Articles Posted in Quality outcome measures

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Breast cancer patients may get a welcome respite from one of the disease’s dreaded aspects — its aggressive and costly treatments. New research suggests that thousands of women with early-stage breast cancer who now are told to get chemotherapy don’t need it, while a larger, significant number of patients can benefit by halving the time they’re told to take an expensive drug with harsh side-effects, especially for the heart.

Although this information should be taken in a positive light, patients should consult with their doctors about appropriate treatment for their individual case.

The prospective shifts in breast cancer treatment, based on new findings, may add to rumblings and criticisms about over-treatment and whether doctors have taken too lightly the toll — physically, mentally, and financially — that this and other forms of cancer inflict on patients.

coveredcalif-300x169Although Republicans have ripped at the health insurance offered under the Affordable Care Act, a less known but also important aspect of Obamacare may soon benefit Californians. This West Coast ACA-related move also may be worth watching by patients and medical safety advocates, as well as employers and insurers.

The Golden State, the San Francisco public radio station KQED reported, soon will tell hospitals that “time’s up” for them to improve their care, and, if they fail to hit new quality and safety targets that will be part of an impending three-year contract with Covered California, the ACA marketplace operator, they will get the boot from Obamacare coverage.

Because bluer-than-blue Democratic California has gone all-in in supporting and putting ACA coverages in place, the state’s Obamacare exchange is big (more than 1 million customers and 11 approved companies) and lucrative — so much so hospitals and insurers can’t ignore the quality demands. They’re neither extreme nor should they be surprising, because state officials emphasize they have consulted with key parties for several years now in the “Smart Care California” collaborative about the plans they intend to put in place.

bowser-240x300Even as District of Columbia officials struggle with deepening woes at the United Medical Center (UMC), advocates from a national, independent, and nonprofit group have offered a dim review of hospitals in the DC area.

The bad news keeps piling on at UMC, a leading provider of medical care for communities of color in the District’s Southeast area and in Prince George’s County, Md.

To its credit, the sometimes locally slumbering Washington Post has put out a disturbing, well-documented report about the death of a 47-year-old HIV-AIDS patient in UMC’s nursing home care. As others witnessing the scene clamored for them to help, UMC nurses, the Post says, let the patient fall to the floor, where he sprawled in his own waste for 20 minutes while his caregivers argued with a security guard. When the patient finally was returned to his bed, he was dead.

mapsample-159x300MapOverview-300x205Patrick Malone & Associates has a new tool for patients to easily check out how their hospital stacks up on quality and safety measures.

The tool is on our website here, and covers all hospitals in the Washington D.C. metropolitan area, including northern Virginia, the Maryland suburbs of DC and the District of Columbia itself.

When you click on the link, you will see a map of the DC area with hospital locations pinned.  Click on any hospital, and a small window will open up giving you an array of stats. Each statistic has an arrow next to it–  up for “better than average” and down for “worse than average.  Our site features these quality measures:

PE-Color-240x300The Republicans haven’t waved a white flag—yet. They may never formally surrender. But the GOP’s seven-year, take-no-prisoners campaign to repeal and replace the Affordable Care Act, aka Obamacare, has foundered. For good?

Political prediction is a knucklehead’s sport. It’s never safe to predict what’s going to happen, especially when unpredictable tragedies rear up like  Sen. John McCain’s brain cancer diagnosis.

No matter. We now know painful truths about the politicians who have sway over our health care—and will continue to do so in vast ways, Trumpcare or no.

IVThree Washington, D.C.-area teaching hospitals have ranked in the lowest-scoring group nationally on preventing infections when their patients are hooked up to central lines, intravenous tubes that supply fluids, medications, and nutrients to those in dire need. Two institutions in the region rated highly.

Consumer Reports deserves credit for its continuing reporting on hospital acquired infections (HAIs), a scourge that in 2011 afflicted 650,000 already ailing Americans and which contributed to 75,000 deaths. The advocacy group says 27,000 patients were felled with central line infections in 2015, with a quarter of these especially sick and frail individuals dying of them. Treating patients for central line infections cost on average $46,000—more than for any other HAI.

The area teaching hospitals that the magazine ranked poorly, based on an analysis of federal data from 2011 to 2015, were: George Washington University Hospital, Holy Cross Hospital in Silver Spring, and Howard University Hospital. The two high-ranking institutions were: MedStar Franklin Square Medical Center in Baltimore and Sentara Norfolk (Va.) General Hospital.

vox ocareAs speculation explodes about what the GOP and the president-elect will or won’t do with the Affordable Health Care Act (aka Obamacare), Medicare, and Medicaid, skeptical citizens would be well-served to learn as much as they can about critical policy concerns. Ask tough questions and be wary of counterfactual contentions. Here are a few prime subjects:

Debunking so-called ‘tort reform’

  • A tip of the hat to the Center for Justice and Democracy at New York University for providing research that debunks what may be a component of the multi-pronged attack on Obamacare: the falsehood that one way to contain rising medical costs is to enact so-called “tort reforms,” especially those that target medical malpractice lawsuits. I’ve written about this canard. These bad policy measures: strip patients of invaluable rights to sue; impose arbitrary, cruel, and unsupported caps on what they can recover from doctors and hospitals that harm them significantly; and fail to curb rising medical costs, no matter how partisans shill to sell them. The center’s new research points out that insurers play a huge role in creating malpractice liability crises. Although they blame malpractice lawsuits for driving up coverage costs and causing physicians to practice “defensive” over-testing and other negative medical practices, insurers, the center’s research shows, actually are at the root of many cost explosions due to their own avaricious practices. That’s because insurers rely on market investments to pump up their premium and capital reserve revenues. They have sent coverage costs skyrocketing in good times and bad to ensure they have money to invest and profit more with Wall Street, or to supplement their reserves when their stock losses mount. Meantime, medical malpractice claims and premiums are at historic lows—certainly nowhere near levels to justify hype about how the health care system would benefit from so-called tort reforms.

spinal cordFederal auditors have found that 80 percent of Medicare spending in a recent year on chiropractic care−some $359 million−was medically unnecessary. The federal insurance program for senior citizens should not have thrown taxpayer dollars at chiropractors to treat strains, sprains, or joint conditions, the Department of Health and Human Services’ Office of Inspector General says.

Its auditors, reporting on 2013 claims, said Medicare should impose limits on how often seniors can receive chiropractic care, which they said became excessive after a dozen visits; after 30 sessions of treatment, the federal watchdogs said, patients were receiving unnecessary care.

The chiropractors’ association denounced the audit and the proposed curbs on their practitioners’ care. The acting director of the Centers for Medicare and Medicaid Services resisted the recommendations for caps on chiropractic treatment, noting the absence of cited evidence and differences in individual patients. The agency noted that it has tightened its rules on chiropractic claims, including requirements soon to take force that will require advance approval for certain kinds of this care.

OdometerHealth care economists have a simple prescription for patients wanting better care: Drive a little farther to a better hospital.

As Austin Frakt writes in the Upshot column for the New York Times, there were measurable and significant survival gains in heart attack patients who chose superior care at hospitals a mile or two farther away. Those improvements were “half as large” as those achieved with “breakthrough technologies,” such as the increased use of stents and clot-busting drugs.

Patients saw similar benefits, albeit at a lesser degree, by going a little farther to high quality hospitals for heart failure and pneumonia, he says, quoting a new research paper still in the works by health care economists from Harvard, the University of Chicago and MIT.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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