Articles Posted in Medical Records

records-300x200Although patients can protect their own health by getting copies of their medical records, few consumers get them, and fewer still take advantage of the federal government’s push to make records easily  available electronically, one of Uncle Sam’s big public protection agencies reports.

The U.S. Government Accountability Office also warns that tumult in the nation’s health care system, notably in Congress’ roller-coaster deliberations to repeal and replace the Affordable Care Act, aka Obamacare, may disrupt patients’ relationships with caregivers. That makes it even more vital for consumers to have their health records.

The Association of Health Care Journalists deserves a tip of the cap for pointing to the GAO blog, where experts note that the ACA had supported a national push to get doctors and hospitals to adopt electronic health records with the aim of providing patients and caregivers more access and transparency about these crucial materials.

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.

harlanYes, there can be progressive steps in health care—and with all the controversy and change going on in the sector it’s worth spotlighting some of these:

Patients should get access to own health records, researchers say

  • Three researchers—Dr. Harlan Krumholz of Yale Medical School (photo right), Connecticut lawyer Jennifer L. Cox, and Yale student Austin W. Jaspers—deserve credit for publishing a pointed opinion piece in the JAMA Internal Medicine detailing the costs and needless obstacles patients confront when they want copies of their own health records. As Krumholz told Reuters of the study’s message about excessive records fees charged by doctors and hospitals:  “Higher costs are a higher barrier for people to get their own information. Without that information it is not possible to correct errors in the record, get informed second opinions, donate your data to research – or share with others what is happening with your care.”  That’s spot on, doctor, as I have written recently and in my book,  The Life You Save: Nine Steps to Getting the Best Medical Care, and Avoiding the Worst. Uncle Sam has stepped in and tried to make it easier and more affordable for patients to get their own records, which Krumholz and company point out should be even more available now that they are digitized (he’s working on software to help, too). But states aren’t doing enough to help, except for Kentucky, which requires a free first copy on request, he and his colleagues say. My firm’s site contains information that may be helpful to those struggling to get their records. Here’s hoping that doctors, hospitals, and other caregiving facilities read the Jaspers, Cox, and Krumholz viewpoint, and, because it appears in one of their publications and Krumholz is a physician-researcher of growing influence, they heed it more.

med-records-300x200In the best of all worlds, none of us will need any time soon to race to a nearby urgent care center or to pop by the retail, walk-in clinics that have sprouted in neighborhood drug stores across the country. But if you do find yourself at one of these “doc-in-a-box” clinics, here is some good advice. A lot of this applies to regular doctor visits, too.

A tip of the hat to Dr. Peter Ubel, who posted recently at Forbes and KevinMD.com, the physician information-sharing site, his suggestions of a half dozen “essentials” that patient-consumers might need to know before a retail clinic visit. He based these on positions taken by the American College of Physicians and published in the peer reviewed  Annals of Internal Medicine.

Ubel says “doc in a box” operations (retail clinics, often staffed with physician assistants or nurses) are suitable for low-level, ordinary treatment for things like poison ivy or sore throat. When patients go to these clinics, they need later to fully inform their doctors about the care they got (see the next paragraph). They shouldn’t take referrals to specialists from staff at walk-in clinics. The facilities are OK for patients who are “relatively healthy,” and who don’t have a “complex medical history,” meaning they lack chronic or difficult conditions. Patients with greater challenges need to see their own doctors, regularly if need be. Ubel calls out his colleagues, noting that if they were more responsive to their patients, or figured out alternatives when they can’t, docs in boxes wouldn’t be flourishing as they are.

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.

Just some quick updates on some topics that the blog has followed in recent days:

Big Soda, Big Pharma spending big to battle ballot measures

SouthDakota-StateSeal.svgSouth Dakotans will need their state lawmakers’ help now to pry open physicians’ iron grip on secret decisions about which doctors get to practice in hospitals and why. That’s because the state’s Supreme Court ruled this vital information must be kept confidential, even if releasing it would serve a wider good of disclosing possible criminal or fraudulent conduct.

The high court ducked its potential role in helping more than 30 patients who claim they were mangled in excruciating, needless surgeries performed by Allen Sossan, an osteopath with an easily discovered criminal past and a checkered medical practice record in the area around Yankton, S.D. I’ve written about this case before.

Several South Dakota hospitals gave Sossan practice privileges after his credentials were reviewed by physician committees, which, since have fought mightily to keep secret what they knew and when they knew it about him. Sossan since has been indicted for providing false information to medical licensing authorities. The convicted burglar and check kiter apparently has fled the country and may be back in his native Iran.

death-certificate-state-by-state-default-750_50California regulators have reversed themselves and decided to require hospitals to report outbreaks of “superbug” cases, rare infections that also can prove deadly. At the same time, officials in the Golden State haven’t moved to increase the information disclosed on death certificates−data that advocates suggest would give the public clearer outlines of just how severe a problem hospital-acquired infections have become.

Kudos to the Los Angeles Times, which delved in a recent front-page investigation into the dearth of information disclosed on death certificates, especially about hospital-acquired infections. The paper detailed how a Los Angeles area patient had contracted, while hospitalized, a rare carbapenem-resistant enterobacteriaceae or CRE infection. This superbug resists treatment with an array of antibiotics, eventually killing half those it afflicts. Its outbreaks are a huge concern for public health authorities.

But, The Los Angeles Times said, hospitals had cried “poor me” to the state, saying it required extensive resources to monitor and report CRE outbreaks. The death certificate for the patient with the CRE infection, the newspaper said, listed a perforated ulcer as her cause of death. Her family was outraged because they had urged Torrance Memorial Medical Center to report a CRE outbreak to the state.

WristbandAs American medicine grows ever more complex, a basic of care is getting risky short shrift: Hospitals may be failing to protect their patients’ safety by ensuring they are clearly identified and their medical records don’t get mixed up.

The Wall Street Journal provides a list of horror stories about wrong patient IDs and record mix-ups. These were detailed in a “deep dive” by the ECRI Institute, a nonprofit patient safety research group that studied more than 7,600 reported “wrong patient errors” at more than 181 health care organizations between January 2013 and July 2015. The mistakes, shared under a law that allows their reporting to federal authorities without liability, likely were only a fraction of the many more that occurred.

ECRI found that: clinicians failed to resuscitate a patient in cardiac arrest because they mistook him for another patient who had a do-not revive order in his chart; a patient who was not supposed to fed, due to a mix-up, got a meal tray and choked; an infant, confused for another, got the wrong mother’s milk and was infected with hepatitis.

prescriptionAmong the plenty of worries when an older patient has to be hospitalized, here’s one to think about:  treating physicians and their ever-ready prescription pads which put patients at risk for serious side effects that can be worse than the problem they’re treating.

Kaiser Health News has continued writer Anna Gorman’s series on the woes that elderly patients experience when hospitalized, with her latest piece giving an eyebrow-raising look, from a pharmacist’s point of view, at the prescribing practices of MDs in hospitals.

As the drug expert observes, it all is “a bit alarming.”

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