Articles Posted in Outpatient Care

nprsuicide-300x224The nation’s rising suicide crisis torments seniors, too, with just under one out of five such deaths in 2017 occurring with individuals 65 and older. Men 65-plus, experts say, face the highest suicide risk, while seniors 85 and older, men and women, rank No. 2 in groups most likely to die by taking their own lives.

As the nation grays — 10,000 baby boomers a day turn 65, in a trend that will persist until 2029 — the already high concern about suicide, especially among seniors, is rising,  National Public Radio reported.

NPR, noting that suicide already is the 10th leading cause of death among all Americans, said that experts see loneliness, bereavement, grief, and depression as key factors in cases in which older individuals kill themselves. They find themselves isolated, overwhelmed, and with unending sadness when spouses and friends die. Their children, grandchildren, and other family members often live far away. They also struggle with their lives due to age’s increasing debilitation. As NPR reported:

saslowstory-295x300Twenty Democrats who are campaigning for president  took to network television for four hours and two nights last week to put health care as a central issue of their campaigns.

The format of this initial candidate “debate,” including hand-raised answers to complex issues, failed to allow the presidential aspirants to delve much into the details of their proposals. But tons of news coverage followed on — and likely will keep doing so up until Americans enter the voting booth — about Medicare, the government health coverage for seniors, and how it might be expanded to benefit tens of millions more. Those interested may wish to check out this podcast primer on the issue.

These future-looking discussions also already have tended to eclipse a key part of the existing Affordable Care Act, the Obama Administration initiative that remains a subject of hot dispute a decade after its passage: The expansion of Medicaid, the federal program to assist the poor and working poor with health coverage.

Bracescamarrest-238x300Federal authorities have busted up what they say is a $1.2 billion Medicare fraud that should give taxpayers and patients pause about long-distance medical consultations and the huge sums of cash washing around the medical device industry.

Two dozen people, some of them doctors, have been charged in a complex ploy to gull seniors into asking about back, shoulder, wrist, and knee braces that were promoted as free on TV and radio ads nationwide. When the older adults called to inquire about the devices, they were transferred to telemarketing centers in the Philippines and Latin America.

In the far-away boiler rooms, trained operators extracted important personal information from callers, then connected them for “telemedicine” consultations with cooperating doctors. The MDs asked cursory questions before then prescribing the devices, whether needed or not. The orders were filled by select companies, which then would send out the braces and charge them to Medicare.

care-300x180Americans have real reason to fear a health care catastrophe: If loved ones suffer major injury or illness, who will feed, bathe, and care for them 24/7 after they get out of the hospital and recuperate at home? Who will take time off from work to set up and take them to unending and long medical appointments? Who will wait for and get all the pills and devices they need?

The nation has been locked in a decade-long battle over health insurance that helps cover medical costs, but caregiving, a crucial part of the social safety net, gets short shrift, writes Aaron E. Carroll, a professor of pediatrics and health research and policy expert at Indiana University School of Medicine. As Carroll noted in a timely and personal column for the New York Times “Upshot” feature:

Americans spend so much time debating so many aspects of health care, including insurance and access. Almost none of that covers the actual impossibility and hardship faced by the many millions of friends and family members who are caregivers. It’s hugely disrupting and expensive. There’s no system for it. It’s a gaping hole.

commonwealth-underinsured-300x216Republicans got their heads handed to them in the midterms because they bungled a decade of efforts to eliminate public options on health insurance, the House minority leader has conceded. But he and other lawmakers, as well as corporate bosses, may face greater political fallout for failing to deal with a bigger health coverage nightmare for  Americans: workplace insurance plans.

More than half of Americans 65 or younger — 150 million-plus — get employer health insurance, while just a quarter of us buy plans on individual markets or get covered by Medicaid, reported the nonpartisan, respected Commonwealth Fund.

Republicans, in control of the House and Senate and now the White House, have ripped at the Affordable Care Act since its passage — although Obamacare has expanded and improved options for those uncovered on the job, including protections for preexisting conditions. Lawmakers in the meantime largely have left alone employer plans.

hospitalprices-300x162Patients and reformers attacking skyrocketing health care costs may want to focus less on doctors and more on big, shiny hospitals, where in just five years prices soared by 42 percent for inpatient care versus the still sizable 18 percent price hikes that MDs scored.

Those findings are part of a new study that examined medical costs based on actual payments, focusing on common procedures like deliveries of babies (vaginal and cesarean), colonoscopies, and knee replacements.  “Hospital prices grew much faster than physician prices for inpatient and outpatient hospital-based care in the period 2007–14 … The same pattern was present for all four of our procedures,” wrote the researchers from Yale, MIT, and Carnegie Mellon. They found that hospital costs also spiked for outpatient care, increasing 25 percent, versus 6 percent for doctors.

This meant that for a knee replacement costing $30,000 or so, the doctors’ mean price was almost $4,900, while the hospital price was almost $25,000. For a $13,000 C-section, the doctor’s mean price was $4,600, while the figure for hospitals was $8,300. These numbers were derived from analyzing hundreds of thousands of procedures.

admitting-300x210Federal regulators have warned nursing homes nationwide to improve the quality and safety of their patient care or face consequences that operators may hasten to heed. That’s because new penalties and rewards will hit them in a place that counts — their pocketbooks.

Two-thirds of the nation’s nursing homes will see a year’s worth of their Medicare funding reduced, the nonprofit, nonpartisan Kaiser Health News Service (KHN) reported, “based on how often their residents ended up back in hospitals within 30 days of leaving.”

KHN said that:

leapfrog-300x300A familiar health care advocacy group will expand its grading of 2,000 or so hospitals across the country to also provide new safety and quality information on 5,600 stand-alone surgical centers that perform millions of procedures annually.

It may seem like a small step, and the devil will be in the details of the new data that will be voluntarily reported, analyzed, and then made public by the Leapfrog Group, a national health care nonprofit that describes itself as being “driven by employers and other purchasers of health care.”

Surgical centers have burgeoned because they can be nimbler than the hospitals and academic medical centers they now outnumber. The centers can be set up without hospitals’ high overhead costs, including for staff and equipment that may be unnecessary for a specialty practice. The facilities also can be set up closer to patients, theoretically offering them greater access and convenience, including with easy navigation and parking.

Medicare-logo-650x250-300x115Critics may want to carve it up and make it tougher to join, while proponents would expand it and add more money to it. But what could the U.S. health system overall learn from real, rigorous research on Medicare, the major health coverage method for tens of millions of Americans age 65 and older?

Politico, the politics- and Beltway-focused news web site, has renewed attention on the work of Ph.D. economist Melinda B. Buntin, a professor who heads Vanderbilt University’s health policy department. She and her colleagues have spent years digging into the money flowing into Medicare, a program that in 2017 paid out $700 billion in benefits, compared with $425 billion in 2007.

As Politico reported, the research shows a surprise beneath the big, aggregate, and problematic Medicare cost: “One of the best-kept secrets in American health care might be that Medicare spending — in important ways — is going down.”

MRI-300x142The health policy wonks and those who purport to “reform” the U.S. health care system may be long on academic and other fancy credentials. But they also persist in demonstrating they can be short on old-fashioned common sense, especially about the way most of us lead our lives.

That’s a point emphasized in a recent column in the evidence-based “Upshot” feature of the New York Times, written by Austin Frakt. He directs the Partnered Evidence-Based Policy Resource Center at the VA Boston Healthcare System and is an associate professor with Boston University’s School of Public Health and an adjunct associate professor with the Harvard T.H. Chan School of Public Health.

Frakt looked at some recent research to dissect a question that occupies many experts: Could Americans cut their health care costs by shopping around more for medical services? This is a fond notion held by a slice of health care “reformers,” whom Frankt proceeds to disabuse.

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