Archive for the ‘Medical practices’ Category

Study: Chances of dying are greater if your doctor is over 60.

January 3, 2018

And, some advice for hedging your bets.
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Researchers at Harvard scoured the records of 730,000 patients treated between 2011 and 2014 by more than 18,800 hospital-based internists (now called “hospitalists”).

The results were originally published in the BMJ (British Medical Journal) and recapped in StudyFinds:

Patients are 1.3% more likely to die when treated by doctors over the age of 60, than if they’re treated by doctors under 40.

That translates to one additional death for every 77 patients under the care of a doctor over 60.

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What’s going on?

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Symptoms & causes: Why diabetes strips are $18 on a hospital bill and less than a buck on Amazon.

February 25, 2013

On Sunday, Business Insider ran a piece called The Most Infuriating Paragraph You Might Ever Read About The Healthcare System

It referenced rants on “Steven Brill’s epic cover story for Time on why healthcare costs so much.”

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The paragraph that set them off from the Brill article should – according to Business Insider — “legitimately get anyone’s blood boiling.”

By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452. The family’s first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece.

There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work.

As for why we can have a system where diabetes-test strips are sold for $18/each in one place, while Amazon sells a box of 50 for $27.85, see this, great piece by Sarah Kliff on the lack of price controls in the US.

My opinion: Apparently these guys have never heard of “absorption costing” or bothered to really ask “why is healthcare so costly?”

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Electronic medical records cut costs … oops, make that raise costs.

October 17, 2012

Interesting expose In the NY Times of all places.

Punch line:

When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs.

But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services.

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How can this be?

Simple, Watson.

First, a system can provide docs with a checklist of separately billable procedures that they might perform … ensuring a complete check-up and making sure that no billing stone is left unturned.

Second, an e-system can make it easier for doctors to “upcode” a procedure in a way to maximize reimbursement rates.

For example, when a doctor enters a billing code, the system can present him with alternative codes for very similar procedures that get higher reimbursement payments … and tell the doctor what addition work needs to be done to qualify for the higher paying code.

So, maybe just asking the patient a couple of more specific questions  may upgrade an examination from ‘simple’ to ‘ complex.  The doc can then ask the questions (or not) and check the higher paying box.

Third, an e-system makes it easy for docs to “clone” common ‘boiierplate’ findings from one patients chart to another patient’s chart … saving time and, perhaps, implying a more detailed examination.

The Times says:

As software vendors race to sell their systems to physician groups and hospitals, many are straightforward in extolling the benefits  of those systems in helping doctors increase their revenue.

In an online demonstration, one vendor promises that it “plays the level-of-service game on your behalf and beats them at their own game using their own rules.”

An expert says “What’s happening is just the problem we feared” … unintended consequences.

For the record, I think that cutting healthcare costs by reducing doctors’ pay is nuts … there is lots of waste, fraud and unnecessary expense in a grossly inefficient system.

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