Again, Medicare shows that it intends to ration medical care for those over the age of 65. At lease other services are willing to report what is happening within Medicare. This time it is the U.S. Preventive Services Task Force (USPSTF) that is saying Medicare is not aligning with their recommendations.
This article is the most damning of anything I have seen about Medicare and how they are potentially doing actual harm to the elderly. Government led euthanasia? I do have to really wonder if this is not the intent.
Since the USPSTF is mandated by federal law and its recommendations are done with evidence-based rigor, the authors conclude that reasonable policy would be for Medicare to cover USPSTF recommended services. Unfortunately, evidence-based, is pure theory and open to much interpretation. However, this seems to be the medical mantra of today.
This article is still important because it spells out some of the faults of Medicare. Of 15 interventions that are USPSTF recommended interventions for adults 65 years of age or older, Medicare only reimbursed fully for one of these. For 60 percent of preventive services, Medicare reimburses fully for the service or test, but only partially reimburses for the coordination of obtaining that service.
For four services, Medicare reimburses partially for the preventative coordination and the actual service. And for one service, Medicare reimburses fully for the coordination and assessment, but not the test or service itself. In addition, it was found that Medicare reimburses clinicians to provide seven services that are not recommended, thereby potentially increasing harm to patients as well as increased medical costs.
Until the Affordable Care Act was deemed temporarily unconstitutional, it was felt that the ACA was going to pressure Medicare into being more realistic in their reimbursements. Now even that may be put on hold.
Read the article here.
05 February 2011
04 February 2011
Is This Another Form Of Medical Rationing?
Researchers did not do this study justice. They had the opportunity, but apparently chose to leave a lot out to spur speculation like I did at first. When I first read this, I was very angry. With the care in the local emergency unit being so variable depending on the doctor on duty and level of expertise and experience, I thought that trauma centers would be much better – wrong.
About one quarter of 87,754 trauma patients or about 22,000 being elderly, this is a sorry statement that only nine of 131 trauma centers in the US were highly rated for care of the elderly. Then to say “in the study we showed that although some centers demonstrate high performance overall, these same centers might not be providing the same high-quality care to the elderly," really lays the fault on the trauma centers and their administration and staff.
This statement "We've shown that elderly patients have different needs from young patients. Centers need to focus on the needs of the elderly specifically in order to improve their quality of care," defines problems in general for trauma centers. When trauma centers are not prepared to deal with the elderly who may have heart disease, lung disease, or diabetes, this shows how ill prepared the staff is or that the training is totally inadequate for the situations trauma doctors face in the trauma center.
Why did I use the title I did? Because this is a situation where there are many places to find fault. First, I am confident that the level of Medicare reimbursement is very low, which means that the trauma doctors are not wanting to spend much time on the elderly. This also means that the administration of the trauma centers are also discouraging doctors from spending much time on the elderly.
To me this means medical care rationing by Medicare. Yes, I am in this group that Medicare will be limiting care for and I am still angry. I can also guess that the “baby boom” generation following me will not be happy with this and will be even more vocal. This is why I place most of the fault and blame on Medicare for encouraging this rationing of medical care.
Now the other areas that can be creating problems and deserve a portion of the fault. It seems that the training received for trauma doctors is lacking for the elderly and they don't have geriatric training for dealing with the elderly. Their training may also not involve dealing with the elderly that have chronic diseases. So I would think that additional training should be necessary.
With the new Affordable Care Act (now unconstitutional), these concerns will continue to mount for people age 65 and older. You know that the governments at the local through federal will be receiving complaints and if care continues to be rationed, voters will insist on change.
Read about the study here.
About one quarter of 87,754 trauma patients or about 22,000 being elderly, this is a sorry statement that only nine of 131 trauma centers in the US were highly rated for care of the elderly. Then to say “in the study we showed that although some centers demonstrate high performance overall, these same centers might not be providing the same high-quality care to the elderly," really lays the fault on the trauma centers and their administration and staff.
This statement "We've shown that elderly patients have different needs from young patients. Centers need to focus on the needs of the elderly specifically in order to improve their quality of care," defines problems in general for trauma centers. When trauma centers are not prepared to deal with the elderly who may have heart disease, lung disease, or diabetes, this shows how ill prepared the staff is or that the training is totally inadequate for the situations trauma doctors face in the trauma center.
Why did I use the title I did? Because this is a situation where there are many places to find fault. First, I am confident that the level of Medicare reimbursement is very low, which means that the trauma doctors are not wanting to spend much time on the elderly. This also means that the administration of the trauma centers are also discouraging doctors from spending much time on the elderly.
To me this means medical care rationing by Medicare. Yes, I am in this group that Medicare will be limiting care for and I am still angry. I can also guess that the “baby boom” generation following me will not be happy with this and will be even more vocal. This is why I place most of the fault and blame on Medicare for encouraging this rationing of medical care.
Now the other areas that can be creating problems and deserve a portion of the fault. It seems that the training received for trauma doctors is lacking for the elderly and they don't have geriatric training for dealing with the elderly. Their training may also not involve dealing with the elderly that have chronic diseases. So I would think that additional training should be necessary.
With the new Affordable Care Act (now unconstitutional), these concerns will continue to mount for people age 65 and older. You know that the governments at the local through federal will be receiving complaints and if care continues to be rationed, voters will insist on change.
Read about the study here.
03 February 2011
Patients In ICUs at Greater Risk
The arguments are being played out and the patients are the ones who will not benefit. Not that the doctors or residents (in training) will fare that much better, but the biggest loser may be the hospitals. They may force both doctors and residents out as they try to keep costs down in that area while raising daily charges for ICU rooms and supplies used in ICUs. Plus hospitals seem to be encouraging doctors to over prescribe medications when patients are dismissed from ICUs.
Now that the Supreme Court has spoken on residents hours and the OSHA is about to make other rules into regulations, if hospitals do not hire more doctors for handling patients in the ICU, the hospitals will lose doctors and patients and may not be able to recover from the downward spiral. Not only will people not trust the ICU but doctors will not want to work there and patients may start requesting to be taken to other hospitals.
That is what is causing the headlines like the article that got me on this topic. Yes, I agree attending physicians are probably putting in far too many hours to the detriment of the ICU patients. But really, where does the fault lie. Doctors are human and start making mistakes after working too many hours. Again, why are they working these long hours?
It is because the hospitals have restricted the number of doctors in ICU. All the studies done will not convince me otherwise. Also most of the physicians are blaming the curtailing of resident hours (or interns) for the problems of working more hours themselves. I realize that the physicians are not going to bad-mouth the source of their pay check, but someday they may be forced into this by rules and regulations.
Hospitals need to realize that if they don't adequately staff ICUs and other places, lawsuits may soon be directed at them and not the physicians. This seems presently to be a no win situation for patients in ICUs. This needs to end.
Read the Medscape article here.
Now that the Supreme Court has spoken on residents hours and the OSHA is about to make other rules into regulations, if hospitals do not hire more doctors for handling patients in the ICU, the hospitals will lose doctors and patients and may not be able to recover from the downward spiral. Not only will people not trust the ICU but doctors will not want to work there and patients may start requesting to be taken to other hospitals.
That is what is causing the headlines like the article that got me on this topic. Yes, I agree attending physicians are probably putting in far too many hours to the detriment of the ICU patients. But really, where does the fault lie. Doctors are human and start making mistakes after working too many hours. Again, why are they working these long hours?
It is because the hospitals have restricted the number of doctors in ICU. All the studies done will not convince me otherwise. Also most of the physicians are blaming the curtailing of resident hours (or interns) for the problems of working more hours themselves. I realize that the physicians are not going to bad-mouth the source of their pay check, but someday they may be forced into this by rules and regulations.
Hospitals need to realize that if they don't adequately staff ICUs and other places, lawsuits may soon be directed at them and not the physicians. This seems presently to be a no win situation for patients in ICUs. This needs to end.
Read the Medscape article here.
02 February 2011
Is TV Really Part of the Food Pyramid?
Until I did some reading, I thought this was humorous and I admit I still do. I understand where this author is coming from and why he has a problem with TV's. Not being a person that eats out with any frequency, I admit I have not seen what he is describing.
David Burley is from Louisiana and was excited about a new restaurant opening is his small town. He was most unhappy that the restaurant was featuring flat-screen TVs in every booth in addition to its family fare.
Apparently this is the latest rage for restaurants and they are trying to out do the popular trend of the 1950's of eating on folding TV trays in front of the TV to watch certain popular shows of that era.
It is apparent that the new fad is having TVs for watching while eating as the owners know that people tend to eat more when watching TV. Sort of like making the TV part of the food pyramid. If we don't get enough TV we will become light eaters and lose weight. And the restaurant owners don't want that! That would mean lost profits.
I am aware of sports bars with multiple TV's that serve food and drinks, but people are there to watch a game and it follows that they will eat and purchase something to drink. But restaurants, guess I am way behind the times. Burley says that people tend to eat more slowly and consume less food when the are not glued to the TV.
As if it isn't bad enough that may people that go out to eat and supposedly enjoy each others company, they often spend time sending and receiving text messages, and now if the restaurants are adding TV's, maybe both should be part of the food pyramid at the top and a wide area added at the bottom for conversation and many servings of conversation.
If you are interested, here is the source of my unusual blog.
David Burley is from Louisiana and was excited about a new restaurant opening is his small town. He was most unhappy that the restaurant was featuring flat-screen TVs in every booth in addition to its family fare.
Apparently this is the latest rage for restaurants and they are trying to out do the popular trend of the 1950's of eating on folding TV trays in front of the TV to watch certain popular shows of that era.
It is apparent that the new fad is having TVs for watching while eating as the owners know that people tend to eat more when watching TV. Sort of like making the TV part of the food pyramid. If we don't get enough TV we will become light eaters and lose weight. And the restaurant owners don't want that! That would mean lost profits.
I am aware of sports bars with multiple TV's that serve food and drinks, but people are there to watch a game and it follows that they will eat and purchase something to drink. But restaurants, guess I am way behind the times. Burley says that people tend to eat more slowly and consume less food when the are not glued to the TV.
As if it isn't bad enough that may people that go out to eat and supposedly enjoy each others company, they often spend time sending and receiving text messages, and now if the restaurants are adding TV's, maybe both should be part of the food pyramid at the top and a wide area added at the bottom for conversation and many servings of conversation.
If you are interested, here is the source of my unusual blog.
01 February 2011
Entire Affordable Care Act Declared Unconstitutional
Now the waters have really been stirred. A federal judge in Florida today declared the entire Affordable Care Act unconstitutional. People are now asking that this be fast tracked to the US Supreme Court. In addition the Justice Department is asking for a stay while it is being appealed. Continue to watch the news on this one. If everything continues, this could reach the Supreme Court this fall, or earlier, instead of mid-2012.
Of course this is what the Democrats want, as they do not want this just before the next general election. They want it decided now to prevent this being an issue in the general election. Then maybe people's memories will forget about it. We will need to see, as the Supreme Court may make this a moot issue if they decide that the law is unconstitutional.
This could make the next election very interesting and hopefully those elected will follow the wishes of the people.
If you are interested, you may read this from Medscape published on January 31.
Of course this is what the Democrats want, as they do not want this just before the next general election. They want it decided now to prevent this being an issue in the general election. Then maybe people's memories will forget about it. We will need to see, as the Supreme Court may make this a moot issue if they decide that the law is unconstitutional.
This could make the next election very interesting and hopefully those elected will follow the wishes of the people.
If you are interested, you may read this from Medscape published on January 31.
31 January 2011
Value of Health Care
At first I was considering just leaving this whole topic sit, but then the doctors had to start discussing it and basically doing nothing but quibbling. While I am not sure if I can add anything of value from a patient perspective, I would like to voice some concerns as a patient.
First, if doctors are so concerned with value, maybe patients should have more input. We may not be as independent or disinterested as a panel of stuff-shirted hospital board members or CEOs. We may have some concerns that are important to us and not the bottom line. I would suggest that missing is another New England Journal of Medicine (NEJM) article titled “Putting the Value Framework to Work”.
So I am drawing my ideas from two NEJM articles and one by Dr. R. Centor and comments to his blog. The second article mentioned by Dr. R. Centor is “What is Value in Health Care?” Dr. Centor's blog is “Measuring Value in Health Care”.
I must agree with Dr. Centor that “value” is a challenging topic. Patients should read it as well as doctors because this is something we will be facing in the near future and some are already involved and feeling the effects. I feel that Dr. Centor has taken the right path in discussing this in a positive manner. It is the law and will be part of our future for a while.
As such, Dr Center does correctly point out something in the article in the NEJM that is complex and has sophistication, and can be achieved. He also points out that the author of the NEJM article changes the focus to the patient and away from the system. This alone says volumes as too many doctors are so immersed in the system that they cannot see the patient. These doctors hide in the system so that they do not have to worry about the patient.
Dr Centor correctly points out that patients often have multiple physicians, use emergency departments, walk-in clinics, and hospitals. Patients do not use systems and may use physicians across several systems. The commentors are probably the doctors we want to stay away from. They seem ridged in their thinking and wanting to keep the current system. They are afraid that value means cost cutting which is not the object of the discussion.
Yes, value is often difficult to define under the current mode of operation. It will take getting out of the current system and probably into an Accountable Care Organization to make value something measurable and worth talking about. The ACOs are yet to be defined and may work, but there are some interesting questions still to be resolved.
Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.
First, if doctors are so concerned with value, maybe patients should have more input. We may not be as independent or disinterested as a panel of stuff-shirted hospital board members or CEOs. We may have some concerns that are important to us and not the bottom line. I would suggest that missing is another New England Journal of Medicine (NEJM) article titled “Putting the Value Framework to Work”.
So I am drawing my ideas from two NEJM articles and one by Dr. R. Centor and comments to his blog. The second article mentioned by Dr. R. Centor is “What is Value in Health Care?” Dr. Centor's blog is “Measuring Value in Health Care”.
I must agree with Dr. Centor that “value” is a challenging topic. Patients should read it as well as doctors because this is something we will be facing in the near future and some are already involved and feeling the effects. I feel that Dr. Centor has taken the right path in discussing this in a positive manner. It is the law and will be part of our future for a while.
As such, Dr Center does correctly point out something in the article in the NEJM that is complex and has sophistication, and can be achieved. He also points out that the author of the NEJM article changes the focus to the patient and away from the system. This alone says volumes as too many doctors are so immersed in the system that they cannot see the patient. These doctors hide in the system so that they do not have to worry about the patient.
Dr Centor correctly points out that patients often have multiple physicians, use emergency departments, walk-in clinics, and hospitals. Patients do not use systems and may use physicians across several systems. The commentors are probably the doctors we want to stay away from. They seem ridged in their thinking and wanting to keep the current system. They are afraid that value means cost cutting which is not the object of the discussion.
Yes, value is often difficult to define under the current mode of operation. It will take getting out of the current system and probably into an Accountable Care Organization to make value something measurable and worth talking about. The ACOs are yet to be defined and may work, but there are some interesting questions still to be resolved.
Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.
Subscribe to:
Posts (Atom)