All of the focus that CMS is putting on hospital readmissions via the Readmissions Reduction Program, and the financial penalties that readmissions can generate, is causing hospital administrators to look to the emergency department and emergency physicians to intervene and resolve the issues that interrupt recovery for post-hospitalization patients.
In today’s world of budget-constrained financing of government health care programs and narrow hospital margins, the question of how best …
As the VA scandal unfolds, with continued revelations of secret waitlists and delayed or denied medical care, calls have been building Veterans Affairs Secretary Eric Shinseki to resign. He did just that, resigning because, “He had become a distraction as the department struggles.”
President Obama, eager to show America that he was being proactive about the scandal, regretfully accepted the General’s resignation. But other than allowing the president to show that he is doing something about …
Here’s a doctor’s health tip for patients that I’ll bet you haven’t heard before.
If you’re a patient who walks into a hospital for an elective procedure of any kind — surgery, or a diagnostic test — and you find out that Joint Commission reviewers are on site, reschedule your procedure and leave. Come back another day, after the reviewers have left.
Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call.
Granted. However, these awful events are part of …
While rotating through the local Veterans Affairs (VA) hospital during my residency in radiology, I noticed a curious phenomenon. When the weather was pleasant a large number of veterans would not show up for their scheduled CT scan or MRI. When the weather was miserable or dangerous the attendance would be maximum.
We named this phenomenon the “VA paradox”: a paradox because this is the opposite of what usually happens.
This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly and in less than 90 minutes from the patient’s arrival across the ER door threshold, he or she is on a cardiac cath lab table, where a coronary stent is …
“Robert Loeb was the best damned ethicist I ever met.”
When I first heard a senior colleague of mine utter these words in the mid-1990s, I was surprised. Time had not been particularly kind to Loeb, who had been the chairman of medicine at Columbia-Presbyterian Medical Center from 1947 to 1960. Among other things, critics had chastised Loeb for being imperious and unwilling to listen; former students had even accused him …
As a new physician, I find myself besieged by data about how happy patients are with the care we deliver. Press Ganey, HCAPS, Consumer Reports, US News and World Report were merely the beginning.
Now, physician reimbursement is tied to how happy patients are after facing and overcoming, at times, life-threatening illnesses in our hospitals. Given the financial incentive, hospitals across the country are seeking the aid of companies like Disney: well-known …
I read an article in the Boston Globe about how doctors are flocking to get Master of Business Administration (MBA) degrees in record numbers. The prestigious program at the Massachusetts Institute of Technology, MIT, apparently now has more students from the health care sector than any other field — accounting for almost 20 percent of the class.
In an effort to save on human resources costs, some hospitals have decided to make locum tenens* doctors and nurses line items in a supply list. Next to IV tubing, liquid nutritional supplements and anti-bacterial wipes you’ll find slots for nurses, surgeons, and hospitalist positions.
This depressing commoditization of professional staffing is a new trend in health care promoted by software companies promising to solve staffing shortages with vendor management systems (VMS). In …
If you read my articles, then you likely know about the scam known as pay-for-performance (P4P). This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it.
In short, P4P pays physicians (or hospitals) more if certain benchmarks are met. More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept. Folks who perform …
After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA. Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true. The place is a mess.
Let’s start with the computer system. The VA medical record system has been held up as an example of an effective EMR system, in which …
In 2010, I lost my mother to cancer. She was a fighter and had survived well past her prognosis, but her hospital costs outlived her.
Let me go back to late 2004. That was the year the doctors suspected she had cancer. My mother, who was not a smoker, was officially diagnosed with non-small cell lung cancer early on in 2005. When the biopsy confirmed that the small lesion in the …
A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation.
Richard Gunderman, writing for the Atlantic, tackled …
Recently in one of the Johns Hopkins Hospital’s intensive care units, a patient was dying from cancer and sepsis, and there was nothing that I, nurse Mandy Schwartz or anyone else could do to stop it. Yet as the patient’s family — two daughters and a husband — suffered at her bedside, Mandy saw their need for comfort, and she responded. Although she was busy with nursing tasks, she delved …
As I travel the country providing coverage for inpatient rehab units, I have been struck by the generally high quality of nursing care. Excellent nurses are the glue that holds a hospital unit together. They sound the first alarm when a patient’s health is at risk, they double-check orders and keep an eye out for medical errors. Nurses spend more time with patients than any other hospital staff, and they are therefore …
I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.
Hospital administrators and insurance company executives do …
I’ve worked at a few VA medical centers, including four years at the Phoenix VA. I’d like to report something missed in the media storm. Before spilling secrets, though, I’ll dispense with the non-secrets. Everyone who has entered a VA hospital knows:
1. The system is overwhelmed. While we might have planned for the increasing needs of aging Vietnam-era vets, I doubt anyone predicted two long wars or the number of …
The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz …
Recently, I began to think of death as a friend. My grandfather was hospitalized on Mother’s Day, and by the time my parents called me on Monday morning they couldn’t tell me anything more than, “He’s in the ICU with multiple seizures. They’re taking him off ventilation tomorrow.” Reaching for the knowledge I’ve spent all year chipping away at textbooks to acquire, I asked about neurologic exams, autonomic drugs and …
