The exhibit below shows the 50 hospitals responsible for 80% of the total 123, 243 cost-defective procedures across all hospitals in the United States in the CMS data. As a result, these hospitals received extra revenues.
Sometimes known as super-utilizers, high-frequency patients or frequent fliers, these patients typically suffer from heart failure, diabetes and kidney disease, along with a significant psychiatric problem. Some are Medicare patients unable to afford the many drugs needed to manage their chronic health problems. Others are younger "dual eligibles" who qualify for Medicare and Medicaid, and who often bounce from emergency room to emergency room, struggling with substance abuse, homelessness and related medical conditions. Still others have private health insurance.
Nearly all wind up in emergency rooms because they have enormous difficulty navigating the increasingly fragmented, complicated and inflexible health-care system. Because of lack of alternatives or force of habit, they use hospitals, often several in the same city, for care that could be provided far more cheaply and effectively in outpatient settings. Many suffer from the phenomenon known as "extreme uncoordinated care."
In the past few years, efforts to lower costs and improve care have proliferated. In Ann Arbor, Mich., two programs at the University of Michigan Health System assign specialized case managers to super-users, some of whom have been in the ER more than 100 times in a year. In a largely rural swath of central Pennsylvania, Geisinger Health System enrolls elderly Medicare patients in its Proven Health Navigator program, calling them after they leave the hospital and providing heart failure patients with scales that transmit data to nurses: Sudden weight gain can signal a problem. In the Washington area, a program sponsored by Medical Mall Health Services -- a program founded by civil rights activist and physician Aaron Shirley that targets medically underserved patients -- provides home visits and helps arrange services for newly discharged patients.
"We've seen situations where for want of a $20 cab ride to get to dialysis, a patient ended up with an emergency hospitalization costing $20,000," said Tim McNeill, chief operating officer of Medical Mall, which is headquartered in Jackson, Miss.
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This week, November 11, the Board of Directors of the Organ Procurement and Transplantation Network (OPTN) adopted a policy that removed two major threats to people with disabilities posed by previous proposals....
Not Dead Yet filed public comments regarding both the proposed protocols and related changes to OPTN bylaws six times in the last two years. You can find them all under NDY Public Policy activities. We pointed to longstanding ethical protections against potential pressures being placed on ill people to die and donate their organs.
Says that customizing to the exact responses of the person instead of mechanical turning is more effective.....
"The findings of the TURN study highlight that turning residents every two hours may no longer be necessary when high-density mattresses are in place and nursing time can be used to attend to other resident needs, such as feeding, assisted mobility and ultimately develop a stronger relationship with their residents," said Susan Horn, Ph.D., co-principal investigator at the Institute for Clinical Outcomes Research.
Previously, mattresses exposed residents to higher pressure, requiring more frequent turning to relieve pressure. Nursing homes formerly used mattresses that were made of spring coils and covered in thick plastic. Newer high-density foam mattresses expose residents to less pressure, and as this study shows, two-hour turning may no longer be necessary.
"We hope using high-density foam mattresses and being very much aware of resident's skin at every turn will decrease the necessity of turning residents every two hours to prevent pressure ulcers and allow residents to sleep more, improving quality of life," Bergstrom said. "Of course, clinical judgment is necessary when implementing results of this study; these findings do not mean that turning is unnecessary."
It was one of a number of experiences with the health-care system that shaped my thinking as a reporter. Every time I write a story, I try to think about it from the lens of patients who deal with the system each day. I try to explain it and demystify it for them, to the best of my ability.
Lately, I’ve been wondering about whether other journalists have been affected by their own brushes with the medical system. I asked four of them to weigh in — Peter Frost of the Chicago Tribune, Gary Schwitzer of HealthNewsReview.org, Lisa Chedekel of Connecticut Health Investigative Team and Katy Butler, author of the book “Knocking on Heaven’s Door.” Here’s what they told me:
The stories are easily recognizable to anyone working in health care reform.
The Hills are Alive....
In the sessions, patients were led through familiar songs from The Sound of Music, Oklahoma, The Wizard of Oz and Pinocchio.
The sessions appeared to have the most striking effect on people with moderate to severe dementia, with patients scoring higher on cognitive and drawing tests, and also on a satisfaction-with-life questionnaire at the end of the study.
Jane Flinn, a neuroscientist at George Mason University in Virginia, said care homes that did not hold group singing sessions should consider them, because they were cheap, entertaining and beneficial for patients with Alzheimer’s.
“Even when people are in the fairly advanced stages of dementia, when it is so advanced they are in a secure ward, singing sessions were still helpful. The message is: don’t give up on these people. You need to be doing things that engage them, and singing is cheap, easy and engaging,” she said.
Results show that during pain anticipation and relief, fibromyalgia patients displayed less robust response within brain regions involved in sensory, affective, cognitive and pain regulating processes. The ventral tegmental area (VTA) - a group of neurons in the center of the brain involved in the processing of reward and punishment - displayed activation during pain anticipation and stimulation, but deactivation during anticipation of relief in healthy controls. In contrast, VTA responses during periods of pain, and anticipation of pain and relief, in fibromyalgia patients were significantly reduced or inhibited.
Dr. Loggia concludes, "Our findings suggest that fibromyalgia patients exhibit altered brain responses to punishing and rewarding events, such as expectancy of pain and relief of pain. These observations may contribute to explain the heightened sensitivity to pain, as well as the lack of effectiveness of pain medications such as opioids, observed in these patients. Future studies should further investigate the neurochemical basis underlying these dysfunctions."
Researchers have discovered that a known neurotoxin may cause chronic pain in people who suffer from paralysis, and a drug that has been shown to remove the toxin might be used to treat the pain.
The toxin, called acrolein, is produced in the body after nerve cells are injured, triggering a cascade of biochemical events thought to worsen the injury's severity. The drug hydralazine, which has been approved by the U.S. Food and Drug Administration for hypertension, has been shown to be effective in reducing acrolein levels in the body.
An underserved community if ever there was one:
Pediatrics & Brain Injury Conference – November 14, 2013 – Livonia, MI
The Brain Injury Association of Michigan is holding a one day conference to focus on the medical, functional, behavioral and psychosocial consequences of pediatric brain injury. Learn strategies for helping families, resolving challenges, and working with the school system from initial transition after injury to beyond graduation.
Download the brochure for more information: http://biami.org/_literature_126998/BIAMI_Pediatrics_and_Brain_Injury_Conference
Visit the conference webpage to register: http://biami.org/november-conference
A patient in a seemingly vegetative state, unable to move or speak, showed signs of attentive awareness that had not been detected before, a new study reveals. This patient was able to focus on words signaled by the experimenters as auditory targets as successfully as healthy individuals. If this ability can be developed consistently in certain patients who are vegetative, it could open the door to specialized devices in the future and enable them to interact with the outside world.