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Archive for April, 2007

MRSA Costs Hospitals Big Money!

I’ll admit it. I was very skeptical when a link for a research report about the cost of hospital infections to hospitals – was sent to me. I’ve never typed these words out loud before, but I’ve always thought that one reasons hospitals ignored (didn’t try to alleviate) MRSA and other hospital-acquired-infections (HAIs) is because they could make more money from patients who got sicker and had to stay in their facilities longer. Made sense to me. I just had no way of demonstrating it.

So I read the report, and re-read it. And you know what? It makes sense. And the bottom line is — HAIs are a major hit to the pocket book of hospitals.

The report was issued by APIC, the Association for Professionals in Infection Control and Epidemiology in February 2007. The stated goals of the report are to dispel the following myths (paraphrasing here):

  1. That HAIs are an expected byproduct of treating an older population with invasive techniques.
  2. That the additional cost of treating HAIs is offset by reimbursements from Medicare, insurance, etc — making them an income stream, or at least neutral for cost.
  3. That the number of HAIs is insignificant, so investing in reducing them isn’t worth the money.

And the bottom line? In a study of 1.69 million admitted patients in 77 hospitals, the COST TO THE HOSPITALS was $286 million — meaning MORE THAN $5000 PER PATIENT.

That’s what it cost the hospital! That came out of the bottom line! That’s not what it cost the patient, and it’s not what it cost to treat the patient. That’s only what it cost the hospital — in dollars. There is also (what they call) an opportunity cost. I remember this one from Economics 101 in college — “opportunity cost = opportunity lost” — and the opportunity lost to hospitals is 7.5 million patient-days nation wide. That means that there would be room for that many more patients in hospitals if the others didn’t acquire infections and have to stay so long.

Now this will really make you sick, too: The average cost of reimbursement per patient — meaning — the money that mostly came from Medicare and came out of YOUR POCKET AND MINE — $ 64,894.

And the cost to the patient? Remember, the great majority of those who acquire infections are the frail, elderly, surgical and catheterized patients. It may not cost them a lot more out of their individual pockets, but it certainly costs them in their health, and their ability to fight whatever was wrong with them prior to needing a hospital stay to begin with. And in the case of 100,000 patients each year — the cost is the ultimate — they will die.

A few suggestions and requests here:

If you know any of the hospital administrators where you live, share a copy of this report with them. Don’t forget — American Health Care is not about health or care. It’s about sickness and money. This should get their attention.

If you know you will be hospitalized, do yourself two favors. First, learn about hospital infection rates in your area (if possible — see “finally” below), and choose a hospital where you are less likely to acquire an infection. And second, follow all those good rules we’ve talked about before. Find them here: http://www.hospitalinfection.org/protectyourself.shtml

Finally — if your state doesn’t require hospitals to publicize their infection rates, then begin contacting your legislators and ask them to work on it. Find other MRSA-related posts in this blog to learn more about which states do, and don’t, require publication of infection rates.

Save your life. Save someone else’s life. Save our pocketbooks, too. Sounds win-win-win to me.

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Alzheimer’s, A Conversation

This morning on my radio show, we aired my interview with Dr. Sharon Brangman, geriatrician and expert in Alzheimer’s Disease and other dementias. As the daughter of a mother who is in the advanced stages of this horrible disease, I was moved to tears by the conversation. It was an opportunity to learn more about it, and even ended with a bit of hope. Here are some points from the conversation — a few basics, and some information that was new to me, too.

  • The numbers of victims are increasing exponentially, mostly because people are living longer, and because of the growing numbers of baby boomers.
  • Dr. Alzheimer was the person who distinguished “his” disease from other forms of dementia — about 65 years ago. The former term was “hardening of the arteries.”
  • How do we know the difference between forgetfulness and the onset of dementia? If the non-remembering begins to get in the way of life, then it may be dementia, including Alzheimer’s. When we can’t remember how to do something we’ve always done, or can’t remember names of people we see frequently, or forget to take our medications consistently, or anything that becomes an interference with everyday living.
  • Caretakers need almost as much care as the actual Alzheimer’s patient. (My opinion: perhaps the patients are patients, and the caretakers and families are the real “victims.”)
  • Dr. Brangman’s metaphor for the physiology of how Alzheimer’s works: think of the brain as a highway system of thought patterns. A protein begins to build and gunks up the highway, putting roadblocks in front of the thought patterns so they can’t be used.
  • There are a handful of dementias — Alzheimers is most prominent, but not all have the same physiology and some are treated differently. It’s important for doctors to discern which dementia is causing problems so it can be treated most effectively.
  • Research shows that people who continually use and challenge their brains may keep Alzheimer’s at bay — and taking the above metaphor another step — it’s because the brain develops more highways for the transport of ideas when it is being used and challenged. With more highways available, the protein does not so easily block the passage of thoughts.
  • Studies about the effect of music on Alzheimer’s patients have shown that familiar music elevates a patient’s mood and brain function. Dr. Brangman hypothesized that it’s because music thoughts are stored in so many areas of the brain, that there are enough of those above-mentioned highways available to translate the thoughts.
  • On the horizon: research that will help develop therapies that will regrow nerve growth cells, and/or repair or dissolve the problems caused by that gummy, gunky protein that develops in the brain.

How do we keep Alzheimer’s at bay in our younger years? Eat right, exercise, don’t smoke… all those good practices that seem to be the answer for keeping any health-related problem out of our lives.

End of post for today. I’m going to go eat a salad and walk a few miles. Then I’m going to call Mom to tell her I love her.

………………
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Alzheimer’s, A Conversation

This morning on my radio show, we aired my interview with Dr. Sharon Brangman, geriatrician and expert in Alzheimer’s Disease and other dementias. As the daughter of a mother who is in the advanced stages of this horrible disease, I was moved to tears by the conversation. It was an opportunity to learn more about it, and even ended with a bit of hope. Here are some points from the conversation — a few basics, and some information that was new to me, too.

  • The numbers of victims are increasing exponentially, mostly because people are living longer, and because of the growing numbers of baby boomers.
  • Dr. Alzheimer was the person who distinguished “his” disease from other forms of dementia — about 65 years ago. The former term was “hardening of the arteries.”
  • How do we know the difference between forgetfulness and the onset of dementia? If the non-remembering begins to get in the way of life, then it may be dementia, including Alzheimer’s. When we can’t remember how to do something we’ve always done, or can’t remember names of people we see frequently, or forget to take our medications consistently, or anything that becomes an interference with everyday living.
  • Caretakers need almost as much care as the actual Alzheimer’s patient. (My opinion: perhaps the patients are patients, and the caretakers and families are the real “victims.”)
  • Dr. Brangman’s metaphor for the physiology of how Alzheimer’s works: think of the brain as a highway system of thought patterns. A protein begins to build and gunks up the highway, putting roadblocks in front of the thought patterns so they can’t be used.
  • There are a handful of dementias — Alzheimers is most prominent, but not all have the same physiology and some are treated differently. It’s important for doctors to discern which dementia is causing problems so it can be treated most effectively.
  • Research shows that people who continually use and challenge their brains may keep Alzheimer’s at bay — and taking the above metaphor another step — it’s because the brain develops more highways for the transport of ideas when it is being used and challenged. With more highways available, the protein does not so easily block the passage of thoughts.
  • Studies about the effect of music on Alzheimer’s patients have shown that familiar music elevates a patient’s mood and brain function. Dr. Brangman hypothesized that it’s because music thoughts are stored in so many areas of the brain, that there are enough of those above-mentioned highways available to translate the thoughts.
  • On the horizon: research that will help develop therapies that will regrow nerve growth cells, and/or repair or dissolve the problems caused by that gummy, gunky protein that develops in the brain.

How do we keep Alzheimer’s at bay in our younger years? Eat right, exercise, don’t smoke… all those good practices that seem to be the answer for keeping any health-related problem out of our lives.

End of post for today. I’m going to go eat a salad and walk a few miles. Then I’m going to call Mom to tell her I love her.

………………
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Alternative Primary Care: Retainer, Concierge, Boutique and Spa

There’s a movement underway among primary care physicians to shift their sources of income, and it could have a profound effect on how we patients view our relationships with our doctors, not to mention our outcomes when it comes to medical problems.

If you remember the Marcus Welby days, or if you’re old enough to remember when the doctor made house calls (raise your hand! yes! there are a few of you out there!) then you’ll appreciate this movement toward taking back their own practices. As a business owner myself, I can’t say as I blame them.

Who do these doctors expect is going to pay them? Patients! Go figure.

Wait! (you might say) Patients pay them now! So what’s different?

In fact, most patients don’t pay their doctors directly. Instead, patients pay for insurance or medicare, and the doctors bill, then get paid, by the insurance companies or medicare. We patients might pay a co-pay, or a smaller percentage of the total bill, but rarely the whole thing.

Also consider this: When doctors send those bills to our insurance companies or medicare, they don’t get paid what they charge. Instead, they get paid what the insurance company wants to pay them. (Picture it this way: when your car needs repair, and the bill comes to $500, you tell the mechanic that yes, you understand the bill is $500, but you will pay him only $350 — take it or leave it.) Plus, doctors employ services or extra staff, just to take care of billing all those third-party payors. Meaning, it costs them extra for the insult.

A number of terms have popped up to describe direct-from-patient-to-the-doctor pay models. “Retainer” or “concierge” medicine, “boutique practices”, “medical spas” — the idea is that a patient pays a set amount in a year, and that gives the patient total 24/7 access to his doctor, often in ways there is limited access now. For example, retainer doctors may provide email access, may accompany a patient to a specialist, and may even make house calls. Everything “old” is new again!

Practices such as family medicine, internists, OB-GYNs, pediatricians and geriatricians are moving to this model. Others may follow suit. And my guess is, if you see a naturopath, then direct-pay-for-service is what you’re used to anyway, although the retainer idea might be new.

I have mixed feelings, but as you know, I’m always a champion of pro-patient programs, and this does seem to be one. In fact, it’s a boon to everyone involved, including the doctors. The only players on the short end of the retainer stick are the health insurance companies, and — well — frankly, who cares?

There are still considerations for patients that don’t get addressed in this model. It can be expensive. I’ve heard amounts ranging from $1,500 to $10,000 annually. And remember, that’s just for primary care. While I’m a firm believer in the idea of primary care doctor as the maestro of the medical care symphony, there are so many problems that must be addressed by other doctors, or in alternate facilities, that will not be paid for in that retainer — so — the patient will have to pay for those services separately. Or, the patient will pay the retainer IN ADDITION TO insurance premiums and co-pays for specialists and other services.

Further, I wonder what percentage of patients can actually afford this boutique-type primary care service? Now, I’m not the person who will tell you that since ALL people can’t afford it, then NONE should have access to it — no way. BUT, it’s a consideration because it does further separate the haves from have-nots. It makes me uncomfortable, at least.

There are a number of resources for patients who want to learn more about retainer services and which doctors are now using this system. Here’s a list of articles that may interest you:

Maryland Business Gazette: On Call – for a Fee and No More Assembly Line Medicine

Seattle Times: Concierge Medicine, An Affordable Option

Connecticut Post: Put Your Doctor on Retainer

What I have not been able to find is a list of doctors who have shifted their practices to this model. I can’t find local lists or state or national lists. If you know of any — will you let me know?

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