Monthly Archives: March 2017

The health care system treats patients like garbage

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The health care system treats patients like garbage

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I started and stopped writing this post many times because it’s mostly whining. But, dammit, it’s a consumer’s right to whine, so here it is: in my experience (YMMV) — and that of many others I know — the health care system largely treats patients like garbage.

I was reminded of this fact during my recent experience dealing with my daughter’s broken arm. It started well enough. Our pediatrician has late hours and an X-ray machine, so we were able to skip the Friday night (and more expensive) emergency department visit for our initial diagnosis, and therefore missed all the attendant waiting and frustration.

Upon viewing the X-rays, the pediatrician conveyed that it was not a bad break and didn’t need to be addressed immediately. A brace, which she provided, was good enough for now. Fair enough. But what was our next step? “The X-rays need to be examined by a radiologist before I can tell you that,” my wife was told. OK …

I wonder how long we would have waited for that to happen. By the middle of Saturday, we became too uncomfortable to find out, so I called the pediatrician’s office. Now, and with no further consideration of the X-rays, they were wiling to give us some recommendations for orthopedic clinics. Why couldn’t those have been given to us on Friday?

Naturally, one clinic was closed on the weekend. But, the other, hospital-based one, had Sunday hours. Great! A call to that clinic got me a voice-mail. I left a message. I have never gotten a call back, but I didn’t wait for one. I called again later and got a person who told me they had 7AM walk-in hours. Just go to the main hospital entrance and ask for the walk-in orthopedic clinic, I was told.

This was bad advice. After dragging my broken-limbed daughter through every door that plausibly seemed like the main entrance, we finally found someone who said we should go through the ED entrance. That was the right answer, but not what we were told on the phone.

After waiting and registering, we finally saw the orthopedist. He was great. It was, in fact, not a bad break. Now it is safely casted. All is well. But not before we had to do a lot of legwork — and received a lot of wrong answers, promises of follow-ups that didn’t happen, etc. Meanwhile, our pediatrician has not (yet) checked in on her patient.

I get it. She’s busy with more urgent matters. It makes sense, but it sucks, and all the more knowing that we spend a fortune for such treatment. No other business would treat customers this way. In health care, inconvenience, uncertainty, lost records, lack of follow-up and coordination, the necessity of self-advocacy, and lots and lots of waiting is the norm.

Of course, there are some examples of good customer service in health care. I’ve even experienced them. But every tasty crumb I’m tossed just reminds me how awful the rest of the meal is.

https://www.wsj.com/articles/with-direct-primary-care-its-just-doctor-and-patient-1488164702

 

If Obamacare Exits, Some May Need to Rethink Early Retirement

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Here’s another possible consequence of repealing the Affordable Care Act: It would be harder for many people to retire early.

Americans reaching 65 become eligible for Medicare. Before reaching that age, some can get retiree coverage from their former employers. But not very many companies, especially small ones, offer medical insurance to retirees. If early retirees are poor enough, they could turn to Medicaid. To retire early, everybody else would need to turn to the individual health insurance market. Without the subsidies and protections the A.C.A. put in place, health care coverage would be more difficult to obtain, cost consumers more where available, and provide fewer benefits than it does today.

That means that if the A.C.A. is repealed, retiring early would become less feasible for many Americans.

This consequence is called job lock — the need to maintain a job to get health insurance. One of the arguments in favor of the A.C.A. was that it would reduce or eliminate job lock. With repeal of the law on the agenda of Congress and President Trump, there is renewed concern about how health insurance could affect employment and retirement decisions.

 

 

Where is the Democratic ACA replacement bill?

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Where is the Democratic ACA replacement bill?

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David Leonhardt says that the Republicans are “unable to agree on a [health care] policy” and “don’t have the votes to pass [an ACA replacement] plan.” OK, but what I want to know is, what is the Democratic alternative?

On the face of things, this is a strange question, because the Democrats cannot pass a bill in this Congress. Nevertheless, the Democrats should think about what they want to see in a replacement. There is a chance that the Republicans will fail to pass a bill that replaces the ACA without harming lots of Americans, including Republican voters. Here’s why:

  • As Nicholas points out, the Republican’s draft bill that recently leaked showed that they are not close to coming up with a coherent plan. Their current draft could lead to higher costs for insurance, or loss of insurance, for many people currently covered under the ACA. This isn’t playing well.
  • The far-right House Freedom Caucus has announced that it will oppose any bill that does not fully repeal the ACA. If all 32 HFC members took this view, the remaining House Republicans would not hold a majority. The leader of the larger but less conservative House Republican Study Group has also said that he “couldn’t support the party’s existing Obamacare replacement strategy.”
  • There are only 52 Republicans in the Senate and a few of them are moderates on the ACA. So it’s not clear that a bill acceptable to the radical right in the House can pass the Senate.
  • Let’s put this gently: President Trump lacks well-formed views about health care policy. He may not be willing or even able to coordinate the Republican factions.

We don’t know what will happen if no bill is passed or if the ACA is repealed without a replacement. But the Women’s March, the flash protests in response to the Travel Ban, and the uptick in support for the ACA suggest that the Republicans will face well-mobilized opposition if they screw up. If so, the GOP could be looking at the 2018 election with a deeply unpopular president and chaos in the health care system for less affluent Americans. If there is a prospect of losing their majorities, the Congressional Republican leadership might be willing to work with Democrats to pass a bipartisan ACA replacement.

As I described here, there is a left argument that Democrats should refuse any compromise and let the Republicans reap the consequences of their policies. A centrist counter-argument is that a lasting change in health care institutions requires bipartisan legislation, and the best time to get a deal is when Republicans are desperate.

Do I think that it’s likely that the Republicans will be willing to negotiate with Democrats about an ACA replacement? No. The lesson of 2016, however, is that anything is possible. So if the opportunity to negotiate arrives, the Democrats will need to have thought through what compromises they would be willing to accept.

Healthcare Triage: How to Give Better Medical Advice

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Healthcare Triage: How to Give Better Medical Advice

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Medical scientists and academics must publish their research to advance. Medical organizations must release health recommendations to remain relevant. News organizations feel they must report on research and recommendations as they are released. But sometimes it’s hard to separate what’s truly a medical certainty from what is merely solid scientific conjecture.

That’s the topic of this week’s Healthcare Triage.

 

In speech to Congress, Trump backs GOP leaders’ healthcare tax credits idea

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http://www.fiercehealthcare.com/aca/speech-to-congress-trump-backs-gop-leaders-healthcare-tax-credits-idea?mkt_tok=eyJpIjoiWkRjeU1tTTFPVEUyTjJaaCIsInQiOiJBNGU4aWlDQkpcL3l6eURqQUMyR2w3aVFtNStxVzBraUpQcTVOamQ4SVNEVUNDeXFQQ1RDWG5qdmptMjI4VWpiVTdHUDltN0ZTMG5ObWlHOWl0cXRmVEpjQ0h2bFU1NXJKM2YzaHBrcnc2VlVJVkoyTHJrQjBndGI5b3BGWmdJV1oifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

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In his address to Congress Tuesday night, President Donald Trump called for an end to the Affordable Care Act while voicing support for a key tenet of GOP leaders’ replacement plan that has met resistance from some within the party.

“Obamacare is collapsing, and we must act decisively to protect all Americans,” Trump said. “Action is not a choice—it is a necessity.”

He outlined five principles that he said should guide Congress as it works to create a better healthcare system:

  • Ensure that Americans with preexisting conditions have access to coverage, and that there is a stable transition for those currently enrolled in plans available on the ACA exchanges
  • Help Americans purchase their own coverage, through the use of tax credits and expanded health savings accounts. In a dig at the ACA’s essential health benefits requirements, Trump added that “it must be the plan they want, not the plan forced on them by the government”
  • Give governors the resources and flexibility they need with Medicaid “to make sure no one is left out.”
  • Give consumers the freedom to purchase health insurance across state lines, “creating a truly competitive national marketplace that will bring cost way down and provide far better care”

Trump’s support of tax credits to help people afford coverage is in line with a recently leaked draft bill from the House, which would give consumers age-based tax credits to purchase individual market plans. That provision received pushback from two prominent conservative House members, who characterized the tax credits as a “new entitlement program.”

Beshear’s response cites Kentucky’s embrace of ACA

In the Democratic response to Trump’s speech Tuesday, former Kentucky Gov. Steve Beshear pushed back against the GOP’s plans to scrap the ACA, saying his state reaped the benefits of embracing the law despite its conservative leanings.

Under Beshear’s administration, Kentucky expanded Medicaid eligibility and set up its own state exchange, Kynect. Thanks to those efforts, Beshear said in his speech, half a million Kentucky residents gained coverage—people who are “not aliens from some distant planet,” but “our friends and neighbors.”

While he acknowledged the ACA does need “some repairs,” Beshear said Trump and his fellow Republicans “seem determined to rip affordable health insurance away from millions of Americans who most need it.”

In Beshear’s own state, his GOP successor Gov. Matt Bevin has moved to shut down Kynect and roll back Medicaid expansion. In that effort, he’s had help from Trump’s pick for to lead the Centers for Medicare & Medicaid Services, Seema Verma.

Hospital floors, sinks pose deadly infection risks

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http://www.fiercehealthcare.com/healthcare/studies-hospital-floors-sinks-pose-infection-risk?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWkRjeU1tTTFPVEUyTjJaaCIsInQiOiJBNGU4aWlDQkpcL3l6eURqQUMyR2w3aVFtNStxVzBraUpQcTVOamQ4SVNEVUNDeXFQQ1RDWG5qdmptMjI4VWpiVTdHUDltN0ZTMG5ObWlHOWl0cXRmVEpjQ0h2bFU1NXJKM2YzaHBrcnc2VlVJVkoyTHJrQjBndGI5b3BGWmdJV1oifQ%3D%3D

hospital hallway

Hospital floors and sinks may pose infection risks, ones that could be overlooked when trying to control the spread of disease.

The floors in patient rooms may be contaminated by bacteria like methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile, according to a new study published in the American Journal of Infection Control. These pathogens, which can cause potentially deadly infections, can be spread when items are dropped on the floor, the researchers noted.

The research team swabbed a number of surfaces, including the floors, clothing, call-buttons and other high-touch items, in 159 rooms at five Cleveland hospitals, according to the study. The study included C. difficile-isolated rooms, and researchers found floors were often tainted by bacteria, most commonly with MRSA, C. difficile and vancomycin-resistant enterococci (VRE). The researchers also found that in 41% of these rooms, at least one high-touch object came in contact with the floor.

The study team said it hopes the results bring more attention to the infection risk posed by floors, which are not often considered in the conversation on infection control.

“Although healthcare facility floors are often heavily contaminated, limited attention has been paid to disinfection of floors because they are not frequently touched,” lead study author Abhishek Deshpande, M.D., Ph.D., an internal medicine physician for the Cleveland Clinic, said in an announcement. The results of our study suggest that floors in hospital rooms could be an underappreciated source for dissemination of pathogens and are an important area for additional research.”

Another recent study noted that hospital sinks may frequently host drug-resistant superbugs like MRSA or VRE. The research, which was published in Applied and Environmental Microbiology, set up five identical sinks in a lab that replicated sinks at the University of Virginia’s hospital in Charlottesville. The researchers then contaminated the sinks with E. coli bacteria, and though colonization began in drain pipes, it inched toward sink strainers before water spread it in the sink.

“This type of foundational research is needed to understand how these bacteria are transmitted, so that we can develop and test potential intervention strategies that can be used to prevent further spread,” Amy Mathers, M.D., an associate professor of medicine at pathology at University of Virginia, told HealthDay.