Health Train Express

Tuesday, May 3, 2016

Medical Costs Vary Wildly Around The Country : Shots - Health News

Medical Costs Vary Wildly Around The Country : Shots - Health News : NPR

Monday, May 2, 2016

The Dangerous Patient Safety Delusions of Evidence-Based Medicine

Is common sense being overruled by Evidence Based Medicine ? That is the core argument in this article in The Health Care Blog written by clinicians, they can lead to clinical errors. MICHAEL L. MILLENSON summons Nortin M, Handler M.D. as his muse, stating the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious rors.

No slouch at his own erudite ambivalence about edicts from the National Academy of Medicine, Millenson comes out as highly suspicious and pessimistic about the evidence based medicine cult which appears to have the upper hand, becoming embedded in institutional cement. Some of his reticence results from the seemingly lack of effect of evidence based medicine in parts of North Carolina Perhaps this is a local cultural resistance to centralized federal government edicts and perhaps the exception that proves the rule. The United States is such a large country and has a heterogeneous diverse population both genetically, in socioeconomic strata as well as culturally that one should not be surprised by regional variations.

“The current medical culture is obsessed with perfect replication and avoidance of error. This stemmed from the 1999 alarmist report of the National Academy of Medicine [formerly the Institute of Medicine], entitled “To Err is Human,” in which the absurd conclusion was propagated that more patients died from medical errors than from breast cancer, heart disease and stroke combined; now updated by The National Academy of Medicine’s (formerly the IOM) new white paper on the epidemic of diagnostic error.

Not long after the National Academies published “To Err is Human. Building a safer health system”, a study from the US Veteran’s Administration demonstrated that the preventable hospital deaths due to medical errors was very much “in the eye of the reviewer.”[1]

In a recent post, the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious clinicians, they can lead to clinical errors. That post was followed by another by Paul Levy, a former CEO of a Boston hospital,arguing that the errors can be diminished and the anxieties assuaged if institutions adhered to an efficient, salutary systems approach. Both Dr. Samuels and Mr. Levy anchor their perspective in the 1999 report of Institute of Medicine Report,

Dr. Samuel's post on THCB is similarly worthy for championing the role of the physician in confronting the challenge of doing well by one patient at a time. Mr. Levy and his fellow travelers are convinced they can create settings and algorithms that compensate for the idiosyncrasies of clinical care. I will argue that there is nobility in Dr. Samuels’ quest for clinical excellence. I will further argue that Mr Levy is misled by systems theories that are more appropriate for rendering manufacturing industries profitable than for rendering patient care effective.

Physicians must not be coerced by government guidelines. These metrics are ruled by the least common denominator, and filtered by ta hierarchy of committees.

America has made a tremendous investment in intensive care units. We have many times the ICU beds per capita as any other resource advantaged country, 25 per 100,000 people as compared to 5 per 100,000 in the United Kingdom. Not surprisingly, when we build them we also build the demand, so-called demand elasticity.[2] The indications for admission in America result in a very different case-mix than anywhere else. We need ICU beds for patients with acute or potentially reversible conditions, but do we need them for the frail elderly or the terminally ill? Maybe the error is not so much in their medical treatments as in the lack of appreciation of their humanity.

Credits:

Nortin M. Handler, Michael Millenson,

The Dangerous Patient Safety Delusions of Eminence-Based Medicine | THCB

Tuesday, April 26, 2016

Health Reform Troubles and the Affordable Care Act

We are now several years into the Affordable Care Act. There are now facts and figures which reveal troubling tremors in the financial underpinning of health insurance for all patients. No one will be exempt from these market forces.

Some politicians and President Obama (for whom the ACA was renamed "Obamacare") insist on how many millions of Americans are now insured. Yes, they carry a card, either a blue one with a stripe (Medi-caid) or a private plan. What many of these newly insured do not know is the card they carry from the ACA is not the same that fully paying patients have in their wallets. The term "What' in your wallet" may be applied to health insurance cards as it has been to certain credit cards. The similarities are frightening.

These subsidized plans required providers to sign new contracts with less reimbursement eliminating any incentive to be credentialed for the affordable care act. It required providers to re-program their practises management software to bill different amounts for the ACA and to accept a lower reimbursement for each procedure code.

In some Western states the impact of undocumented workers remains largely unknown. However there are those who want to include the segment of our population. I think these immigrants do need to be protected, and not be excluded from the American health system. We have always been a country that welcomes immigrants and usually assimilate them fairly quickly.

Here is what is building.

ACA News

Will Covered California Sell Health Coverage To The Undocumented?
ObamaCare premiums expected to rise sharply amid insurer losses
United’s Departure From Marketplaces Could Impact Consumers’ Costs, Access

United HealthCare has absorbed multiple other companies during the past two years, to insulate itself from competition and have full reign over the market for insurance plans. These mergers include or will include the following competitors.

United HealthCare and Humana to Merge - PR Newswire

Wikinvest lists these UHG mergers and acquisitions and divestitures in the past ten years

This includes former independent health insurers, Oxford, Pacificare,Mid Atlantic Medical Services Inc.,Definity Health Corporation (Definity).Uniprise USS, Exante

United Health Group has several other companies in their sights Humana and Aetna. Anthem also
has eyes on Humana and Aetna is bidding on Cigna. As the old baseball adage goes (So who's on first?)

Readers can see more..........

The changes will impact consumers in different states, according to market share and other factor such as the amount of care to patients with long standing expensive chronic disease, more advanced because of neglect in the group of the uninsurables. The impact of lifestyle becomes a significant issue for some states where poor nutritional habits affect health and the development of chronic illness, diabetes, obesity, hypertension, the effects of depression, unemployment, environmental hazards. Social change and erosion of the middle class will impact health as well.

The longstanding organization of employee based health care is disappearing, and group policies are re-organizing.

Wall Street is ablaze with speculation and the huge increase in share value for many of these companies.

Fortune's headline proclaims,

UnitedHealth-Aetna colossus would overtake Apple on the Fortune 500.
As things develop eventually there may only be several players in the health insurance
market....."too big to fail". Uncle Sam steps in when all is lost.......and there you have it "UNIVERSAL PAYER" Who wudda thot ?
So where do patients and providers fit in?
Parts of this article are from Fortune, and reporting from the California Medical Association.

Planning for the Next Generation of Health Care Delivery: Designing for Telemedicine Spaces – Telehealth and Medicine Today ™

Sunday, April 24, 2016

F.A.S.T. Are you at Risk for a Stroke

I have had many illnesses, including heart disease and a mild stroke. I went through open heart surgery and several angioplasties for heart disease.

On a scale of dread, heart disease was about a 2 on a scale of 1 to 5. The idea of a stroke was a 6 in my mind, and when it happened quite suddenly, while I was asleep i had an acute anxiety attack.

When I awoke I realized there was something amiss in my non-dominant right hand, it was numb. In the past I would at times awaken and have one of my hands tingling or numb which I attributed to a cervical disk problem.(one of my cervical disks bulges,and I have had a surgery on my lower back for a ruptured intervertebral disk) However this did not go away even with stretching my neck. Try as I might my right arm and hand refused to obey my commands.

I am fortunate. The symptoms and signs diminished quickly over a period of two weeks. I was left with some residual balance and gait disorder, for which I have learned to compensate.

The best way to treat a stroke is to not have one. I ignored a serious and common factor for stroke risk. Snoring and sleep apnea, both of which are successfully treated. It is listed as a risk factor, but is overshadowed by cholesterol issues, hypertension, and diabetes. I ignored my spouses warnings about my snoring and periods of sleep apnea. Sleep apnea occurs when there is total airway obstruction from snoring. Patients are unaware of these episodes but whoever sleeps with or near them will hear a gasp and see the victim roll over or moan.

Sleep apnea or severe snoring should be characterized as an urgent medical problem. There are tests to easily diagnose the problems, and even an at home testing device, which screens for sleep apnea. A formal sleep apnea test in a sleep lab is still necessary. It's a small price to pay, sleeping away from home for a night, however it is a small price as compared to paralysis

I share this as an admonition for this month' preventive measure as well as weight reduction, a healthy diet, and exercise.

AUT researchers have developed an app to calculate stroke risk factors. Available on both iOS & Android platforms, the Stroke Riskometer App was selected by leading doctors as a top health app for 2014 from 100,000+ apps available. It is available on iTunes and Google Play Store.It is endorsed by the WSO (World Stroke Organization

Remember !

	Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
	Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
	Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." I s the sentence repeated correctly?
	Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you'll know when the first symptoms appeared. This is critical for medical personnel to know if blood thinners will be effective in treating the stroke.

Friday, April 22, 2016

Online Doctor Consultation & Virtual Doctor Visit Reviews

Thursday, April 21, 2016

The Mess That is MACRA | THCB

The Stoessel Report

Unfortunately for John Stoessel he was diagnosed with lung cancer this month. I pray for his speedy recovery. In the process of being discharged from hospital he complained the customer service was terrible.. His complaint was not extraordinary. Mr. Stoessel of FOX news is known for ihis acerbic commentary about current events.

Mr. Stoessel did not specify how or if his medical care suffered. This event by a visible 'celebrity' will undoubtedly ring bells and remove stars (*****) from the hospital's HEDIS ranking and Medicare's STAR system of measuring quality assurance. I pity the hospital CEO or the VP of medical affairs. For certain the Board of Trustees will forgo their usual free lunch to allow this item to be placed on the next agenda.

I would like to add that his physicians probably have the same complaints about provider services. Such things as having to wait for an operating room, or the constant demands for paper work, signing orders, inadequate parking,and having to wear an identification card and/or a security card. and of course being frowned upon for dissing nurses administrators. This says nothing about the disappearance of free meals every day and steaks on Friday. When I was a sprig of a physician back in mid 20th century I expected a full buffet spread with a chef to serve me in the doctor's dining room. This of course ocurred in Orange County California where normalcy included two Mercedes in the garage (there were no Tesla's at the time) and a beach house. At the time hospitals were popping up in the bean fields. Doctors would chose their hospital rounds at a time when meals were being served.

Today all of those perks are gone. The small one story hospitals are gone or have morphed into multistory hotels without customer service. There are even chains of hospitals managed or owned by nationwide companies.

John, I would like to thank you for your objective measure of hospital quality. I do pray for your prompt recover, thanks to modern medicine. The cost of things now just does not allow for 'customer service.' That went out the window due to cutbacks long before the Affordable Care Act.

As a very visible 'celebrity' I salute your expose. I hope you will join those of us who campaign daily for patient and provider advocacy. I wholeheartedly encourage you to continue your commentary about patient experience's.

And please don't forget us poor providers.Perhaps we should invite you to a medical staff meeting. Perhaps I can assist you there. Do you have an agent ?

A fan,

Gary M.Levin M.D.

Wednesday, April 20, 2016

Don Quixote and the Health Professional’s Endless Quest | THCB

Recently The Health Care Blog featured a post by Richard Gunderman M.D.

Don Quixote on his mount, Rocinate, with Sancho Panza

Are we as physicians destined to also flail at windmills? In the modern era we face similar obstacles

"April 22 marks the 400th anniversary of the death of the greatest novelist who ever lived, Miguel de Cervantes. Though the day will pace unnoticed by most physicians, it is in fact one many should note. Why? Because both his life and work can serve as vital sources of inspiration and resilience for health professionals everywhere."

Cervantes faced numerous disappointments and setbacks in life – poverty, imprisonment, slavery, serious injury, and repeated rejection. Not unlike many contemporary health professionals, he had many reasons to become discouraged and give up. Yet he found the will to carry on. Where did he find such inspiration and resilience? I believe that he found them above all in his work – not the reactions of critics or the royalties he collected, but his deep belief in his life’s mission.

Though the novel is filled with battles of various kinds, Don Quixote reminds contemporary health professionals that the real battle takes place within.

"In giants we must kill pride and ignorance. But our greatest foes, and those we must chiefly combat, are within. Envy we must overcome by generosity and nobleness of spirit; anger, by a reposed and quiet mind; riot and drowsiness, by vigilance and temperance; lasciviousness, by our inviolable fidelity to the mistresses of our thoughts; and sloth, by our indefatigable peregrinations through the universe. . . . This, Sancho, is the road to lasting fame and good and honorable renown."

Richard Gunderman makes me realize it is time to re-read Miguel de Cervantes.