Archive for the ‘Healthcare’ Category
Paul Kiel (ProPublica) and Chris Arnold (NPR) have an interesting story on how bad the US healthcare system is, compared to healthcare in most Western countries:
On the eastern edge of St. Joseph, Missouri, lies the small city’s only hospital, a landmark of brick and glass. Music from a player piano greets visitors at the main entrance, and inside, the bright hallways seem endless. Long known as Heartland Regional Medical Center, the nonprofit hospital and its system of clinics recently rebranded. Now they’re called Mosaic Life Care, because, their promotional materials say: “We offer much more than health care. We offer life care.”
Two miles away, at the rear of a low-slung building is a key piece of Mosaic—Heartland’s very own for-profit debt collection agency.
When patients receive care at Heartland and don’t or can’t pay, their bills often end up here at Northwest Financial Services. And if those patients don’t meet Northwest’s demands, their debts can make another, final stop: the Buchanan County Courthouse.
From 2009 through 2013, Northwest filed more than 11,000 lawsuits. When it secured a judgment, as it typically did, Northwest was entitled to seize a hefty portion of a debtor’s paycheck. During those years, the company garnished the pay of about 6,000 people and seized at least $12 million—an average of about $2,000 each, according to a ProPublica analysis of state court data.
Many were uninsured Heartland patients who were eligible for financial aid that would have eliminated or drastically cut their bills. Instead, they were charged full price for their care, without the deep discounts negotiated by insurers, according to court records, interviews and data provided by Heartland. No other Missouri hospital sued more of its patients.
Blue collar workers, Walmart cashiers, nursing home aides, clerical staffers—these types of patients have long been the most vulnerable to unexpected debt. They can’t afford insurance, yet they’re not poor enough for Medicaid. Even after the 2010 Affordable Care Act, about 30 million Americans remain uninsured, in part because some states, like Missouri, have not expanded Medicaid to cover more of the poor.
Earlier this year, ProPublica and NPR reported that the wages of millions of U.S. workers are diverted to pay off a variety of consumer debts. Most states, like Missouri, allow creditors to take a quarter of after-tax wages—an amount that government surveys show is unaffordable for lower-income families.
Consumer advocates say the laws governing wage garnishment are outdated and overly punitive, regardless of the debt’s source. But the consequences are especially dire when garnishment is used to collect unavoidable health care bills—with interest and legal fees piled on.
No one tracks how many hospitals sue their patients and how frequently, but . . .
Continue reading. And do read the whole thing: it’s an in-depth article.
The US could fix this if it wanted, but it’s easier just to screw over poor people.
Hannah Block reports for NPR:
Checking into a hospital can boost your chances of infection. That’s a disturbing paradox of modern medical care.
And it doesn’t matter where in the world you’re hospitalized. From the finest to the most rudimentary medical facilities, patients are vulnerable to new infections that have nothing to do with their original medical problem. These are referred to as healthcare-acquired infections, healthcare-associated infections or hospital-acquired infections. Many of them, like pneumonia or methicillin-resistantStaphylococcus aureus (MRSA), can be deadly.
The World Health Organization estimates that “each year, hundreds of millions of patients around the world are affected” by healthcare-acquired infections. In the United States, the Office of Disease Prevention and Health Promotion in the Health and Human Services Department estimates that 1 in 25 inpatients has a hospital-related infection. In developing countries, estimates run higher.
Hospital bed safety railings are a major source of these infections. That’s what Constanza Correa, 33, and her colleagues have found in their research in Santiago, Chile. They’ve taken on the problem by replacing them, since 2013, with railings made of copper, an anti-microbial element.
Copper definitely wipes out microbes. “Bacteria, yeasts and viruses are rapidly killed on metallic copper surfaces, and the term “contact killing” has been coined for this process,” wrote the authors of an article on copper in Applied and Environmental Microbiology. That knowledge has been around a very long time. The journal article cites an Egyptian medical text, written around 2600-2000 B.C., that cites the use of copper to sterilize chest wounds and drinking water.
Correa’s startup, Copper BioHealth, has not yet assessed the railings’ impact in Chilean hospitals. But a study of the effects of copper-alloy surfaces in U.S. hospitals’ intensive care units, published last year in Infection Control and Hospital Epidemiology, showed promising results: Their presence reduced the number of healthcare-acquired infections from 8.1 percent in regular rooms to 3.4 percent in the copper rooms.
Correa spoke with Goats and Soda a few hours before she presented her work at a Latin America innovation conference earlier this month, hosted by the Inter-American Development Bank in Washington, D.C.
You have a simple strategy to combat hospital-associated infections. Tell me what it involves. . .
Len Charlap, a retired math professor, has had two outpatient echocardiograms in the past three years that scanned the valves of his heart. The first, performed by a technician at a community hospital near his home here in central New Jersey, lasted less than 30 minutes. The next, at a premier academic medical center in Boston, took three times as long and involved a cardiologist.
And yet, when he saw the charges, the numbers seemed backward: The community hospital had charged about $5,500, while the Harvard teaching hospital had billed $1,400 for the much more elaborate test. “Why would that be?” Mr. Charlap asked. “It really bothered me.”
Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue — especially because the equipment to perform them has generally become far cheaper, smaller and more highly mechanized in the past two decades.
And echocardiograms, ultrasound pictures of the heart, are enticing because they are painless and have no side effects — unlike CT scans, blood draws,colonoscopies or magnetic resonance imaging tests, where concerns about issues like radiation and discomfort may be limiting. Though the machines that perform them were revolutionary and expensive when they first came into practice in the 1970s, the costs have dropped considerably. Now, there are even pocket-size devices that sell for as little as $5,000 and suffice for some types of examinations.
“Old technology should be like old TVs: The price should go down,” said Dr. Naoki Ikegami, a health systems expert at Keio University School of Medicine in Tokyo, who is also affiliated with the University of Pennsylvania’s business school. “One of the things about the U.S. health care system is that it defies the laws of economics, and of gravity. Once the price is high, it just stays there.” . . .
Kevin Drum quotes from the article with emphasis added:
The five hospitals within a 15-mile radius of Mr. Charlap’s home here charge an average of about $5,200 for an echocardiogram, according to an analysis of Medicare’s database. The seven teaching hospitals in Boston, affiliated with Harvard, Tufts and Boston University, charge an average of about $1,300 for the same test. There are even wide variations within cities: In Philadelphia, prices range from $700 to $12,000.
….In other countries, regulators set what are deemed fair charges, which include built-in profit. In Belgium, the allowable charge for an echocardiogram is $80, and in Germany, it is $115. In Japan, the price ranges from $50 for an older version to $88 for the newest, Dr. Ikegami said.
Because Mr. Charlap, 76, is on Medicare, which is aggressive in setting rates, he paid only about $80 toward the approximately $500 fee Medicare allows. But many private insurers continue to reimburse generously for echocardiograms billed at thousands of dollars, said Dr. Seth I. Stein, a New York physician who researches data on radiology. Hospitals pursue patients who are uninsured or underinsured for those payments, he added.
Best medical system in the world, eh?
This is a positive development, reported at NPR by Ina Jaffe:
It’s a sunny autumn afternoon and a good time to make apple crisp at Pathstone Living, a memory care facility and nursing home in Mankato, Minn. Activities staffer Jessica Abbott gathers half a dozen older women at a counter in the dining area, where the soundtrack is mostly music they could have fox-trotted to back in the day.
It seems residents can always find something to do around here. That can help to relieve the agitation common in some people with Alzheimer’s or other forms of dementia — agitation that in other nursing homes might be managed with antipsychotic drugs.
Though antipsychotics are approved to treat serious mental illnesses like schizophrenia and bipolar disorder, the FDA says the drugs can increase the risk of death for people with dementia. Still, they’re prescribed for nearly 300,000 nursing home residents nationally.
A few years ago, antipsychotics were used frequently at Pathstone, too.
“We saw these as medications that were supposed to help the patient and, of course, we gave them to them with the feeling that we were doing good,” saysShelley Matthes, a registered nurse who is head of quality assurance for the nonprofit Ecumen, which runs Pathstone and about a dozen other nursing facilities in Minnesota.
Dr. Tracy Tomac is a psychiatrist and medical consultant at Pathstone. In the old days, a resident might have been started on antipsychotics to deal with an emergency, Tomac says, “but they would just stay on it. They would never be taken off for many months or even years.”
So in 2009, she and a colleague at a small Ecumen nursing home near Duluth decided to see if they could reduce the use of antipsychotics there.
“At the end of six months or so,” Tomac says, “we were able to get them all off any antipsychotics.”
The next year they extended the policy to all of Ecumen’s nursing homes. “Our goal, Matthes says, “was to reduce our antipsychotic use by 20 percent. And in the first year we reduced it by 97 percent.”
Continue reading. An important sidebar:
Nursing Home Patients Bill Of Rights
All U.S. residents of nursing homes have specific legal rights, detailed in the Nursing Home Reform Act of 1987. Some of the most important rights include:
- The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.
- The right to confidentiality of personal and clinical records.
- The right to current clinical records of the resident upon request , and to get those records within 24 hours (excluding hours occurring during a weekend or holiday) of when the resident or a legal representative makes the request.
- The right to choose a personal attending physician, to be fully informed in advance about care and treatment, and to be fully informed in advance of any changes in care or treatment that may affect the resident’s well-being. Also, the resident (or a legal representative) has the right to participate in planning care and treatment or changes in care and treatment.
Finally, psychoactive drugs (including antipsychotics as well as drugs for depression and anxiety) may be administered only on the orders of a physician and only as part of a written plan designed to eliminate or modify the symptoms for which the drugs are prescribed. Such drugs may be given only if, at least annually, an independent, external consultant reviews the appropriateness of the drug plan of each resident receiving such drugs.
Source: Cornell University Law School Legal information Institute
At the link, NPR lets you check medication rates at facilities local to you:
Check NPR’s interactive database . . . to see the history of antipsychotic drug usage at nursing homes in your area and how they compare to national and state averages.
The road to hell is famously paved with good intentions…
Very interesting article by Scott Kellogg in Pacific Standard:
Anyone who believes in progressive drug policy reform and in embracing a more humanistic system of care would agree that we are living in a time when amazing things are happening. Both the Global Commission on Drug Policy and the Drug Policy Alliance, among others, have helped us realize that the War on Drugs has actually been a war on people, and that while drug use can clearly be destructive, the impact of prohibition and incarceration is frequently even worse. It is also an exciting time in the field of addiction treatment because that, too, is in the middle of a major paradigm struggle. The question at the heart of this conflict is: Are individuals who have difficulties with drugs and alcohol bad people who should be punished or sick people in need of healing?
The Moral/Social Model: The “Bad” Tradition
The mainstream addiction treatment system is filled with thousands of dedicated and compassionate clinicians and other professionals. Nonetheless, the belief that people who use drugs and alcohol in problematic ways are fundamentally bad is an assumption that permeates the system. It is also at the heart of what I call the Moral/Social model of treatment.
This model is not only supported by the larger culture and the criminal justice system, but also, tragically, by the 12-step fellowship tradition and the Therapeutic Community movement. “In the AA understanding, the core of alcoholism, the deep root of alcoholic behavior, lies in character,” write Dr. William Miller and Dr. Ernest Kurtz in “Models of Alcoholism Used in Treatment.” “‘Selfishness—self-centeredness! That, we think, is the root of our troubles,’ reads a key passage of AA’s description of ‘How It Works.’”
In turn, Dr. George De Leon, a student of therapeutic communities, emphasized the importance of values and morals in the Therapeutic Community model. “Drug abuse is regarded as a disorder of the whole person…. Cognitive, behavioral, and mood disturbances appear, as do medical problems; thinking may be unrealistic or disorganized; and values are confused, non-existent, or antisocial. Frequently there are deficits in verbal, reading, writing, and marketable skills. Finally, whether couched in existential or psychological terms, moral issues are apparent,” he wrote in “The Therapeutic Community: Toward a General Model.”
To be fair, mutual aid societies are free to have any beliefs they wish, and the Therapeutic Community movement continues to evolve. Nonetheless, this underlying moral vision has, at times, served as a foundation for attitudes and actions toward addicted patients that we would deem to be unacceptable for patients with other disorders. (I call this a social model because of the overwhelming emphasis on groups as a vehicle for change. This stands in direct contrast to the general emphasis on individual therapy in the treatment of other psychiatric or mental health disorders.)
A recent example of this model’s continuing influence can be seen in a report released by the Institute for Behavior and Health earlier this year. Entitled “The New Paradigm for Recovery,” the report was spearheaded by psychiatrist Robert DuPont, a former drug czar and director of the National Institute on Drug Abuse (NIDA). Starting in a scientific vein, the report affirms NIDA’s view that substance use disorders are now understood to be a chronic disease that involves a “hijacked” brain.
But in an unexpected shift, the authors then advocate for a public policy that promotes the stigmatization of problematic substance use: “Unhealthy patterns of drug and alcohol use warrant ‘stigma,’ to warn others to avoid such behaviors and to help persons engaged in such behaviors [to] identify the need for help.” (This recommendation is quite striking because there have been a number of efforts to reduce the stigma around addiction, including some by NIDA.) Although the IBH report clarifies that it is the behavior, not the person, that should be stigmatized, it seems to me that the damage is already done. . .
Marshall Allen and Olga Pierce report in Pacific Standard:
Patients who suffer injuries, infections, or mistakes during medical care rarely get an acknowledgment or apology, researchers at the Johns Hopkins University School of Medicine report.
The study was based on responses of 236 patients who completed ProPublica’s Patient Harm Questionnaire during the one-year period ending in May 2013 and who agreed to share their data.
Results of the study, led by professor of surgery Marty Makary and conducted independently from ProPublica, were published online November 13 by the Journal of Patient Safety. The study found:
- It was common for health care providers to withhold information about medical mistakes. Only nine percent of patients said the medical facility voluntarily disclosed the harm.
- When officials did disclose harm it was often because they were forced to. Nine percent of respondents said the harm was only acknowledged under pressure.
- Apologies were infrequent. Only 11 percent of patients or their family members reported getting an apology from a provider.
- More than 30 percent reported paying bills related to the harm. The average cost: $14,024.
Another study last year in the Journal of Patient Safety estimated that at least 210,000 U.S. hospital patients a year die from medical mistakes. Yet while the problem is widespread, Makary and his research team wrote, there is little research into how patients feel about experiencing medical harm.
Clinicians may see the need to be more open with patients but lack the “moral courage” to do it, researchers said. Patient advocates and providers should work together on how to best inform patients, and medical schools and training programs can introduce the needed skills, they said. . . .