems of her own, to keep allowing establishment medicine to deem its relentless chiseling, oops, a little mistake.