Articles Posted in Medical Practice Management

clockYour time is precious, and when you are a patient, you may feel it’s more so, especially if you’re ill or even in the end stage of your life.

So why do health care providers keep us waiting, or worse, why must doctors and hospitals act downright oblivious to how valuable our time might be as opposed to theirs—and what might be done about it?

Take a look at a thoughtful piece on how one health system has tried to keep true to the idea that patients matter above everything else and the delivery of care needs to focus on them:

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.

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:

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

hospital-300x209When a giant institution like MedStar Georgetown University Hospital announces it will spend more than a half-billion dollars to improve, rebuild, and expand its facilities, few of us blink.

That’s because we know that hospitals, in general, are “among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes,” observes Druv Khullar, an M.D. and M.P.P. at Massachusetts General and Harvard Medical School.

Khullar, however, goes on to write in a trenchant Op-Ed column in the New York Times that, “evidence suggests we’ve been building [hospitals] all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us.”

obamacare-cartoon-2-a-300x240As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the legislation’s repeal-and-replace proponents — despite seven years and several dozen U.S. House votes  to roll back the ACA — have yet to detail how 20 million Americans who have gotten health insurance under Obamacare will be covered in the days ahead.

Opponents also haven’t explained how they may change the far reach of the ACA, including how the law and the Obama administration have reshaped, and often, improved American health care, for example, by changing entrenched payment practices and forcing greater accountability.

The New York Times, in reviewing the presidential legacy, has reported on what it terms the transformational aspects of Obamacare that also may sustain, no matter the partisan attacks on the attempt to provide broader health insurance coverage. In brief, the paper says Obamacare forced health care in this country to become more data-driven and evidence-based, as well as refocused on patients and their needs. Although some of the major drivers of these reforms, including hefty spending for electronic health records, haven’t hit the high marks advocates hoped for, progress has occurred.

commty care ncHospitals and health systems are making stark choices between offering models to assist their communities and reduce medical costs−or raking in profits, no matter how outrageous and shame-provoking their charges might be. Evidence of the extremes came this week in reports about alternative realities.

Let’s start with the positive view, recognizing exemplary efforts in the Charlotte, N.C.-area to both help patients and to sharply cut medical costs. Forward-looking health policy experts decided to dive into the highest Medicaid users of emergency services, discovering, for example, that just one patient, a homeless alcoholic man, visited the ER 223 times in 15 months and had undergone 150 redundant and needless X-rays or other scans. Many of the top 100 “frequent flyers,” poor and repeat ER patients, took an exceedingly costly route to fill prescriptions or to seek pregnancy or other routine tests; 86 of these individuals were known to have behavioral woes, including depression or bipolar disease. The experts found that these individuals visited multiple ERs on the same day, sometimes crossing a street or two to do so. They appeared on hot or cold days, suggesting their real need might not be medical but for shelter.

Community Care North Carolina — an umbrella group, with cooperation and support from hospitals, social workers, nurses, and social service agencies — searched out the heaviest using Medicaid-ER patients. They needed to comb the streets, jails, and even a strip club. They helped the patients find responsive primary care doctors, and other assistance, for example, in managing chronic illnesses and conditions. They connected them with social service agencies for assistance with existing housing, nutrition, jobs, and transportation programs. As the Charlotte Observer reports:

skin“Skin to skin” therapy? That was the line item charge that appeared on the hospital bill for a young couple, and the dad decided to check it out. What he found has blown up across the Internet.

It turns out that the Utah parents were charged $ 39.35 by their hospital just so the new mom and dad, just after the C-section delivery of their son, could have their baby placed between her neck and chest. There, proud pops took the requisite newborn pictures.

Only later, as part of $13,280.49 tab for their son’s delivery, did the couple see the skin to skin charge. They posted the bill on a popular online site, where it drew more than 11,000 comments.

nubillAfter partnering with hospital systems, medical finance specialists, and AARP, the advocacy group for Americans 50 and older, Uncle Sam has chosen its top competitors who tried to answer the vexing question: Can anyone do anything to fix the infuriating confusion caused by the typical hospital bill?

Sure, it’s a little gimmicky. A $5,000 prize these days doesn’t seem all that grand. But a little credit is due to the intent and participants in the federal Health and Human Services design contest, “A bill you can understand.”

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