Washington, Please don’t bail out the health care industry

From the Health Care Blog:

A health care Marshall Plan — $50 Billion stimulus to get electronic health records (EHRs) in every doctor’s hands or $50,000 to each physician -– what an incredible marketing job.

Detroit, are you listening? Stop whining to Congress that you need a bailout. Tell them you want to be the new alternative energy Manhattan Project, get the money, and then keep building SUVs and flying around in corporate jets.

To Congress, Daschle, and Obama, please don’t do this. Our industry, health care, combines the worst of the Big Three automakers with the worst of the hubris, dishonesty, and failure of the public trust of Wall Street. Please do not bail us out.

Free-standing ERs promise good medicine plus customer service

From the Kansas City Star:

At most of America’s 4,500 or so hospital emergency rooms, the old ways still rule. But a new type of emergency facility is emerging across the country, one that isn’t at a hospital at all and whose claim to fame is customer service.

Often situated in the fast-growing suburbs, these “freestanding” emergency rooms trumpet shorter wait times and a more pleasant environment and, at their best, bring much-needed emergency diagnostic and clinical expertise to underserved areas.

Typically staffed by board-certified emergency physicians, they’re equipped to evaluate, stabilize, diagnose and treat patients with conditions as varied and serious as broken bones and severe burns. They currently operate in only about 16 states, so they’re not commonplace yet. But their numbers are growing fast. Between 2005 and 2006 alone, the total grew more than 20 percent, to 179, according to the American Hospital Association.

USA Today Editorial on Malpractice

From USA Today:

Health care costs are out of control, as we heard constantly during the presidential campaign. Yet that doesn’t stop sensible physicians from shunning the sickest patients or ordering needless hospitalizations, drugs, tests and invasive procedures.

Against their better judgment, physicians practice “defensive medicine” — actions designed to protect themselves from lawsuits rather than serve patients’ best interests.

Why? The threat of being sued is pervasive, and doctors simply don’t trust the legal system. One in seven obstetricians/gynecologists has stopped delivering babies, and three-quarters have been sued at least once, according to a 2003 study. Years of staggering malpractice premium increases have forced many to alter their practices or quit treating patients.

The decline of family practice residency training programs

From Kevin MD:

It’s well known that fewer medical students are opting to become family physicians.

This is having a deleterious effect on training programs, where slots are going unfilled. It costs approximately $100,000 to train a single doctor, and hospitals are operating family practice residencies at a loss.

Two programs in Arizona are eliminating such primary care training positions, citing cost and declining student interest.

As “doctors are more likely to launch their careers near where they complete their medical training,” this further depletes the region of much-needed new primary care blood.

Economy Affects Hospitals In U.S.

From eFluxMedia:

Healthcare companies and organizations are about to confront with a “watershed” 2009, a report released by PricewaterhouseCoopers LLP’s Health Research Institute reveals.

Medical facilities throughout the United States are making great efforts in order to stay afloat amid the financial crisis, even though many of them have had pecuniary issues for a long time, Medicare, Medicaid and other such government health programs often being the ones to be criticized.

The economy already started to have an impact on the health industry and the effects will be more noticeable in the coming year. Despite the fact that the health care industry “historically has been less vulnerable to economic downturns than other industries, the disrupted economy will hit healthcare in 2009,” PricewaterhouseCoopers informed.

ERs could shut doors

From the Las Vegas Sun:

Nevada hospitals are in such dire financial condition that at least two are considering closing their emergency rooms and refashioning themselves as something other than full-service hospitals, according to the head of the Nevada Hospital Association.

Bill Welch, president of the trade group, declined to say which hospitals are discussing the option.

Because emergency room patients with no ability to pay are financially draining hospitals’ bottom lines, they are considering closing and reopening as rehabilitation, psychiatric or skilled nursing facilities.

At What Price Physician Autonomy?

From the New York Times “Today’s Economist” Blog:

After a lengthy discourse on health policy with a physician, I asked him to describe the ideal health system from a physician’s perspective. “Everyone in society should have access to needed health care,” he responded. “Only the physician and the patient should decide how to respond to a given medical condition. And someone should reimburse providers of health care at reasonable rates.”

Leave aside the fact that providers of health care are “paid” for their services, not “reimbursed,” the latter method always breeding bad managerial habits. Leave aside also that the definition of “needed” health care is highly elastic. Focus instead on the core of the ideal: complete clinical autonomy for physicians and their patients to throw whatever resources they wish at given medical conditions, usually at someone else’s expense, with little or no accountability for their preferred treatments’ quality or success.

Most physicians, and I would suspect most of their patients, probably subscribe to this ideal. Alas, a mounting body of research leads experts to doubt that physician autonomy actually serves society well and that it will be affordable much longer.

Medicaid owes Peoria hospitals millions

From the Peoria (IL)  Journal Star:

They aren’t panicking, but Peoria health-care providers have serious concerns about the millions of dollars state government owes them.

Their worries are understandable.

The Journal Star checked with selected providers in town and found they are due at least $32 million from the state – mainly for medical care they gave to people who have low incomes and are on Medicaid. In many cases, the bills are several months old.

Bill would give tax break as incentive for doctors

From the Kansas City Star:

A (Missouri) state lawmaker is pushing legislation that would provide health care workers tax breaks as an incentive for them to see more Medicaid recipients.

State Sen. Jason Crowell, R-Cape Girardeau, said the bill would allow doctors, nurses and dentists to deduct Medicaid payments from their taxable income.

He said such a move would make up some of the gap between how much the taxpayer-funded program reimburses for health care and how much that care actually costs. The generally low payments have led many health care providers to avoid treating Medicaid patients, creating a bottleneck for those patients to find care.

In the year that ended June 30, Medicaid payments to health care providers was $206.7 million. Crowell estimates his bill would provide tax savings to those providers of about $12.4 million.


KevinMD on a New England Journal of Medicine “Perspectives” article

Stanford’s Abraham Verghese has a wonderful perspective piece in the current NEJM.

With the advent of electronic information systems in hospitals, today’s medical residents spend more time in front of computer monitors instead of talking to patients.

Dr. Verghese coins the term the “iPatient,” where “emergency room personnel have already scanned, tested, and diagnosed, so that interns meet a fully formed iPatient long before seeing the real patient. The iPatient’s blood counts and emanations are tracked and trended like a Dow Jones Index, and pop-up flags remind caregivers to feed or bleed.”