Health – Page 95 – artdiamondblog.com

Medication Errors Harm 1.5 Million a Year

The report described below documents an incredibly high rate of errors in the administration of medications. Notice that one of the recommended practices is for patients to bring with them to each doctor’s visit, a complete listing of all of their medicines. It reminded me of accompanying my mother and father while my father was being treated for melanoma at one of the top cancer hospitals in the country. We were shuttled from doctor to doctor. And at each stop we were asked to give a full account of the medicines that Dad was taking. It gradually sunk in to me that the doctors at this prestigious hospital did not even know which drugs Dad had been prescribed, from within the hospital itself.

The Institute of Medicine has identified a problem, but has not identified a cure. If we really want to reduce medical errors, the key is not just to push isolated practices. The key is to change the system so that medical practitioners and institutions are rewarded when they do a better job of reducing errors. If the system provided the right incentives, then the practitioners themselves would be competing to invent and learn the practices that would be most efficient at improving patient health and well-being.

(p. A12) WASHINGTON, July 20 — Medication errors harm 1.5 million people and kill several thousand each year in the United States, costing the nation at least $3.5 billion annually, the Institute of Medicine concluded in a report released on Thursday.

Drug errors are so widespread that hospital patients should expect to suffer one every day they remain hospitalized, although error rates vary by hospital and most do not lead to injury, the report concluded.

The report, “Preventing Medication Errors,” cited the death of Betsy Lehman, a 39-year-old mother of two and a health reporter for The Boston Globe, as a classic fatal drug mix-up. Ms. Lehman died in 1993 after a doctor mistakenly gave her four times the appropriate dose of a toxic drug to treat her breast cancer.

Recommendations to correct these problems include systemic changes like electronic prescribing and tips for consumers like advising patients to carry complete listings of their prescriptions to every doctor’s visit, the report said.

. . .

Drug computer-entry systems, which are supposed to ensure that hospital patients get the right drugs at the right dose, are used in just 6 percent of the nation’s hospitals, said Charles B. Inlander, president of the People’s Medical Society, a consumer advocacy group, and an author of the report released Thursday.

Electronic medical records can help ensure that patients do not receive toxic drug combinations. The 1999 report urged widespread adoption of these systems. Thursday’s report called for all prescriptions to be written electronically by 2010.

Just 3 percent of hospitals have electronic patient records, said Henri Manasse, chief executive of the American Society of Health-System Pharmacists. Few doctors prescribe drugs electronically.

Even simple medication safety recommendations — block printing on hand-written prescription forms — are widely ignored.

. . .

Thursday’s report said that in any given week, four out of five adults in the United States took at least one medication. A third take at least five different medications. As the use of medications has soared, so, too have medication errors, Dr. Manasse said.

Effective strategies to prevent such errors have, however, been known for years, Mr. Inlander said.

“This is not rocket science,” Mr. Inlander said. “It’s simple. The key is having the will to make these changes in an organized and uniform way. And it’s not that expensive.”

For the full story, see:

GARDINER HARRIS. "Report Finds a Heavy Toll From Medication Errors." The New York Times (Fri., July 21, 2006): A12.

For a link to the full "Preventing Medication Errors" report from the Institute of Medicine, see: http://www.nap.edu/catalog/11623.html#toc

Exercising to Win, Hurts Lifetime Fitness

Source of image: online version of the NYT article cited below.

(p. E1) The dirty secret among former high school and college jocks is that many don’t remain active as adults. In their glory days they were the fittest among their peers. But as adults many are overtaken by nonjocks who embrace fitness as a commitment to health, forget the varsity letter.

Onetime elite athletes often languish once organized competition is over and a coach isn’t hounding them, sports scientists and exercise physiologists say. Many are burned out. Others become discouraged when their lackluster fitness can’t compare to their highlight reels. Running on a treadmill in a sea of anonymous gym-goers doesn’t compare to the thrill of being an m.v.p. on campus.

"Basically, they’ve been to the mountaintop and now they’re on these little hills, and that is difficult to deal with," said Dan Gould, the director of the Institute for the Study of Youth Sports at Michigan State University in Lansing.

Extrinsic motivation is tricky business, said Dr. Gould, a professor of kinesiology. He said he has found that athletes who played for trophies (p. E8) or attention are more at risk of becoming sedentary as adults than people who have taught themselves to get off the sofa and exercise, those with "intrinsic motivation."

For the full story, see:

JILL AGOSTINO. "Once an Athletic Star, Now an Unheavenly Body." The New York Times (Thurs., July 6, 2006): E1 & E8.

Global Warming Ranked at Bottom of World Priorities by Economists and Ambassadors

Bjorn Lomborg. Source of image: online version of WSJ article cited below.

(p. A10) Bjorn Lomborg busted — and that is the only word for it — onto the world scene in 2001 with the publication of his book "The Skeptical Environmentalist." A one-time Greenpeace enthusiast, he’d originally planned to disprove those who said the environment was getting better. He failed. And to his credit, his book said so, supplying a damning critique of today’s environmental pessimism. Carefully researched, it offered endless statistics — from official sources such as the U.N. — showing that from biodiversity to global warming, there simply were no apocalypses in the offing. "Our history shows that we solve more problems than we create," he tells me. For his efforts, Mr. Lomborg was labeled a heretic by environmental groups — whose fundraising depends on scaring the jeepers out of the public — and became more hated by these alarmists than even (if possible) President Bush.

Yet the experience left Mr. Lomborg with a taste for challenging conventional wisdom. In 2004, he invited eight of the world’s top economists — including four Nobel Laureates — to Copenhagen, where they were asked to evaluate the world’s problems, think of the costs and efficiencies attached to solving each, and then produce a prioritized list of those most deserving of money. The well-publicized results (and let it be said here that Mr. Lomborg is no slouch when it comes to promoting himself and his work) were stunning. While the economists were from varying political stripes, they largely agreed. The numbers were just so compelling: $1 spent preventing HIV/AIDS would result in about $40 of social benefits, so the economists put it at the top of the list (followed by malnutrition, free trade and malaria). In contrast, $1 spent to abate global warming would result in only about two cents to 25 cents worth of good; so that project dropped to the bottom.

"Most people, average people, when faced with these clear choices, would pick the $40-of-good project over others — that’s rational," says Mr. Lomborg. "The problem is that most people are simply presented with a menu of projects, with no prices and no quantities. What the Copenhagen Consensus was trying to do was put the slices and prices on a menu. And then require people to make choices."

Easier said than done. As Mr. Lomborg explains, "It’s fine to ask economists to prioritize, but economists don’t run the world." . . .

So all the more credit to Mr. Lomborg, who several weeks ago got his first big shot at reprogramming world leaders. His organization, the Copenhagen Consensus Center, held a new version of the exercise in Georgetown. In attendance were eight U.N. ambassadors, including John Bolton. (China and India signed on, though no Europeans.) They were presented with global projects, the merits of each of which were passionately argued by experts in those fields. Then they were asked: If you had an extra $50 billion, how would you prioritize your spending?

Mr. Lomborg grins and says that before the event he briefed the ambassadors: "Several of them looked down the list and said ‘Wait, I want to put a No. 1 by each of these projects, they are all so important.’ And I had to say, ‘Yeah, uh, that’s exactly the point of this exercise — to make you not do that.’" So rank they did. And perhaps no surprise, their final list looked very similar to that of the wise economists. At the top were better health care, cleaner water, more schools and improved nutrition. At the bottom was . . . global warming.

For the full interview, see:

KIMBERLEY A. STRASSEL. "The Weekend Interview with Bjorn Lomborg; Get Your Priorities Right." The Wall Street Journal (Sat., July 8, 2006): A10.

(Note: first ellipsis is added; the second ellipsis is in the original.)

Source of book image: http://www.amazon.com/gp/product/customer-reviews/0521010683/ref=cm_cr_dp_2_1/104-0101568-2686373?ie=UTF8&customer-reviews.sort%5Fby=-SubmissionDate&n=283155

“My Merit Is My Caste; What Is Yours?”

NEW DELHI, May 22 — The problem of caste prejudice here is as ancient as the Hindu texts. The efforts to redress it date from the formation of modern India nearly 59 years ago. Today — as India enjoys awesome rates of economic progress and confronts the challenge of spreading the benefits to its needy majority — the nation faces a polarizing totem of public policy: a government plan to extend college admission quotas to certain "backward" castes.

Affirmative action is in some ways an even more emotional issue in India than in the United States. In recent weeks, a proposal to extend quotas for admission to some of the country’s flagship, federally financed universities has caused fresh turmoil.

Protests — particularly by medical students who say merit should be the only basis for admission to India’s intensely competitive medical schools — have spread across the country and, here in the capital, hobbled public health services. Advocates and opponents of the measure have exchanged often ugly rants.

. . .

Medical students have been particularly outraged because the plan would further restrict the limited number of seats. Medical education in India begins with a five-year undergraduate program, and the proposal could affect students’ chances of completing their training.

The central lawn of the All India Institute of Medical Sciences, the pre-eminent public hospital, was occupied Friday by medical students on the fifth day of a strike that began last week and continued on Monday. "My merit is my caste. What is yours?" read one T-shirt.

. . .

The opponents say set-asides would diminish the quality of India’s best universities and divide students along caste lines.

"Why after 55 years are we still thinking in terms of caste-based reservation?" demanded Poojan Aggarwal, a third-year student at Safdarjung Medical College here. "We should talk now of total meritocracy. We know on this issue none of the political parties will support us."

For the full story, see:

SOMINI SENGUPTA. "Quotas to Aid India’s Poor vs. Push for Meritocracy." The New York Times (Tues., May 23, 2006): A3.

(Note: ellipses added.)

Doctor Overhead Increased 15 – 20% Due to Insurance Delays in Paying Claims

Source of the graphic: the online version of the NYT article cited below.

What is noteworthy in the table above is not the differences in delays in paying. What is noteworthy is that the fastest payer still takes a month to pay.

(p. C1) Few things rankle a doctor more than an insurance company’s saying it cannot find a claim for medical services. Particularly when there is even a signed return receipt to document delivery of the bill.

"We actually had the little green card to show who signed for the dang thing," said Elizabeth Wertz, chief executive of the Pediatric Alliance, a large group of Pittsburgh doctors. "We sent it by certified mail. The insurance company said they didn’t have it."

The claim was for several thousand dollars, according to Ms. Wertz, who declined to identify the company, a large regional insurer, for fear of making it more difficult to wrangle payments. It is a problem known to many doctors as they struggle to balance the rising cost of providing patient care with what they see as a reluctance by some powerful insurers to pay promptly.

Pediatric Alliance’s 37 doctors are among the 7,000 physicians, nurse practitioners and other health care providers around the country who are clients of the claims-processing company Athenahealth, which plans today to present a rare warts-and-all look at how well — or not — the nation’s seven biggest health insurers pay their bills.

Not well enough, in many cases, according to the data and to experts who say the survey provides the most comprehensive look yet at the state of accounts payable vs. accounts receivable in the nation’s health care system.

Tardiness or refusal to pay what doctors consider legitimate medical claims may add as much as 15 to 20 percent in overhead costs for physicians, forcing them to pursue those claims or pass along the costs to other patients, according to Jack Lewin, a family doctor who is chief executive of the California Medical Association, a professional group of 35,000 physicians.

. . .

(p. C10) Athenahealth, which says it collected $1.8 billion on behalf of its physician clients last year, is among the biggest of several thousand companies that help doctors and hospitals get paid by editing their claims and helping them to deal with difficult cases. Health care providers who can afford such services say they have become a necessary part of doing business.

In the case of Pediatric Alliance, with 37 pediatricians in a dozen offices in and around Pittsburgh, the doctors’ group spends at least $250,000 a year on salaries for eight billing clerks who handle claims and pursue money owed by insurers and patients. That is on top of salaries in Pediatric Alliance’s offices for staff members to verify the patient’s coverage and collect co-payments, plus paying an outside company to check for errors before the bills go out.

Ms. Wertz, the alliance’s chief executive, says some insurers’ telephone call centers limit claims-related issues to 10 per call. "That’s incredibly inefficient," she said. "We see thousands of patients. Our people have to sit on phone 30 minutes to get a live person."

. . .

"I would much rather have my staff talking to patients than talking to insurance companies," Dr. Katz said.

For the full story, see:

MILT FREUDENHEIM. "The Check Is Not in the Mail." The New York Times (Thurs., May 25, 2006): C1 & C6.

(Note: The "Dr. Katz" mentioned is "Dr. Molly Katz, a Cincinnati gynecologist and former president of the Ohio Medical Association.")

Paperwork is 31% of U.S. Health Care Costs

. . . , a large part of America’s health care spending goes into paperwork. A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.

For the full commentary, see:

PAUL KRUGMAN. "The Medical Money Pit." The New York Times (Friday, April 15, 2005): A19.

Canada may beat the U.S. in this dimension of health care, but they lose in many other important dimensions–for example the wait time to receive ‘elective’ surgeries. And anyway, isn’t 17 percent still too high?

British Pull Own Teeth Under Public Dental Care

"William Kelly, 43, extracted part of his own tooth, leaving a black stump. He plans to pull one more." Source of caption and image: online version of NYT article cited below.

ROCHDALE, England, May 2 — "I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth.

Now it is a jagged black stump, and the pain gnawing at Mr. Kelly’s mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth. "I’m in the middle of pulling that one out, too," he said.

. . .

But the problem is serious. Mr. Kelly’s predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said. Instead, it is due in large part to the deficiencies in Britain’s state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try.

Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting — "I’ve seen people with bleeding gums where they’ve ripped their teeth out," he said grimly — he has arrived too late and missed the cutoff.

"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim. "Churchill once said that the British are great queuers, but I don’t think he meant that in connection to dental care."

Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.

And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice — some 2,000 in April alone, the British Dental Association says.

. . .

The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals.

Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat.

Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape.

"I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.

Some people simply seek treatment abroad.

For the full story, see:

SARAH LYALL. "In a Dentist Shortage, British (Ouch) Do It Themselves." The New York Times, Section 1 (Sun., May 7, 2006): 3.

(Note: ellipsis added.)

Disruptive Innovation in Medicine

Source of image: http://online.wsj.com/article/SB114540135592529301.html?mod=home_personal_journal_middle

(p. D1) The dysfunctional doctor’s office is getting a makeover.

A growing number of programs around the country are helping doctors redesign their offices to wring more profit out of their practices and fix problems that have long frustrated patients: weeks-long delays to get appointments, hours in the waiting room, too-brief visits with the doctor, and the near impossibility of getting the physician on the phone. While the goal is to improve care, the programs also aim to avert a looming shortage of primary-care doctors who are frustrated with low pay, long hours and rising overhead costs.

The new programs borrow lessons from other industries to help doctors work more efficiently, especially those in solo and small group practices who account for the majority of outpatient office visits. One approach employs calculations used by airlines, hotels and restaurants to predict demand: The idea is that doctors can cut patient waits much the way restaurant chains seat diners and turn over tables efficiently. Others involve relatively simple changes, such as leaving afternoon appointments open for urgent visits, or having patients fill out paperwork ahead of time online.

Managed-care giant Kaiser Permanente is launching a program to help 12,000 doctors that contract with its health plan increase their efficiency with a new electronic-medical-records system. Portland, Ore., physician Chuck Kilo, whose GreenField Health Systems helps restructure medical practices, and is assisting with the program, says that too many doctors’ appointments take up valuable office time with follow-up that could be accomplished with phone calls and email.

Other models involve more-radical change, such as one called "Ideal Micro Practice" that sharply reduces or even eliminates support staff. With this blueprint, doctors rely on electronic health records and practice-management software to quickly dispense with administrative tasks. And they may run their offices solo, greeting patients personally as they come in the door.

"The office practice hasn’t changed much in 50 years," says John Wasson, a Dartmouth Medical School professor and practice redesign expert who is helping to launch a national program to expand the Micro Practice concept. "This is a disruptive innovation that can lead to increased quality and reduced costs."

For the full story, see:

LAURA LANDRO. "Cutting Waits at the Doctor’s Office; New Programs Reorganize Practices to Be More Efficient; Applying ‘Queuing Theory’." The Wall Street Journal (Weds., April 19, 2006): D1 & D3.

Source of graphic: http://online.wsj.com/article/SB114540135592529301.html?mod=home_personal_journal_middle

Radiologist Outsourcing Is Mainly a Myth

David Leonhardt. Source of image: http://www.nytimes.com/2006/04/19/business/19leonhardt.html?_r=1&oref=slogin

A few years ago, stories about a scary new kind of outsourcing began making the rounds. Apparently, hospitals were starting to send their radiology work to India, where doctors who make far less than American radiologists do were reading X-rays, M.R.I.’s and CT scans.

It quickly became a signature example of how globalization was moving up the food chain, threatening not just factory and call center workers but the so-called knowledge workers who were supposed to be immune. If radiologists and their $350,000 average salaries weren’t safe from the jobs exodus, who was?

On ABC, George Will said the outsourcing of radiology could make health care affordable again, to which Senator Charles E. Schumer of New York retorted that thousands of American radiologists would lose their jobs. On NPR, an economist said the pay of radiologists was already suffering. At the White House, an adviser to President Bush suggested that fewer medical students would enter the field in the future.

"We’re losing radiologists," Representative Sherrod Brown, an Ohio Democrat, said on CNN while Lou Dobbs listened approvingly. "We’re losing all kinds of white-collar jobs, all kinds of jobs in addition to manufacturing jobs, which we’re losing by the droves in my state."

But up in Boston, Frank Levy, an economist at the Massachusetts Institute of Technology, realized that he still had not heard or read much about actual Indian radiologists. Like the once elusive Snuffleupagus of Sesame Street, they were much discussed but rarely seen. So Mr. Levy began looking. He teamed up with two other M.I.T. researchers, Ari Goelman and Kyoung-Hee Yu, and they dug into the global radiology business.

In the end, they were able to find exactly one company in India that was reading images from American patients. It employs three radiologists. There may be other such radiologists scattered around India, but Mr. Levy says, "I think 20 is an overestimate."

Some exodus.

For the full story, see:

Leonhardt, David. "Political Clout in the Age of Outsourcing." The New York Times (Weds., April 19, 2006): C1 & C4.

An Osama-Sudafed Link?

The drug cops want everyone to share their mission. They think that doctors and pharmacists should catch patients who abuse painkillers — and that if the doctors or pharmacists aren’t good enough detectives, they should go to jail for their naïveté.

This month, pharmacists across the country are being forced to lock up another menace to society: cold medicine. Allergy and cold remedies containing pseudoephedrine, a chemical that can illegally be used to make meth, must now be locked behind the counter under a provision in the new Patriot Act.

Don’t ask what meth has to do with the war on terror. Not even the most ardent drug warriors have been able to establish an Osama-Sudafed link.

The F.D.A. opposed these restrictions for pharmacies because they’ll drive up health care costs and effectively prevent medicine from reaching huge numbers of people (Americans suffer a billion colds per year). These costs are undeniable, but it’s unclear that there are any net benefits.

In states that previously enacted their own restrictions, the police report that meth users simply switched from making their own to buying imported drugs that were stronger — and more expensive, so meth users commit more crimes to pay for their habit.

For the full commentary, see:

JOHN TIERNEY. "Potheads and Sudafed." The New York Times (Tues., April 25, 2006): A27.

Doctors Erect Barriers to Keep Out Competition

A Bangalore radiologist. One of three radiologists in India known to be reading U.S. scans. Each of the three has a U.S. degree, as required by U.S. law. Source of image: http://www.nytimes.com/2006/04/19/business/19leonhardt.html?_r=1&oref=slogin

(p. C1) Radiologists seem like just the sort of workers who should be scared. Computer networks can now send an electronic image to India faster than a messenger can take it from one hospital floor to another. Often, those images are taken during emergencies at night, when radiologists here are sleeping and radiologists in India are not.

There also happens to be a shortage of radiologists in the United States. Sophisticated new M.R.I. and CT machines can detect tiny tumors that once would have gone unnoticed, and doctors are ordering a lot more scans as a result.

When I talked this week to E. Stephen Amis Jr., the head of the radiology department at Montefiore Medical Center in the Bronx, he had just finished looking at some of the 700 images that had been produced by a single abdominal CT exam. "We were just taking pictures of big, thick slabs of the body 20 years ago," Dr. Amis said. "Now we’re taking thinner and thinner slices."

Economically, in other words, ra-(p. C6)diology has a lot in common with industries that are outsourcing jobs. It has high labor costs, it’s growing rapidly and it’s portable.

Politically, though, radiology could not be more different. Unlike software engineers, textile workers or credit card customer service employees, doctors have enough political power to erect trade barriers, and they have built some very effective ones.

To practice medicine in this country, doctors are generally required to have done their training here. Otherwise, it is extremely difficult to be certified by a board of other doctors or be licensed by a state government. The three radiologists Mr. Levy found in Bangalore did their residencies at Baylor, Yale and the University of Massachusetts before returning home to India.

"No profession I know of has as much power to self-regulate as doctors do," Mr. Levy said.

So even if the world’s most talented radiologist happened to have trained in India, there would be no test he could take to prove his mettle here. It’s as if the law required cars sold here to have been made by the graduates of an American high school.

Much as the United Automobile Workers might love such a law, Americans would never tolerate it, because it would drive up the price of cars and keep us from enjoying innovations that happened to come from overseas. But isn’t that precisely what health care protectionism does? It keeps out competition.

For the full story, see:

Leonhardt, David. "Political Clout in the Age of Outsourcing." The New York Times (Weds., April 19, 2006): C1 & C4.