Articles Posted in Outpatient Care

choosing-wisely@2x-300x197Up to a third of medical spending goes for over-treatment and over-testing, with an estimated $200 billion in the U.S. expended on medical services with little benefit to patients. But getting doctors and hospitals to stop this waste isn’t easy, nor is it a snap to get patients to understand what this problem’s all about so they’ll push their health care providers to do something about it.

Which is why kudos  go to Julie Rovner, of the nonprofit, independent Kaiser Health News Service, and National Public Radio for the recent story on how older women with breast cancer suffer needlessly and run up wasteful medical costs due to over-testing and over-treatment.

Rovner and Kaiser Health News worked with a medical benefit management company to analyze records of almost 4,500, age 50-plus women who received care for early-stage breast cancer in 2017. She found that just under half of them got a medically appropriate, condensed, three-week regimen of radiation therapy. Research has shown this care is just as effective as a version that’s twice as long, costs much more, and subjects patients to greater inconvenience, especially with more side-effects.

eyedropWhether it happens in the drip, drip, drip of costly eye drops or it occurs in the flash of a pricey imaging scan, patients get gouged by modern medicine’s wasteful practices. The inefficiencies can be traced to many and different causes. But Americans need to keep asking whether they can allow or tolerate profit-seeking enterprises to keep getting bigger and ever more expensive.

It’s good to see that two online news organizations, Vox and Pro Publica, are digging into soaring costs for medical goods and services.

Vox is aiming to crowd-source some of its investigation, and it has tantalized its audience with a motivating source of outrage—a story detailing a sky-high bill for a 30-minute imaging scan for Elodie Fowler, an ailing 3-year-old girl. The site says her parents got socked with a $25,000 tab for her test. That sum was far higher than they expected, even after they researched and shopped around to find their most affordable option, given their insurance and various providers operating the service.

clown-246x300Social media have become a “circus” for some plastic and cosmetic surgeons to clown around in unprofessional ways, including: videos in which one doctor has cradled fat removed from a tummy-tuck like an infant and put a baby face on it using a Snapchat filter. Other costumed surgeons have posted visual displays of themselves dancing before surgery and showing off on camera procedures or with tissues they have removed.

The abuses have become so bad that faculty and students from Northwestern University’s medical school, after researching incidents online, have published a prospective social media code of ethics for plastic surgeons, calling for its adoption by specialists at their next major meeting.

Robert Dorfman, one of the Northwestern students and an author of the draft ethics proposal,  has described plastic surgery’s social media landscape “like the Wild West out there, with no guidelines or rules.” Clark Schierle, senior author of the guidelines, a plastic surgeon, and a medical school faculty member, has observed that practitioners in the field are “uniquely drawn to social media because we tend to do more marketing and we are a visual specialty.”

harvey-300x200Houston’s medical system was staggered, but it stood up to the pounding inflicted by Hurricane Harvey’s winds and rains. But for the millions of residents of the nation’s fourth largest city huge challenges will persist for some time to their health and well-being.  Texans’ tragedies may offer us painful reminders we should heed about planning and disaster preparedness.

The Gulf Coast, of course, knows hurricanes well, and experiences with Katrina, Rita, and other storms had gotten doctors, hospitals, nursing homes, and other care=giving facilities well-launched into emergency planning.

Still, Ben Taub—one of the metropolis’s major emergency and public care facilities—found itself inundated and struggling with sudden patient evacuations, while other hospitals, including many in the city’s sprawling medical center complex, stayed drier and open. The big Texas Medical Center had installed huge submarine protective doors, which it shut to successfully protect vital equipment critical to running hospital infrastructure. Even so, rising, rushing waters cut the center and many other hospitals off, making them islands away from stranded staff and patients in potential need.

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:

Medicare CardTwo new case studies show how hard it is to cut the gigantic costs of America’s medical industry. The first concerns how tinkering with Medicare payment incentives can drive up some already soaring drug costs. The other revisits how retail clinics that have popped up at chain drug stores affect health care spending.

Medicare drug incentives

The Obama Administration “touched off a tempest,” the New York Times said, by proposing to experiment with finances affecting some drugs covered under Medicare Part B. Patients get them in doctors’ offices and hospitals to treat cancer, rheumatoid arthritis and other conditions. The paper observed that:

Hypodermic-NeedleIt’s one thing when the makers of sodas or breakfast cereals tweak their packaging to maximize their profits. But Big Pharma deserves a slap for its practice, newly spotlighted by researchers, of putting out over-sized dosages of cancer fighting drugs. This ensures that $3 billion in already costly drugs get tossed out and wasted each year.

Nurses and physicians have no choice about using jumbo size packages of these injectable drugs. They typically give the shots in offices and clinics, and they toss out unused portions to avoid transmitting one patient’s germs to the next patient. Some of the one-size-fits-all vials, the New York Times said, contain a dose, based on patients’ weight and height, that’s suitable for an NFL linebacker or an NBA forward.

As the co-author of the study on this mendacious packaging said: “Drug companies are quietly making billions forcing little old ladies to buy enough medicine to treat football players, and regulators have completely missed it. If we’re ever going to start saving money in health care, this is an obvious place to cut.”

Here’s another device you probably don’t need. Or do you?

That’s the question Austin Frakt, who writes for the New York Times, tried to answer for himself when his cardiologist told him that one of his heart’s chambers sometimes pumped when it shouldn’t. The doctor had been “99.9% certain” that it wasn’t worrisome, and doctor advised against additional tests and visits.

But even though he’s a health economist, and knows that many commonly prescribed tests aren’t necessary, Frakt is only human. “As a patient,” he acknowledged in his story in The Times, “I’m not confident I know which ones.”

Earlier this year, both patients and providers were shocked when a rash of hospital patients got seriously ill or died after medical devices used to examine their gastrointestinal tracts infected them because they were not sufficiently cleaned after previous use. 

Now, it seems, inpatients aren’t the only ones who need to worry about contaminated medical instruments — according to an advisory issued by the Centers for Disease Control and Prevention ( CDC) and FDA, a wide range of reusable diagnostic instruments used in doctors’ offices and other outpatient facilities are vulnerable to the same risk of carrying other patients’  bacteria.

And last week, the FDA followed up that notice with a warning that bronchoscopes specifically can transmit infections if not adequately cleaned — 109 such adverse events have been recorded by the agency in the last five years, according to Bloomberg.com. Bronchoscopes are instruments inserted into the mouth or nose and through the windpipe (trachea) to examine the lungs’airways.

Here’s another story with a satisfying ending and the take-home lesson that it’s a bad idea to cheat taxpayers and abuse medical resources.

A chain of hospices agreed to settle a lawsuit over its overbilling of Medicare, and driving up payments by providing care to patients for whom it wasn’t appropriate. St. Joseph Hospice, which operates in four states will pay $5.9 million, reported Associated Press (AP).

Hospice care is for people with terminal illnesses, and generally provides palliative services, which address symptoms, not curative care. Hospice patients usually receive the care in their homes, enabling them to die where they are most comfortable, instead of in a hospital or other care facility. Doctors prescribe hospice care only for people who are not expected to live longer than six months.

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