The good news: the media have done a reasonably good job of getting the word out to consumers of healthcare with respect to the prevention of medical and surgical mistakes in acute care settings. The bad news? Here in Minnesota, the numbers of “wrong surgeries”, a collective term meaning never-events in this care realm, topped 2010′s tally by five cases — creating a surge in such cases last year.
The figure is the highest in eight years of self-reporting by Minnesota hospitals. Officials cited many reasons for the mistakes — from doctors filling out incorrect orders to sloppy inventories that make it easy to grab the wrong joint implants for orthopedic procedures.
While the surge appears to be from the absolute numbers of incorrect procedures performed, the rate of adverse events has globally decreased, bringing into question the efforts of many healthcare systems in the processes involved in preventing completely avoidable lapses in care delivery. | LINK
Robbing Peter to pay Paul — in terms of Medicare cost sharing, that is. A new Medicare benefit design will enable increased costs for lower utilizers of the government entitlement (relatively healthier beneficiaries). This limit on cost-sharing among beneficiaries would decrease the costs per sicker beneficiary for, say, acute visits to the hospital rather substantially, leaving those who do not use services as much shouldering the burden.
A melding of the services by hospitals (part A) and doctor visits (B) as they relate to deductibles, plus a requirement that participants pay 20 percent toward a $5500 limit would increase the payment of almost 75 percent of beneficiaries (the lower utilizers of acute care) by almost $200/month. My take? It’s potentially a mechanism for some savings by the federal government, and it may give more ammo to Republicans who are interested in tiering beneficiary eligibility — such as via so-called means-testing.
All this in an interesting study via Kaiser. | LINK
Sign of the times: social media’s use in increasing interaction among patients with dementia. A researcher, part of a team, is busy at work on a web-based app based upon Facebook for utilization among cognitively impaired elders. She states:
“We have already carried out some practical testing of other web-based communications systems. Among other things, we have tested a “digital diary” and a “scrapbook” containing personal photos, newspaper cuttings and information found online.”
What is both curious and puzzling at the same time regarding this research is that it is being conducted in Norway, of all places. Why not here in the good ol’ U.S. of A? Innovation of this type began and germinated here. Social media’s global function of “keeping one in the loop”, including the elderly, can not be understated in its potential in non-pharmacologic dementia research. Here’s to hoping it gains ground on these shores.
The rise in prescription drug abuse in this country has been muted somewhat by the traditional messaging by anti-drug campaigns which advocate the overarching “just say no” philosophy … and have done so since the heady days of the Reagan administration some 25 years ago. A different kind of advocacy is needed, say the appropriate groups; that is, one of attention toward the ripple effect of the “other” illicit drug — the prescription narcotic (including, most notably, hydrocodone and oxycodone).
In scenarios in which the levels of violent crimes (pharmacy robberies and assaults) are belied by the common perceptions of acquisition of such drugs (petty theft, paper script forgeries, etc), it’s easy to see why some say the FDA has been lukewarm at efforts to control this burgeoning problem.
The 12-year delay in the federal regulators’ final decision about hydrocodone – the second most-abused pain drug – has been agonizing, to say the least — all the more so as the Drug Enforcement Administration and Food and Drug Administration are apparently still studying whether to move hydrocodone-containing medicines to Schedule II category of medicines from the less restrictive Schedule III. Advocates for tighter controls over hydrocodone opine that it is time the government took concrete action to save lives — since a study funded by the National Institutes of Health has shown that nearly 8 percent of the 12th-graders in the US have abused hydrocodone in the last year.
The agency says many factors — chief among them the logistics involved in augmenting widespread training and retraining of healthcare providers as to the merits of prescribing in this new climate of addiction — have complicated movement forward on the matter. It’s a problem that’s not going away anytime soon. Those hoping for a sweeping decision by the FDA to correct things are better off considering scenarios in which the government agency can partner with other entities to begin to address oversight in prescribing lapses, formulary monitoring, and drug utilization reviews in healthcare organizations. | LINK
How does obtaining health coverage (insurance) compare to not getting it at all? According to a trial published via the National Bureau of Economic Research (Harvard/MIT), beneficiaries’ quality of life was enhanced and made a “big difference” in those patients’ self-health perceptions and their daily outlook — according to the study’s lead author. A quick glance at the results confirms that all encompassing statement, especially since the study employed the diagnostic “gold standard” in trial research by utilizing a randomized, controlled design.
Taking a look at approximately the first year of coverage for Medicaid beneficiaries in the state of Orgeon, the study showed that healthcare expenditures for those who got coverage increased by almost $800/year. Those who received Medicaid were around 60 percent more likely to get mammograms. Medicaid recipients were over 50 percent more likely to have a regular primary-care doctor. They were also in better shape financially and less likely to have unpaid medical bills. Those who got Medicaid were also far more likely to report themselves in good or excellent health. ED admissions did not decrease; however, the increase in ED utilization by beneficiaries was not statistically significant.
It is clear from the results that coverage, in and of itself, has a positive effect on patients’ perceptions of health and wellness. What is not documented as much at this time is how this translates into outcomes with respect to various chronic problems such as obesity, diabetes, and risk factors (such as serum cholesterol, blood pressure, etc.) for heart disease. Also, it is unclear how these results translate into real numbers once reform increases Medicaid rolls substantially by 2014. Researchers plan on following the participants for at least another year. | LINK
Doctor Pundit appears to be taking a step further into the physician social media space. Yes, the blog is already on Twitter. (I continue to resist Facebook, for personal reasons.) But, it looks like it has caught the eye of the marketing team behind one of the Interweb’s largest online social networks for physicians: Sermo. 
I must admit that I have only reluctantly ventured out into social media as a willing participant — opting mostly to occupy the “push” aspect (blogging; RSS; the very occasional off-topic tweet) instead of indulging the more complex mano a mano interactions many more psychologically intrepid docs other than myself utilize — media such as Facebook, LinkedIn, and, of course, Sermo.
So, imagine my surprise when Sermo contacted the blog to be included as one of its “selected sites”. At this point, many thoughts raced through my very constant linear judgment. Do I need to become more active in social media other than merely possessing a presence on Twitter or Facebook? Are message boards really for me? Do I really feel like I have something to offer in an alternative manner to the straight-up matter-of-fact blog? What will my patients think? Am I a social prude? Does anyone but me really care about any of this?
Then, I figured it out. The realm of physician social media is expanding into places beyond the simple message board. Perhaps the initial reticence of social media sites like Sermo in finally trekking out of its own constraints to include influential alternatives such as Doctor Pundit is representative of a changing of the guard in this space. By including voices in the medical blogosphere this relatively public migration of the completely private Sermo (the site is only open to licensed U.S. physicians) is obviously a prudent move. Why shouldn’t Doctor Pundit be meeting Sermo halfway in this endeavor? So much (social) pressure; so little time.
Well, I suppose in the time it has taken you to read this blog post, I have already decided to acknowledge Sermo with it. Guess that speaks for itself. Shhh! Hear that? That’s the sound of this blog jumping into this partnership with both feet.
The shift to a sharp decline in the prescribing of neuroleptic (antipsychotic) medications to treat paranoid symptoms and behavioral instability in patients with dementia (no psychiatric indication/past medical history) was begun well before the unified FDA response in imposing a black box[1] warning as to its usage, according to a VA study.
According to the principal investigator, this demographic shift in the usage of these class of medications would not have occurred if it had not been for the adjustment (taking statistical account) with respect to patients over 65 — as opposed to those with longstanding psychiatric illness. This trial[2] just confirms what most geriatricians, including myself, have known about this class of medications all along: that since the early 2000s, the overall risks of death from all causes were specific to this class and this specific demographic of patients. It’s a far cry from the rather liberal use of these medications in the routine treatment of the non-mentally ill aged during my training.
A major national trial is about to begin actively collecting data. It’ll track kids from pre-birth to the 21st year of life, and identify physical, biological, and social factors in their health. There will be seven locations taking part. Ramsey Co. (St. Paul), MN is one of those locations.[1] Apparently, this trial is described as “landmark” in its information- and data-gathering techniques for the sole purpose of accurately detailing the state of pediatric health in this country.
“Times have changed since the early ’60s,” said Pat McGovern, a University of Minnesota professor who will be lead researcher of the Minnesota arm of the study. “We have more single-parent families [and] more two-parent families in which both parents are working. Immigration patterns have changed. Children’s exercise and diet habits have changed. There’s a whole lot more chemicals we’re all exposed to in the air and water.”
This study aims to provide definitive data on pediatric and adolescent medical care for the 21st century. Dubbed the National Children’s Study, the federally funded venture will continue to provide data over time, gleaning information from as many diverse sources as possible over many years. Perhaps it will provide significant answers surrounding the development and optimal treatment of disorders such as asthma, ADD, and autism. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
