Health – Page 98 – artdiamondblog.com

Urgent Care Clinics Are Replacing Emergency Rooms

“An urgent-care clinic in Atlantic Beach, Fla.” “Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. D1) When a heavy metal door swung over her 14-year-old son’s foot, ripping the nail almost completely off his big toe, Tina Mobley didn’t want to take her chances in a crowded hospital emergency room or wait for an appointment at the pediatrician’s office the next day. Instead, she drove to an urgent-care clinic inside a Wal-Mart in Yulee, Fla., near her rural home. Within minutes, the doctor on duty numbed the pain with an injection, removed the nail, and cleaned and bandaged the injury.

Patients who need immediate care for injuries and illness, be it a nail-gun puncture or a severe stomach bug, are increasingly turning to walk-in urgent-care clinics. These facilities aim to fill the gap between the growing shortage of primary-care doctors and a shrinking number of already-crowded hospital emergency departments, with no appointment necessary and extended evening and weekend hours. Urgent-care clinics are staffed by physicians, offer wait times as little as a few minutes and charge $60 to $200 depending on the procedure — a fraction of the typical $1,000-plus emergency department visit. Some offer discounts and payment plans for the uninsured; for those with coverage, co-payments vary by insurance plan but may be less than half the amount of an ER visit, which can range from $50 to $200.

While the Yulee clinic that treated Ms. Mobley’s son is one of three operated inside Wal-Mart stores by Jacksonville, Fla.-based Solantic, urgent-care centers aren’t to be confused with the new crop of retail health clinics popping up in drugstores, which are run by nurse practitioners who prescribe medicine for minor illnesses and provide vaccinations. Urgent-care-center physicians and other medical staffers can put casts on broken bones, sew up lacerations, provide intravenous fluids for dehydrated patients, and deploy advanced life-support equipment for both adults and children. They often have equipment not available in physicians’ offices, such as X-rays.

For the full story, see:
LAURA LANDRO. “THE INFORMED PATIENT; Options Expand For Avoiding Crowded ERs.” The Wall Street Journal (Weds., August 6, 2008): D1-D2.

Fewer Jobs Under Obama’s High-Cost Health Plan

“Dave Ratner, owner of four pet stores in Western Massachusetts, is worried about being able to pay into a state health benefits plan.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. A16) AGAWAM, Mass. — Dave Ratner, owner of Dave’s Soda and Pet City, is pretty sure he is about to get “whacked” by the new state law that requires employers to contribute to health care benefits for their workers or pay a $295-per-employee penalty. In order to avoid thousands of dollars in fines, Mr. Ratner is considering not adding part-time workers at his four pet supply stores in Western Massachusetts.

But the penalty in Massachusetts is picayune compared with what some health experts believe Senator Barack Obama, the Democratic presidential nominee, might impose as part of his plan to provide affordable coverage for the uninsured. Though Mr. Obama has not released details, economists believe he might require large and medium companies to contribute as much as 6 percent of their payrolls.
That, Mr. Ratner said, would be catastrophic to a low-margin business like his, which has 90 employees, 29 of them full-time workers who are offered health benefits.
“To all of a sudden whack 6 to 7 percent of payroll costs, forget it,” he said. “If they do that, prices go up and employment goes down because nobody can absorb that.”

For the full story, see:

KEVIN SACK. “Businesses Wary of Details in Obama Health Plan.” The New York Times (Mon., October 27, 2008): A16.

Hospitals Lack Hospitality

Source of book image: http://www.simplenomics.com/wp-images/settingthetable-1.jpg

(p. R7) Most successful entrepreneurs like rattling on about how they did it.

The bookshelves have never been more crowded with such exploits from consultants, real-estate moguls and retailers. And publishers say there are more on the way. With layoffs and cutbacks dominating the headlines, demand for advice books based on true-life stories is peaking.
. . .
So what does it take to succeed?
“Pragmatic advice, [a book written by] somebody with a fairly high public profile, and a person who can hit the lecture circuit after the first rush of publicity and keep the book selling,” says Grand Central’s Mr. Wolff.
Those factors have contributed to the staying power of restaurateur Danny Meyer’s book, “Setting the Table: The Transforming Power of Hospitality in Business.”
News Corp.’s HarperCollins Publishers first published 30,000 copies in October 2006. (News Corp. also publishes The Wall Street Journal.) Mr. Meyer’s work, chatty personal anecdotes wrapped around a core message that emphasizes hospitality as the key to creating satisfied customers, proved a hit.
. . .
“The most surprising thing was the interest from the hospital community,” Mr. Meyer says. “That’s an industry in turmoil based on the absence of hospitality. They over-focus on the metrics of stays and cure rates rather than how they make people feel.”

For the full story, see:

JEFFREY A. TRACHTENBERG. “Running the Show; Me, Me, Me; So many entrepreneurs are writing books about how they made it. Their books, though, aren’t nearly as successful.” The Wall Street Journal (Mon., June 16, 2008): R7.
(Note: ellipses added.)

Medicare Pays $110 for Walker that Wal-Mart Sells for $60

Source of table: online version of the NYT article quoted and cited below.

(p. C1) On Wal-Mart’s Web site, you can buy a walker for $59.92. It is called the Carex Explorer, and it’s a typical walker: a few feet high, with four metal poles extending to the ground. The Explorer is one of the walkers covered by Medicare.
But Medicare and its beneficiaries aren’t paying $59.92 for the Explorer or any similar walker. In fact, they’re not paying anything close to it. They are paying about $110.
. . .
(p. C5) In the abstract, fixing the health care system sounds perfectly unobjectionable: it’s about reducing costs (and then being able to cover the uninsured) by getting rid of inefficiency and waste. In reality, though, almost every bit of waste benefits someone.
Doctors who perform spinal fusion surgeries, despite decidedly mixed evidence that they’re effective, are making a nice living. Hospitals that order $1,000 diagnostic tests, even when a cheaper one would work just as well, are helping their bottom line. Medical equipment makers selling walkers for $110, while Wal-Mart sells them for $60, are fattening their profits.
The current fight to protect those profits is a microcosm of what you can expect to see if a larger effort to rein in health costs ever gets going. The defenders of the status quo won’t say that they are protecting themselves. Instead, they’ll use the same arguments that the medical equipment makers are using — that a change will destroy jobs, bankrupt small businesses and, above all, harm patients.
. . .
But this is a case in which the market can clearly do a better job than a government-mandated fee schedule. Just look at Wal-Mart’s Web site or, for that matter, the bids that Medicare has already received.
By standing in the way of this competition, Congress is really standing up for higher health care costs.

For the full commentary, see:
DAVID LEONHARDT. “ECONOMIC SCENE; High Medicare Costs, Courtesy of Congress.” The New York Times (Weds., June 25, 2008): C1 & C5.
(Note: ellipses added.)

A.D.A. Tries to Stop Dental Therapists from Competing with Dentists

“Aurora Johnson, left, a dental therapist, filled cavities for Paul Towarak, 10, in the village of Unalakleet, Alaska. For more involved procedures, Ms. Johnson refers patients to a dentist.” Source of caption and photo: online version of the NYT article quoted and cited below.

Clayton Christensen (and co-authors) have suggested that disruptive technologies could reduce the cost and improve the quality of health care. One pathway for this to occur is new technologies that permit effective treatment to be carried out by para-professionals with less education than MD’s.
The article below illustrates Christensen’s idea, and also highlights the main obstacle to its implementation: professional organizations asking the government to regulate and restrict competition from the lower-cost para-professionals.

(p. A1) UNALAKLEET, Alaska — The dental clinic in this village on the edge of the Bering Sea looks like any other, with four chairs, a well-scrubbed floor and a waiting area filled with magazines.
But to the Alaska Dental Society and the American Dental Association, the clinic is a place where the rules of dentistry are flouted daily. The dental groups object not because of any evidence that the clinic provides substandard care, but because it is run by Aurora Johnson, who is not a dentist. After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities.
Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. John-(p. A15)son’s. And while such arrangements are common outside the United States, only one American dental school, in Anchorage, offers such a program.
. . .
(p. A15) In Alaska, the A.D.A. and the state’s dental society had filed a lawsuit to block the program that trained people like Ms. Johnson, who are called dental therapists. The groups dropped the suit last summer after a state court judge issued a ruling critical of the dentists. But the A.D.A. continues to oppose allowing therapists to operate anywhere in the lower 49 states. Currently, therapists are allowed to practice only in Alaska, and only on Alaska Natives.
. . .
Therapists are a low-cost way to provide care to people who might not otherwise have access to it, according to Dr. Ron Nagel, a dentist and consultant for the Alaska Native Tribal Health Consortium, a nonprofit group financed mostly by federal money that provides medical and dental care to tribal communities. “There’s a huge need for these basic services,” Dr. Nagel said.
. . .
Since 1990, the number of private dentists has remained roughly flat, at 150,000, even as the United States population has increased 22 percent. As a result, dentists can easily fill their appointment books without seeing people who cannot meet their fees, and patients who have decayed teeth are suffering needlessly, said Tammy Guido, 50, who is one of seven students now training in Anchorage to become a therapist.
“We’re meeting a need that is not being met,” Ms. Guido said.
Alaskan tribal organizations sponsor Ms. Guido and the other students in Anchorage for the program. To be accepted, students must have a high school diploma or equivalency degree; for the newest class, 7 of 18 candidates were accepted.
In interviews, the students in this year’s class all said they were enthusiastic about the chance to serve communities that have little access to care. All seven had quit full-time jobs and must now get by on a $750 monthly stipend during the two years of training.
“Anybody who’s ever had a toothache can tell you it hurts,” said Ben Steward, 24, the only man in this year’s class. “But talk to someone who’s had a toothache for a year.”

For the full story, see:
ALEX BERENSON. “Dental Clinics, Meeting a Need With No Dentist.” The New York Times (Mon., April 28, 2008): A1 & A15.
(Note: ellipses added.)

One source of Christensen’s views on health care can be found in a chapter in:
Christensen, Clayton M., Scott D. Anthony, and Erik A. Roth. Seeing What’s Next: Using Theories of Innovation to Predict Industry Change. Boston, MA: Harvard Business School Press, 2004.

Health Care Spending Takes a Large and Growing Share of Income

Source of graph: online version of the NYT article quoted and cited below.

The most interesting part of the article quoted below, was the above graph, that dramatically shows health care’s large and growing share of disposable personal income.

(p. 28) Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.

Health costs are “burying small business,” said Mike Roach, who owns a small clothing store in Portland, Ore. He recently testified on health coverage at a Senate hearing led by Ron Wyden, Democrat of Oregon.

Last year, Mr. Roach paid about $27,000 in health premiums for his eight employees. “It’s a huge chunk of change,” he said, noting that he was forced to raise his employees’ yearly deductible by 50 percent, to $750.

For the full story, see:

REED ABELSON and MILT FREUDENHEIM. “Even the Insured Feel Strain of Health Costs.” The New York Times, Section 1 (Sun., May 4, 2008): 1 & 28.

Brain-Controlled Prosthetics Within Reach

“A grid in the monkey’s brain carried signals from 100 neurons for the mechanical arm to grab and carry snacks to the mouth.” Source of caption and photos: online version of the NYT article quoted and cited below.

(p. A1) Two monkeys with tiny sensors in their brains have learned to control a mechanical arm with just their thoughts, using it to reach for and grab food and even to adjust for the size and stickiness of morsels when necessary, scientists reported on Wednesday.

The report, released online by the journal Nature, is the most striking demonstration to date of brain-machine interface technology. Scientists expect that technology will eventually allow people with spinal cord injuries and other paralyzing conditions to gain more control over their lives.
The findings suggest that brain-controlled prosthetics, while not practical, are at least technically within reach.
In previous studies, researchers showed that humans who had been paralyzed for years could learn to control a cursor on a computer screen with their brain waves and that nonhuman primates could use their thoughts to move a mechanical arm, a robotic hand or a robot on a treadmill.
The new experiment goes a step further. In it, the monkeys’ brains seem to have adopted the mechanical appendage as their own, refining its movement as it interacted with real objects in real time. The monkeys had their own arms gently restrained while they learned to use the added one.

For the full story, see:
BENEDICT CAREY. “Monkeys Think, Moving Artificial Arm as Own.” The New York Times (Thurs., May 29, 2008): A1 & A18.

Sprouted “Methuselah” Seed Is 2,000 Years Old

“One of a handful of 2,000-year-old seeds (top) from the fortress of Masada in present-day Israel grew into a date palm plant (bottom) called Methuselah in 2005.” Source of caption and photos: online article quoted and cited below.

The oldest-sprouted seed in the world is a 2,000-year-old plant from Jerusalem, a new study confirms.
“Methuselah,” a 4-foot-tall (1.2-meter-tall) ancestor of the modern date palm, is being grown at a protected laboratory in the Israeli capital.
In 2005 the young plant was coaxed out of a seed recovered in 1963 from Masada, a fortress in present-day Israel where Jewish zealots killed themselves to avoid capture by the Romans in A.D. 70.

For the full story, see:

Anne Minard. “”Methuselah” Tree Grew From 2,000-Year-Old Seed.” National Geographic News online (June 12, 2008), downloaded on 6/19/08 from: http://news.nationalgeographic.com/news/2008/06/080612-oldest-tree.html

Paternalistic Doctors With Way Too Much Time on Their Hands

(p. C6) The American Medical Association is hulking mad at Marvel Studios.
Last week, the advocacy arm of the powerful physicians’ group unleashed a tsk-tsk campaign against “The Incredible Hulk,” a Marvel film that opened on Friday and is distributed by Universal Pictures. The complaint was of “gratuitous depictions of smoking.”
In the movie, which drew a PG-13 rating from the Motion Picture Association of America, Gen. Thunderbolt Ross, a bad guy played by William Hurt, is rarely seen without a smoke-spewing cigar. (Presumably, the physicians’ association worries that children who identify with the authoritarian general — who wants to annihilate the Hulk, played by Edward Norton — may be tempted to pick up the habit.)

For the full story, see:
BROOKS BARNES. “Physicians’ Group Furious at Cigars in ‘Hulk’ Movie.” The New York Times (Mon., June 16, 2008): C6.

After Tort Reform, 7,000 M.D.s Have Gone to Texas

(p. A9) When Sam Houston was still hanging his hat in Tennessee in the 1830s, it wasn’t uncommon for fellow Tennesseans who were packing up and moving south and west to hang a sign on their cabins that read “GTT” – Gone to Texas.

Today obstetricians, surgeons and other doctors might consider reviving the practice. Over the past three years, some 7,000 M.D.s have flooded into Texas, many from Tennessee.
Why? Two words: Tort reform.
In 2003 and in 2005, Texas enacted a series of reforms to the state’s civil justice system. They are stunning in their success. Texas Medical Liability Trust, one of the largest malpractice insurance companies in the state, has slashed its premiums by 35%, saving doctors some $217 million over four years. There is also a competitive malpractice insurance industry in Texas, with over 30 companies competing for business. This is driving rates down.
The result is an influx of doctors so great that recently the State Board of Medical Examiners couldn’t process all the new medical-license applications quickly enough. The board faced a backlog of 3,000 applications. To handle the extra workload, the legislature rushed through an emergency appropriation last year.

For the full commentary, see:

JOSEPH NIXON. “CROSS COUNTRY; Why Doctors Are Heading for Texas.” The Wall Street Journal (Sat., May 17, 2008): A9.

“Creaky Regulations . . . Act as a Brake on Innovation”

“Paul Metzger, holding the Handler, an anti-microbial device that helps users avoid touching surfaces that might carry germs.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. C5) With so many people worried about getting sick — whether from the common cold and flu or exotic new strains of antibiotic-resistant bacteria — Paul and Jeffrey Metzger had every reason to hope that the germ-fighting key fob they invented would be a runaway hit.
Their device, known as the Handler, began selling last year online and in stores like Duane Reade pharmacies for about $11. It features a pop-out hook so germophobes can avoid touching A.T.M. keypads, door handles and other public surfaces where undesirable microbes may lurk. As added protection, the Handler’s rubber and plastic surfaces are impregnated with tiny particles of silver to kill germs that land on the device itself.
But those little silver particles have run Maker Enterprises, the Metzger brothers’ partnership in Los Angeles, into a big regulatory thicket. The Metzgers belatedly realized that the Environmental Protection Agency might decide that a 1947-era law that regulates pesticides would apply to antimicrobial products like theirs.
The agency ruled last fall that the law covered Samsung’s Silvercare washing machine. Samsung was told it would have to register the machine as a pesticide, a potentially costly and time-consuming process, because the company claims the silver ions generated by the washer kill bacteria in the laundry.
The Metzgers halted production of their key fob while they sought legal guidance on how to avoid a similar fate.
Their quandary highlights a challenge facing the growing number of entrepreneurs who have ventured into nanotechnology, a field that gets its name from its reliance on materials so small their dimensions are measured in nanometers, or billionths of a meter.
. . .
“They don’t really know how they want to register these particles,” said Tracy Heinzman, a lawyer in Washington who deals frequently with the E.P.A. “There’s no clear path forward.”
More broadly, the limbo into which the Handler has tumbled shows how the limited resources of agencies like the E.P.A. can combine with creaky regulations to act as a brake on innovation. “The marketplace is always ahead of the E.P.A.,” Ms. Heinzman said.

For the full story, see:
BARNABY J. FEDER. “Small Business; Fighting Germs and Regulators; Pesticide Rules May Apply to Tiny Particles That Kill Microbes.” The New York Times (Thurs., March 6, 2008): C5.
(Note: the title of the online version was “Small Business; New Device for Germophobes Runs Into Old Law.”)
(Note: ellipsis added.)