Movin’ Meat: Private payers: the unlevel playing field
A Tour de Force.

Popularity: 3% [?]

And probably since Jamestown.

WASHINGTON, Nov 13 (Reuters) - The number of U.S. adults who smoke has dropped below 20 percent for the first time on record but cigarettes still kill almost half a million people a year, health officials said on Thursday.

About 19.8 percent of U.S. adults — 43.4 million people — were smokers in 2007.

Anecdotally, my patients in the ED run 60% plus.  And I’ll never understand the indignation in the sentence, ‘yes, I smoke, but I don’t drink’, to which I’ll tell them if they quit smoking and have a drink a day they’ll live a lot longer.

If you’re a smoker, it’s time to quit.  That’s all the nagging I do.  On that.

Popularity: 7% [?]

I was distracted before the election, and didn’t post my usual list of TEXPAC endorsements.  That’s probably why their endorsed slate only got to 93% success.

The only TMA member in Congress, U.S. Rep. Michael Burgess, MD (R-Texas), was reelected and announced he is running to become chair of the House Republican Policy Committee, which would place him as the number four most powerful member in the House Republican caucus. All four of TEXPAC’s endorsed statewide candidates [PDF] (U.S. Sen. John Cornyn and three Texas Supreme Court justices) won, as did all but one of the congressional candidates we backed and most of the candidates TEXPAC supported for the Texas House and Senate.

I blame myself.

Thanks to all of you for supporting the Party of Medicine.

Popularity: 7% [?]

Movin’ Meat: Critical Care
So what is “Critical Care” anyway?
The nice thing is that Medicare provided a very loose and vague definition, and left it to physicians to decide on a case by case basis.

Tremendous review of E&M Critical Care billing.

Our billing company called us together a year or two ago to point out that, in a facility that has 90K visits a year, accepts 2K transfers a year fo higher level of care, out CC billing didn’t even show up on a graph.

I would have been nice to have read the Movin Meat review, as we had been billing CC only for the care that really mpressed us, and not per the guideines.  We’re doing a touch better.

Popularity: 9% [?]

Yet Another Patient Dies Waiting For Emergency Care « WhiteCoat Rants
Mr. Herrera waited 19 hours for care and still had not seen a doctor when he went into a cardiac arrest and died.

Dreadful.  And, unfortunately, predictable.

ED’s are one of those “If you build it, they will come” things, but they’re not funded or equipped (those are related) to see everyone.  I fear the answer will be some bureaucratic “Everyone must be screened within…” (some arbitrary number) and will generate the corresponding foolishness to comply with a foolish requirement.

It won’t change a thing.  Until our ED’s are properly equipped and funded, this will keep happening.

(There’s a WTF in there for ?why is it okay to have patients waiting that long? and where is the administration?  They should have a protocol to call in more of whatever is needed to keep anyone from waiting that long, absent Act of God.  ‘Because we’ve always done it that way’ is an incorrect answer).

Popularity: 15% [?]

I wonder how many hospitals are looking into this alternative from the Joint Commission and their mission creep via ModernHealthcare:

CMS grants accrediting authority to DNV Healthcare

Story posted: September 25, 2008 - 5:59 am EDT

The CMS will allow Det Norske Veritas Healthcare to accredit U.S. hospitals, a move that puts the company in a small group of “deemed” organizations and could bring an increased focus on international standards, most notably ISO 9001, to hospitals across the country.

…DNV Healthcare is expected to certify healthcare organizations as compliant with ISO 9001 quality management standards, as well as the Medicare conditions of participation.

The company’s authority to accredit hospitals will run through September 26, 2012.

Well, now. 

Popularity: 11% [?]

I’ve read some ED blogs commenting on transfers recently (well, when I started writing this post), and I’d like to add my two cents, as an EM doc working in a facility that accepts more than 2,000 transfers a year.

At my hospital the vast majority of transfer calls are fielded by the EM doc on duty, and it’s an interesting dance: listen to the physician who wants to send, determine if you have the resource the sending docs’ patient needs, and then make a decision if our receiving hospital can medically handle the patient being sent.  This includes a lot of facility-specific knowledge, not just the ‘on call’ list but our special capabilities that aren’t on the call list, etc.  Of course, this is just the “medical” part, then there’s the “Administrative” part, over which I have nor want any influence.

The rules about this are myriad and complex, and typically we err on the side of accepting a transfer.

A style point: if you’re trying to send a patient, start with “I have a patient who needs ENT, do you have that coverage” rather than the much more typical, “Mr. Smith is a 74 year old male with hypertension, diabetes and CHF…” because I will then cut you off and say ‘what do you need, and how can we help you’?.  This is a ‘Just the Facts Ma’am’ conversation, and should be short and sweet, respecting both our times.

And, the hard and ugly truth: transfers have allowed a lot of very dysfunctional hospitals to stay open, IMHO.  A hospital cannot get Ortho coverage (for example, not specific to bones), for the myriad reasons specific to that specialty?  Well, just transfer them to a hospital that does.  In this way, bad hospitals (administrators and medical staffs alike) aren’t confronted with their failures, their failures are transferred.  The inadequate hospital now doesn’t have to face angry patients and their families for their inability to manage their medical staffs, they just defer their responsibility to those who are just that: responsible.

I have told sending docs I would take their patient, but they had to go out and pry the word “Hospital” off their signs.  If it was you I was talking to……..I meant it.

Popularity: 17% [?]

The emergency department; where social revolutions fall apart at edwinleap.com

…I feel comfortable saying that we have shown.with remarkable precision that the more radical social revolutions of the 20th century were shameful, stunning failures.  …

Dr. Leap s on a tear, and I cannot help but agree with the premise.

Popularity: 20% [?]

Kevin, MD hits one out of the park:

Doctors’ pay cuts save little in health costs - Opinion - USATODAY.com

By Kevin Pho

“Why should I care if doctors get a pay cut?” my patient recently asked me.

Therein lies the delicate dilemma physicians face today. While the common perception is that the medical profession is well-compensated, there are serious implications in targeting physician pay to control medical spending.

To say I concur would be too mild.

Popularity: 24% [?]

Can Infections Be Preve… - Blogs - Revolution Health

Dr. Val has a good post predicting some unintended consequences of the medicare ‘never’ events.

There are always unintended consequences.

Popularity: 19% [?]

The Happy Hospitalist: The Culture Of Fear

Read the post, but at the end he’s found a very interesting development about the Joint (heh) Comission and their certifying authority…

What kinda skinny dogs are those, anyway?  Does he feed them?

Popularity: 20% [?]

Kevin, M.D. - Medical Weblog: The Happy Hospitalist: All for one and none for all
The Happy Hospitalist: All for one and none for all
The following is a reader take by The Happy Hospitalist.

All for one and none for all. That is the state of the current government program called Medicare. The entitlement program that threatens the financial security of our nation. On March 25, 2008 the Boards of Trustees released their Annual Report of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. In this 43rd edition, the Trustees note a government program covering just over 44 million people at an expense of $425 billion dollars during 2007. That equates to approximately $10,000 per beneficiary.

The Medicare Crisis has the potential to kill this economy, and something has to give.  Read the whole article: it’s well written, it’s a good prescription to avoid the oncoming disaster train, and there’s essentially no way it’s going to happen.

Too bad.  We’re all going to pay for this, literally and figuratively.

Popularity: 20% [?]

The MedGadget guys have the courage of their blogging convictions, and have started a new site focused on medical politics:

Medpolitics.com is a blogging platform and a social network maintained for and by US physicians. Our primary focus is on the politics of healthcare. If you are an American doctor who feels strongly about the challenges our profession is facing, consider to join our community.

Yes, if you’re a physician, and are interested in blogging there, join up!

I’m on the fence about joining, and not because of Dr. Ostrovsky or any of the MedGadget folks, it’s just that I have so little to fill this blog I don’t know if I should dilute what little output I have now.  Time will tell.

Best of luck to MedPolitics!

Popularity: 21% [?]

Medgadget Interviews Dr. J. James Rohack, President-elect of the AMA - Medgadget - www.medgadget.com
Medgadget rarely ventures into politics. However, after one of our editors contacted the American Medical Association (AMA) public relations department to check out how the AMA is doing, we were offered a chance to talk to senior leadership in the organization. We, of course, couldn’t have missed such an opportunity! The result is an interview with J. James Rohack, MD, a cardiologist from Bryan, Texas, in the Texas A&M Health Science Center College of Medicine, and recently announced president-elect of the American Medical Association. Dr. Rohack will assume the AMA presidency in about a year from now, in June 2009.

Looks to be a good interview.  I’ll read it when I get home tonight.  Way to go Dr. Ostrovsky!

Popularity: 17% [?]

Repeat ’super users’ are swamping the ER

by Carol Ann Campbell/The Star-Ledger Sunday July 13, 2008, 8:45 AM

Bean-thin and sallow, George tugged on a cigarette in the blistering parking lot of a Camden men’s shelter. Standing on the pavement, his foot on a picnic bench, he recalled how he took his first drink at 13.

George, here talking to a social worker in Camden, is an emergency room ‘’super user,” having been admitted to ERs in the small city between 30 and 40 times in the past year.

The hard living shows in the lines of George’s face — and in his medical history. When he gets sick, which is often, the 55-year-old has no place to go except one of the city’s emergency rooms.

George is a “super user,” a new name coined to describe people who turn to the ER with astonishing frequency and at an astonishing cost to a health system under siege on all fronts.

This is a very well written article, and I’d bet every ED in America has the same group of ’super users’, patients who are in the ED a lot, not because they want to be but because for a variety of reasons they don’t have other choices.  It’s unfortunate that their only choice is horribly expensive and fragmentary care.

Nobody has an answer to the problem, but I applaud New Jersey for trying to do something about it.

Popularity: 16% [?]