In the Public Eye

Like it or not, it's a numbers game

jtaylor — Tue, 07 Sep 2010 19:55:00 GMT

I started off as a psych major at New York University until I fell head first into a brick wall of a course -- psych statistics. Then I switched to journalism, confident that the only numbers I'd ever need worry about thereafter were the very puny ones on my paycheck.

Wrong, well, except for the paycheck part. It's a numbers world -- 30 years as a reporter/editor taught me that, and 10 years of tracking government butchery of health care's financial footings confirmed that while you may never know what all the numbers mean, it's worth paying close attention. Following are some recent figures that caught my eye:

Billion-dollar hospitals: Four of them are in the works in California, three in Texas (two by the military) and three pediatric (California, Illinois and Pennsylvania). Modern Healthcare cites one explanation -- "local challenges," aka earthquake standards.
Concierge medicine: Some patients are willing to fork over $1,500 a year -- in addition to the costs of their medical care -- to get personalized, 24/7 access, same-day appointments to their docs. Nope, not covered by traditional insurance. And more of this is likely as the health reform law fully unfurls.
Be well and save: Kaiser estimates that sick days cost companies about $3,600 annually per employee, the Sac Bee reports, with smoking adding another $1,600; obesity, $1,300; and high blood pressure, $1,600.
It's only money: Workers are now paying about $4,000 for family insurance coverage, the Kaiser Family Foundation reported, about 14% more than the previous year. That, too, is expected to rise for many as reform plays out.
Living like it's 1999: The Wall Street Journal reports than nearly one-third of American households -- 35 million -- have no form of life insurance.
Job-hopping: The Journal also found people's career habits haven't changed much. In 1996, about 9% had been with the same company 20 years or more; that figure is now 10.3%. The only variant of note is that in 1996, 26% had been with the same boss for 12 months or less; that's now 22.9%. Of course, nothing was surveyed about job satisfaction.
Medical malpractice: Accounts for $55.6 billion annually in costs, or 2.4% of annual health care spending (Health Affairs magazine). That includes $45.6 billion spent on defensive medicine -- ordering tests to avert lawsuits.
Assessors nightmare: Forty-eight of California's 58 counties saw their property values decline, the state reported. The overall value of properties fell 1.8% statewide to $4.4 trillion. Last year the values fell 2.4%. Honestly, when was the last time "trillion" ever had a positive context?

What Rotarians say about reform

jtaylor — Thu, 02 Sep 2010 19:21:00 GMT

It was hard to get my 7 a.m. mouth to move at digital, rather than metronome, speed but -- wow, the topic was health reform -- and nearly 20 members of the Fresno Sunrise Rotary Club were slamming back bacon and coffee.

After my 20-minute presentation on the 2,000 pages of legislation -- the effects of which begin to unfold this month (Sept. 23rd to be exact) -- the questions they posed showed concern, frustration and not very much of the "fatigue" that lawmakers say has gripped them since last March when President Obama enacted the first monumental change to health care in 45 years.

There was a joke sheet circulating in the room essentially saying that lawmakers voted for what they hadn't read, that it was signed by a president who smokes, overseen by an obese surgeon general -- how could anything possibly go wrong?

The questions: How could anyone enact a law where it's cheaper for a business to pay penalties that pay for the cost of insurance? If we can't get more physicians and medical professionals educated fast enough -- and paid adequately enough (Medi-Cal, Medicare) -- how can this expansion do anything but make matters worse? Aren't more docs quitting or taking early retirement to dodge the coming nightmare? And (my favorite) is there anything good in this law?

Thanks to the Sunrise Rotary for its kind invitation and very active give-and-go with me. Clearly, both the backers and foes of this law have a long ways to go to educate, persuade and crusade with a very engaged and chagrined portion of the population.

Media and health reform

jtaylor — Mon, 30 Aug 2010 19:00:00 GMT

It's been a little more than five months since President Obama signed the Patient Protection and Affordable Care Act -- aka, health reform -- into law. Following are some of the topics that the media have spotlighted from the 2,000-plus pages of legislation (and the thousands of pages of rules and regs that will be propagated by the law).

Lawsuits filed by numerous states challenging the law's constitutionality.
Why should everyone pay for the poor lifestyle choices of others?
The billions to be spent hiring more IRS agents and fraud investigators, as well as the billions spent in creating new state and federal bureaucracies.
What's meaningful -- remote home monitoring -- vs. what's down in the weeds -- menu ingredients.
Governments closing, selling their public hospitals because they're already under water and the new electronic medical records and other upgrades will kill them off.
Where will the moral/spiritual convictions of some care givers collide with mandates of the law?
Shortages of doctors, inpatient hospital beds; education cuts that crimp the pipeline of new nurses, pharmacists, techs.
The pending war between insurers and hospitals.
The fact that Congressional Budget Office estimates are often off the mark.
Explosion of two-tier medicine -- "concierge" docs for those that can afford them vs. docs for the rest of us, if they'll have us.
More docs refusing to see Medicare, Medi-Cal patients.
The 50-worker threshold on employers needing to provide insurance will curtail business growth. And the fact that employers are already dumping insurance or insurers are raising premiums in anticipation of the law, which will unfold more intensely by 2014.
Health care fatigue -- been talked to death so let's just forget about reform for a while.
What's going to happen to insurance salesmen -- commissions fading away?
Making insurance virtually universal -- will it dry up the labor market as people won't be hard-pressed looking for work?
If companies will save money on insurance, will that mean they'll pay their workers more -- and the Social Security funding will last longer than estimates?

For one source of reader-friendly information on the law, check out the Kaiser Family Foundation website: http://healthreform.kff.org/

The joys of nursing in 1887

jtaylor — Fri, 27 Aug 2010 17:16:00 GMT

No scientific research to back me up, but I believe bloggers are social creatures. For some, blogging is their only way of making contact with the world. For others, including me, I could strike up a conversation with a former president I met at the airport (Gerald Ford) or a fly before I swatted it.

Bloggers tend to read other bloggers (no research, but roll with me here). One of those I read regularly is "Nurse Ratched's Place." This nurse, who sadly lost her husband recently, posts lots of tales about her profession and lots of old-time nursing photos.

I'm swiping this wonderful 1887 nursing job description from her blog -- you can find it plenty of other places on the Web. I hope she keeps up her blogging.

Having spent a lot of time lately with RNs at Community Regional Medical Center, I hope this brightens their day -- and the days of all the great men and women in the profession.

"In addition to caring for fifty patients, nurses had to perform these tasks:

Sweep the floors of your ward daily. Dust the furniture and windowsills.
Maintain an even temperature in your ward by bringing in a scuttle of coal at the beginning of each workday.
Light is important for observing the patient’s condition. Therefore each day fill the kerosene lamps, clean chimneys and trim wicks.
Wash all ward windows once a week.
The nurse’s notes are important to the physician. Make your pens carefully. You may whittle nibs to your individual taste.
Day duty nurses will report every day at 7 a.m. and leave at 8 p.m. except on Sunday on which day you will be off from 12 noon until 2 p.m.
Graduate nurses in good standing with the Director of Nurses will be rewarded with an evening off each week for courting purposes, or two evenings, if you regularly go to church.
Each nurse should lay aside from her wages a goodly sum of her earnings. This is for her benefit during her declining years so she will not become a burden. For example, if you earn thirty dollars a month, you should save fifteen.
Any nurse who smokes, uses rouge, uses liquor in any form, gets her hair done at a beauty parlor, frequents dance halls, or who engages in levity on Sunday, will give the Director Nurses good reason to suspect her worth, intentions, and integrity. If her misconduct in such an unseemly and unladylike manner is brought to the attention of the Hospital Administration, she will be asked for her resignation.
The nurse who performs her labors, serves her patients and doctors faithfully and without fault for five years, will be rewarded by the Hospital Administration with a 5 cent pay day increase, providing there are no hospital debts that are outstanding.
Free soap is provided for personal cleanliness. Its use is mandatory."

Dollars, data, people

jtaylor — Mon, 23 Aug 2010 19:56:00 GMT

Credit the Wall Street Journal for these tidbits from recent days:

Unspent stimulus money: $39.48 billion appropriated for the U.S. Department of Health and Human Services, of which 23% or roughly $8.89 billion has been paid out. (For health care info technology for hospitals and doctors, $1.7 billion was awarded but only $27.2 million paid so far. It takes a looong time to write all those regs!)
Workplace fatalities: Deaths due to workplace injuries fell to a historic low in 2009 at 4,340, the Labor Department reported, a dip of 17% from the previous year. A bad economy meant fewer risky construction jobs and a decline in highway fatalities (882). Most dangerous jobs: fishing-related (200 deaths per 100,000 workers) logging (61.8) and airplane pilots/flight engineers (57.1). (Kind of explains those Discovery and other cable channel reality shows.)
Bad to worse: In 2005, the city of Buena Vista, Va., pledged its city hall and police station to refinance a $9.2 million public golf course. Now the city of 6,500 people is in default and may lose those buildings. (Proving not all boneheads live in the Golden State.)
Children of illegal immigrants: 1 in 12 babies born in the U.S. in 2008 was born to illegal immigrants, according to the nonpartisan Pew Hispanic Center. Undocumented residents represented 4% of the population but accounted for 8% of all births in the U.S. in 2008. (That was front-page news to the Journal, owned by Rupert Murdoch.)
Quote of the day: "We never don't know anything about someone." -- John Nardone, chief executive of an Internet data mining company known as [x+1] Inc.

Crazy busy ERs -- and why

jtaylor — Tue, 17 Aug 2010 21:47:00 GMT

Not quite in keeping with the old Johnny Cash ("I've Been Everywhere") song, but I've been in nearly every Fresno/Clovis emergency room either as a patient or advocating for a patient in the last couple years.

You don't earn bragging rights or discount points at CVS pharmacy, but you do earn the right to wonder who all is glutting these places.

So, given that Community Regional Medical Center operates one of the busiest ERs in the nation -- 140,000 or so visits a year -- I thought some of the following recent national research on ERs might be of interest:

Patient visits to the ER jumped from 95 million in 1997 to 117 million in 2007, up 23%.
Number of ERs declined 5%, from 4,114 in 1997 to 3,925 in 2007.
43% of ERs were considered "safety net" in 1997 -- meaning one third or more patients were Medicaid or uninsured; that number leapt to 63% in 2007.
Most of the increased demand came from adults covered by Medicaid.
Leading reasons for ED visits,those 65 and older -- chest, abdominal pain shortness of breath; for children -- fever, vomiting, cough; for adults 15-64 -- pain, abdominal pain.
Two-thirds of all injury-related visits were from unintentional injuries.
Two-thirds of patient visits required ED waits of four hours of less.
Two-thirds of visits arrived after normal business hours, or on weekends.
Homeless patients visited at twice the rate of those living in private dwellings -- accounting for 542,000 visits.
Leading lab tests ordered: blood counts, X-rays and urinalyses.

(Sources: Journal of the American Medical Association, federal National Health Statistics Report, UC San Francisco)

My little red folder

jtaylor — Tue, 10 Aug 2010 21:40:00 GMT

Have trouble remembering your spouse's birthday? Well, how well do you know the prescriptions and over-the-counter medications they take? Surgeries, which leg and when? Food allergies? If the world went to heck, do you know what their final wishes are?

We keep a red folder -- red because it says "urgent." It has been invaluable after calling an ambulance to know where that folder is -- and to grab it. I take the information with me when I travel.

We update it regularly, because life changes. If my blood pressure goes down, I downsize my dosages (working with my doc).

The folder includes -- a list of surgeries, injuries, findings of significant medical events, dates and doctors involved. It includes lists of prescribed medications -- dosages, etc. What kinds of vitamins and supplements we take. What foods (cinnamon, ginger), medications (non-steroidal anti-inflammatories) and items (laytex bandages) might cause us problems.

And it includes a signed advanced directive.

Some people have found it useful to put a "red folder" onto their flash drives or on some paid Internet site. I've heard some horror stories of data filching, and some tales of doctors/clinics saying they have to write everything down -- no gizmos. That will change in some more secure, IT nirvana of the future.

But for now, if you're not already doing it, why aren't you in possession of a "red folder"? And for those who are, what more do you think I should have in mine?

Gore, Newt, DeeDee

jtaylor — Wed, 04 Aug 2010 17:57:00 GMT

Nice to name-drop some big names. Here are some snippets from keynote speakers at the recent American Hospital Association health summit in San Diego:

Ian Morrison, emcee/futurist/synthesizer: "Maybe I missed the class, but somehow Medicaid has become a good idea."
Nobel winner and former U.S. Veep Al Gore, citing an African proverb: "If you want to go quickly, go alone. If you want to go far, go together."
Morrison, again: "I'm not into data. I'm a social scientist. I'm into sweeping generalizations."
Author of Freakonomics/economist Steven Levitt, speaking after Gore's presentation, says Gore is making global warming a moral issue and that sidetracks many potential solutions.
Levitt, again: Many of the problems in health care arise from distorted incentives. By way of example, when an IRS thinker said the agency ought to compel taxpayers to list the Social Security numbers of their children with their annual forms, 7 million kids disappeared overight, federal revenue soared -- and there was no reward given to the gifted thinker.
Author/former White House press secretary DeeDee Myers: "If high school football counts for something, raising kids ought to count."
Myers, again: Maybe I'd be selling more books if I changed the title. You don't see many men walking through airports carrying a book titled "Why Women Should Rule the World."
Former House speaker/for-profit health think-tanker/possible presidential candidate Newt Gingrich: "Take 80% of your management talent and make sure you understand (the new health reform law) and use the remaining 20% to determine what is the reform we need after the reform fails."
Gingrich, again: "If (CMS, the agency overseeing health reform) had to approve the IPhone, it would've taken 40 years and it wouldn't have worked."
Questioner from the audience to Gingrich: "I've seen you on TV but actually in person you are really smart."
Morrison, again: "Let the nerds decide and let the jocks respond."
Documentarian Ken Burns: "Where does the great muscle of the English language get its exercise?"