Articles Posted in Outpatient Care

us-cash-184x300Here’s something that many Americans likely would want to think twice about letting happen: Should good health and long lives be just another of the spoils reserved to the rich?

Vox, a news and information site, has posted a provocative dig into national data on longevity — a measure that has raised experts’ concern with its recent rare, two-years-in-a-row dive, notably due to fatal overdoses of opioid drugs, including prescription painkillers, heroin, and fentanyl.

Experts scrutinizing the data, Vox says, keep finding that “what’s often lost in the conversation about the uptick in [U.S.] mortality … is that this trend isn’t affecting all Americans. In fact, there’s one group … that’s doing better than ever: the rich. While poor and middle-class Americans are dying earlier these days, the wealthiest among us are enjoying unprecedented longevity.”

blkmom-300x222The bad news for expectant black moms isn’t confined to those living in the nation’s capital: A new investigation has found higher risks of harm for women in New York, Florida, and Illinois when they deliver at hospitals that disproportionately serve black mothers.

ProPublica, a Pulitzer Prize-winning investigative site, analyzed two years of hospital inpatient discharge data from the three states to “look in-depth at how well different facilities treat women who experience one particular problem — hemorrhages — while giving birth.” Reporters found negative patterns that underscored big woes identified by other research before:

[B]lack women … fare worse in pregnancy and childbirth, dying at a rate more than triple that of white mothers. And while part of the disparity can be attributed to factors like poverty and inadequate access to health care, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver, which are often in neighborhoods disadvantaged by segregation. Researchers have found that women who deliver at these so-called ‘black-serving’ hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women.

usfs-thomas-fire-300x200The clock may be counting down to 2017’s end but Mother Nature isn’t giving up on whipping up calamities that wreak havoc on parts of the nation’s health care system and millions of Americans’ well-being. After swaths of the country were inundated by hurricanes and flooding, the West Coast is now battling yet more huge blazes.

Raging wildfires in Southern California not only have added big time to the billions of dollars that such blazes have caused this year in damage and suffering to people, property, and animals, they also have provided the entire coast with a harsh reminder of the importance of air quality to health.

With luck, public cooperation, and outstanding work by fire fighters, police, and other first-responders, the loss of life has been low in a series of blazes on the Westside of Los Angeles, in the city’s northern reaches, in San Diego, and most especially in Ventura and Santa Barbara. The “Thomas Fire,” burning over hundreds of acres in Ventura and Santa Barbara, has become the third largest wildfire in California record books. The Southern California blazes follow hard on the heels of disastrous infernos in Northern California’s wine country.

asthma-300x123Even as they rake in big bucks and ride  a tsunami of mergers and consolidations sweeping the U.S. health care system, big hospitals and academic medical centers must step up on patients’ behalf, doing much more, for example, to battle America’s growing asthma woes and the opioid drug abuse epidemic.

Kaiser Health News, the Capital News Service, and the Washington Post deserve credit for their report on “Forgetabout Neighborhood,” the “worst asthma hot spot” in Baltimore. This part of the city is filled with “decrepit houses, rodents and bugs” that “trigger [asthma] and where few community doctors work to prevent asthma emergencies,” the news organizations have found. They say that residents of this neighborhood “visit hospitals for asthma flare-ups at more than four times the rate of people from the city’s wealthier neighborhoods.”

This area, zip code 21223, also sits in the shadow of not just one but two renowned medical centers, noted, among other things, for their respiratory expertise: Johns Hopkins, and the University of Maryland Medical Center. As the news organizations have reported:

jet-300x154Tens of thousands of Americans will hit the skies in the next few days, struggling to squeeze in that last bit of business before the holidays shut down 2017 opportunities. Are these business travelers harming their own health?

The New York Times has put up an interesting report on the ubiquity and stress of business-required travel, arguing that jet-setting for work not only has lost whatever glamor it once may have held but also that experts increasingly are worried about the health toll it inflicts.

The paper, noting that more formal research needs to done, cites studies showing that “frequent business travel accelerates aging and increases the likelihood of suffering a stroke or heart attack, and that more than 70 percent of business travelers report some symptoms of an unhealthy lifestyle, including poor diet, lack of exercise, excess drinking, stress, mood swings and gastrointestinal problems.”

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:

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