Beginning October 1, 2008, Medicare, and many health insurance companies, will no longer pay hospitals for the additional services needed for patients who suffer from “never events.”

Never Events, as defined by the National Quality Forum, are those events which should never happen to a patient.  There are 28 errors on the list ranging from wrong site surgeries to drug errors to crimes committed by medical professionals.

Not included on the list from the NQF are HAIs (hospital-acquired infections).  There may be many reasons for this, but there are many groups and organizations that believe HAIs like MRSA, C.Diff and VRE SHOULD be included on the list.  Many of them, although not all of them, are preventable.

Regardless of what the left hand is doing (NQF), the right hand of payers (Medicare and many insurers) have decided that these infections will no longer be covered.  That means that any hospitalized patient who contracts, or at least presents with, an infection during a hospital stay may not be charged for the extra cost of treating the infection, nor will the hospital be paid by Medicare or many of the health insurance companies.

I don’t have the expertise to say whether this is right or wrong.  On the one hand, I believe it’s absolutely necessary to force hospitals to figure out ways to decrease the numbers of patients who contract these infections, estimated to be upwards of 5 million patients per year.

On the other hand, I know that sometimes patients arrive with pre-existing infections that may be apparent when they are admitted.  Can they be tested upon arrival?  Of course they can — although some hospital personnel point out how expensive that is, and that insurance won’t cover that either.  I have no doubt that there will be some problem for patients that crops up from this new ruling.  Hospitals will refuse to admit patients at risk, or they will discharge them too early so they can — at least in the paperwork — ignore an infection just as it begins.  Hospitals will do whatever they need to to protect their *sses — and it will be at the expense of patients.  Unintended consequences, all based on money.  What else is new?

During the past few days, a dialogue has taken place… wait… make that a diatribe…. on the blog of a certain “buckeye surgeon” where complaints and barbs have been thrown at a newspaper reporter who wrote about this October 1 date for reimbursement stoppage.  On just about the same day, the Wall Street Journal printed an article by Dr. Betsy McCaughey, founder of RID (Reduce Hospital Deaths) that gave some statistics about hospitals that have addressed infection problems — and have successfully reduced their numbers, one (claims) to 0 patients over a span of years.

So –I pulled some quotes from Dr. McCaughey’s WSJ article and posted them to the blog — and you would have thought I was the devil-incarnate…. whoa!  A regular lightening rod!  All those doctors so quickly turned their ire on me.  And I thought angry patients got worked up!  They can’t hold a candle to posters like “white coat” and “anonymous” who — God forbid — don’t even use their real names.

No — they attacked me one after the next.  In fact, it began when I suggested that SOME hospitals were actually trying to help patients!  SOME hospitals are actually asking their doctors and personnel to adhere to a checklist that — (you won’t believe this) — actually prevents infection!

Oh — one even attacked me for not being grateful that I was misdiagnosed with cancer.  She told me I should not have been upset at the misdiagnosis — I should have been relieved that I didn’t have it.  (My standard reply, which I didn’t bother with is — “gee — you didn’t get hit by a car today.  Are you relieved and grateful?”)  Of course — what on EARTH does this have to do with infections?  I’m not sure.

What’s the bottom line?  What can we learn from this?  Honestly — I do NOT believe that including HAIs on the list of never events Medicare and some insurances will no longer pay for was the right approach.  While some infections could have been listed and it would have been helpful, instead I think Medicare has only thrown down the gauntlet for hospitals to go underground.  Patients will pay the price in even worse health problems.  We must be more vigilant and be prepared to stand up for ourselves and our loved ones, and once October 1 rolls around, that will be even more difficult.

What the Trisha-bashing on the Buckeye Surgeon’s blog has shown me is that when we patients begin to stand up for our NEED for decent healthcare, we become the enemy.  The point I tried to make on a couple of the blog posts was that I think patients and providers need to remember that we have the same goal — improved patient care.  But those folks didn’t want to go there.  They just wanted to bash me.

I pray none of them is ever hurt by a medical error.  I hope none of them ever suffers at the hands of a medical practitioner who is probably just in a big hurry because he doesn’t get reimbursed well enough for his work.  I hope they don’t lose a loved one, like I did, after she acquires MRSA.

But mostly I hope they will stop taking their frustration out on the messenger.  Afterall — excuse me — I THOUGHT we all had the same goal?

Don’t we?

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I’ve been reminded twice in the last two days about the oncologist who was a part of my misdiagnosis story. He’s a big part of it; if he hadn’t been such an arrogant SOB, then I probably would not have changed careers to help other patients help themselves.

But most days I don’t even think about him. So two reminders in two days? That’s a double whammy.

The first came yesterday as I participated in the Susan G. Komen breast cancer Race for the Cure. There were almost 8,000 participants, among them several hundred breast cancer survivors. I had the opportunity to speak to a handful of them, and when they were particularly happy about how successful their treatment was, i would ask them who their doctors were.

One woman shared a litany of doctor’s names, among them was the same oncologist I had dealt with. She spoke in glowing terms about all the other doctors, but his name was just a part of the list. Nothing good to say — he was just a participant.

I didn’t comment. I didn’t ask her about her experience with him. I have never shared his name publicly because my goal has never to cast dispersions on him personally. I will confess, however, that if someone is seeking a new oncologist for a second opinion, or for referral purposes, and they have told me he is under consideration, then yes — I have shared my experience. Have I had an influence on which patients have chosen to see him? Yes, I’m sure I have — but not much of one.

Then this morning, I found this article from the New York Times, entitled, “Doctor’s Start to Say ‘I’m Sorry’ Long Before ‘See You in Court.’ And there it is again — that feeling…. argh. He held my life in his hands, and he was so ready to treat me with deadly chemicals for no reason….

One aspect of my dealings with him continues to confound me. He never apologized.

Once my misdiagnosis was proven by the National Institutes of Health, I contacted all the doctors who had participated in the odyssey. Of those who had made mistakes and contributed to the errors, I asked for apologies. I made it clear I was not interested in lawsuits.

All the doctors who had contributed to the mistakes apologized — except the oncologist. In fact, he sent me a long letter outlining why he had done the right things. Never mind the fact that he had never read the results of lab tests indicating one more test was being run — yet he had never looked at the results. Never mind the fact that when I told him I wanted another opinion, his answer to me was “what you have is so rare, no one will know anymore about it than I do!”

There is much in the medical literature these days about the positive outcomes when doctors own up to the mistakes they’ve made. This article from the NY Times is one example. Patients heal better, fewer lawsuits are filed, there are so very many aspects of improved health and service that come as a result of professionals taking responsibility.

It’s too bad for this particular doctor that his ego won’t allow him to do the right thing. On the other hand — had he been more forthcoming, perhaps I would not have been angry enough to make sure these kinds of problems wouldn’t happen to other patients?

We’ll never know. But I sure as heck hope that, as time goes on, he’ll realize his ego is getting in the way of his competency. A good doctor is a decent human being, too. In my opinion? Until he learns to own up to mistakes, he’s not much of doctor.

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What do you think of those prescription ads you see on TV, in magazines, newspapers and other places? Do you think they are helpful? Do you get frustrated because you know you can’t purchase those drugs directly anyway? Did you go to your doctor to ask about one of them? Do you think they are dangerous?

Prescription drug ads will be on TV for a long time. People may be objecting, but pharma is making a lot of money from them. I expect we’ll see many more of them, not fewer.

Truth is — if viewed in the right way, they can be useful. Unlike the dozens of anti-pharma folks who call for the demise of those ads, I say — if you can’t beat ‘em, then learn about ‘em.

And now, my friend Kim Witczak, founder of Woody Matters, has teamed with Consumer’s Union (non-profit publishers of Consumers Report) to petition the FDA to make these ads more helpful to consumers. It’s an idea borne of Kim’s wish to make drugs safer for Americans, based on the death of her husband, Woody, whose side effects from Zoloft caused him to take his own life.

The idea is that many side effects are unreported by drug companies, and the FDA can’t know about them unless those who take the drugs report them. (Don’t EVEN get me started on how that happens!) The proposal / petition asks for all pharma drug ads to include an 800 number and web address to report these problems as a part of the ad or commercial. Kinda like the warning on cigarette packaging — but even more useful because it’s a way we patients can really take action.

MedWatch is the FDA’s process for consumers to use to report their negative side effects and outcomes, but most consumers don’t know about it. The toll free number and web addresses already exist for reporting. (See below for that info.)

Consumer’s Union is hoping to garner 50,000 signatures — and you can easily sign right here online. You can take 30 seconds to say YES! to the idea of adding these two ways to report problems with drugs. Just follow this link to have your say.

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Do you want to report side effects, problems or adverse events for a drug you take to the FDA?

Link here to MedWatch.

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It’s been a busy several days — as the holiday season always is. Haven’t written anything new on this blog for your consideration, but I have been busy!

Here are the topics I’ve covered, and links so you can find them:

What about Nataline?

The 17-year-old who got caught in the crossfire over insurance coverage, then died from liver failure… Would universal insurance have saved her?

Is Your Family Together for the Holidays?

Why not talk about healthcare issues? Recording a family history can be helpful to all blood relatives.

Do You Have a Flexible Medical Spending Account?

You may have to use it up before December 31 — or you may have until March 15. Here are some ways you can — or can’t - use that money.

An Ounce of Prevention…

Costs much less than that pound of cure. Why not stay healthy and save money, too?

Sure enough… plenty of empowered patient reading for these quieter times between the holidays. If you think of a topic you’d like me to cover, then contact me!

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	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	………………………………………………………………..
	Join Trisha in the Patient Empowerment Forum at About.com
	………………………………………………………………..
	Or link here to empower yourself at EveryPatientsAdvocate.com
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