Get me a neurosurgeon, stat!

From US News and World Report:

Across the country, three quarters of emergency departments report a shortage of specialists like neurosurgeons and orthopedists, according to a 2006 survey by the American College of Emergency Physicians. That’s up from two thirds when the survey was done in 2004. “This is the weak link in the chain of survival,” says Loren Johnson, the emergency department director at Sutter Davis Hospital in Davis, Calif., and a researcher on medical staffing shortages. Emergency rooms depend on specialists to come in at any hour, any day, to, say, treat stroke victims or reattach fingers severed in an accident. But “specialists just don’t want to cover emergency rooms anymore,” says Johnson. Earlier this month, he coauthored a study published in the online edition of the Annals of Internal Medicine reporting that nearly half of Oregon’s hospitals cannot provide emergency on-call treatment around-the-clock in at least one specialty. A recent survey of emergency departments throughout the Southeast showed that 54 percent had to divert patients to another hospital because they didn’t have the appropriate specialist on call.

These delays hurt, and sometimes kill. The Joint Commission, hospitals’ major credentialing body, has cited lack of specialists as the cause of 21 percent of emergency department “sentinel events”—unexpected deaths or serious injuries due to slow treatment.

So where have all the specialists gone? They’ve been driven away, observers say, by three modern maladies of American healthcare: too much work, too little pay, and the fear of malpractice lawsuits. “Put all those things together, and who would want to be in this business?” asks Todd Taylor, who teaches emergency medicine at Vanderbilt University in Tennessee.

Norms for Staff of UWMC Emergency Department

Norms for Staff of UWMC Emergency Department

1. Remember the patient is the reason we are here
2. Treat the patient and their families with dignity and care for them with compassion
3. Maintain patient confidentiality at all times; keep your voice down and discuss patients only in private areas
4. Wear your name tag and introduce yourself to patients and their families
5. Maintain your professionalism by avoiding personal conversations and laughter which can be overheard by patients and their families
6. Participate as a team member in the care of patients in the department. Treat all members of the team with respect
7. Show pride in our department by helping to maintain it in a clean and presentable manner, for patients, families and staff
8. Be aware that far more is communicated by tone (43%), body language (50%), than by words (7%)
9. Address disagreements with other staff members directly, in private, and at the appropriate time
10. Be flexible

1. Say “it’s not my job”
2. Ask someone to do something you could easily do yourself
3. Shoot the messenger
If norms are broken:
1. Adress the behavior directly in a private place
2. Respect the person
3. Use “I” statements when expressing your concerns

If broken norms persist:
1. Re-address the behavior
2. Document behavior
3. Involve your “chain of command”

"An Rx for Deadly Dosages"

From Time:

Flawed prescriptions each year kill more than 7,000 people in the U.S. and injure more than 1.5 million. To reduce such errors, a coalition of health-care companies and tech firms is launching eRX Now, a Web-based program that will enable all physicians in the U.S. to write electronic prescriptions for free. It will also let them check drug interactions and prevent illegible hand-writing–or smudged decimal points on dosages–from ending in disaster. The $100 million project, whose backers include Allscripts, Dell, Aetna and hospital groups, is targeting the 30% of M.D.s who write 80% of the country’s 3.2 billion prescriptions a year. (Although 90% of the 550,000 doctors in the U.S. are online, fewer than 10% use software to write prescriptions.) “Our goal long term is to get the prescription pads out of doctors’ hands, to get them working on computers,” says Dell V.P. Scott Wells. Docs going online will be good for patients–and for tech sales.

Comments on EMR


Not long ago, I regularly coached students and residents that during their patient encounters, they should put their papers and notes aside and listen to the person — look them in the eyes. There was so much more to be learned by having doctors use their eyes as well as their ears.

Today, a flat-screen computer sits between the doctor and the patient — just as a fence divides two neighbors. My students and residents — like doctors around the country — are slaves to the computer and electronic medical records. If you’ve not had the experience of sitting across from your doctor as she or he types your medical history into the computer, then just wait, as it is likely coming. One health-care expert calls the push for the electronic medical record (or EMR, as it is called in medical circles) the search for medicine’s holy grail.

Woman files complaint that doctor offered patients $10 to go home

From the Sault Star:

An Echo Bay woman plans to file a complaint with Sault Area Hospital that an emergency room doctor was offering patients $10 to go home.

Diane Edwards had been waiting eight hours to get a prescription refilled when a physician told the “room full of people he’d pay them $10” each if they left, she told CBC Radio in Sudbury this week.

Changes Proposed for Medicaid Funding

Bush administration plan would cut spending, affect many small hospitals, nursing homes

WASHINGTON (AP) – Many rural hospitals and nursing homes would get fewer federal dollars under a proposal to save Medicaid almost $4 billion over the next five years. The change would have “a significant economic impact on a substantial number” of health care providers, the Bush administration acknowledges.

At issue are financing arrangements between states and local governments. These deals tend to increase Washington’s share of spending in Medicaid, the joint state-federal program covering 55 million poor and disabled people, even when a state’s share is unchanged or drops.

The federal share of the program ranges from 50 percent to 76 percent, depending upon the state. Poor states receive a greater federal share.

In many states, financing arrangements between health care providers and the state result in the federal government paying more than the law says it should. Dennis Smith, director of the federal Center for Medicaid and State Operations, said the proposed rule made public late Friday would put a crimp on that practice.

“This is about the match rate, and states have demonstrated they’re willing to fund their share of the program,” Smith said in an interview Saturday. “It’s just that for many years previous to us, they were not paying their share.”

The Kaiser Family Foundation, which conducts health care research, said some of these arrangements have helped states maintain important services, such as nursing home care, during tough economic times.

The proposed rule says that Medicaid payments to health care providers operated by local governments such as counties cannot exceed costs. The rule says health care providers – not a state or local government – must get all of the reimbursement they are entitled to get when they treat a Medicaid patient.

“We expect this rule to have a significant economic impact on a substantial number of small entities, specifically health care providers that are operated by units of government,” the proposed rule says.

According to federal data, there are 1,153 hospitals operated by local governments or hospital districts; 822 nursing homes with such ownership; and 113 intermediate care centers for the mentally retarded.

The Health and Human Services Department did not estimate how many of those facilities would be affected by the rule.

Smith, however, sought to play down the economic effect, saying he did not believe the rule would have a dramatic impact on providers. He framed the savings, estimated at $3.9 billion over five years, in the context of the $200 billion that the federal government spends annually on Medicaid.

Smith cited an example of improper financing: A hospital gets paid $100 – half from Washington and half from the state – but then gives $10 back to the state and the state spends the money as it wants.

Smith said the federal government is saying that the true cost of the procedure should have only been $90, shaving Washington’s true match to $45.

The Government Accountability Office said in a 2004 report that some of the financing arrangements that states use to increase federal funding undermine the program’s integrity. Some of its key recommendations are in the proposed rule.
Rachel Klein, deputy director of health policy at Families USA, said she agrees with the need for an evenhanded and efficient program, but limiting how states come up with their Medicaid match also puts the squeeze on states.

“It affects their ability to fund the Medicaid program,” Klein said. “In turn, that makes it harder for people to get the critical health care services they rely on.”
Families USA promotes policies it believes will increase health coverage for the poor.

The public has 60 days to comment on the proposal. The department will subsequently issue a final rule that would have the force of law.

Proposed Rule:

2007 Medicare Payment Rates Posted

2007 Medicare Payment Rates Posted

The Centers for Medicare & Medicaid Services (CMS) and Medicare contractors have posted 2007 physician payment rates on their Web sites following our victory in December halting their proposed payment cuts. These revised fees, which went into effect 1/1/07, result from the Medicare physician payment provisions of the “Tax Relief & Health Care Act of 2006” (HR 6111). Due to the revisions to the 2007 fee schedule, CMS has extended the participation enrollment period to 2/14/07. The 2007 conversion factor ($37.8975) and the geographic adjustments are the same as in 2006. Carriers must process claims at the revised rates. For more details, see the official instruction provided to the Medicare carriers:, or visit DO-Online ( to see a table showing the combined impact of the various Medicare payment changes.