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Showing posts from February, 2010

reforming health care at the state level

This keeps coming back to me: federal level health care reform is stalled, related to massive dysfunction in the legislative branch of government in Washington D.C.  Add to that the fact that we have a huge and incredibly diverse country, and it is not too surprising that we haven’t come up with an acceptable health care reform bill.

But what about Massachusetts? They managed to pass health care reform, and though it is not perfect, it beats the heck out of what they have in Washington and Idaho, the states in which I practice medicine.
Just today I read an article in the New England Journal of Medicine about the way the medicaid system is administered in Oregon. They use cost effectiveness research to determine a basic health care package, and then budget to allow as many people as possible to be covered by the state Medicaid system.  This is the article: http://content.nejm.org/cgi/content/full/362/7/e18

I would very much like to see Idaho, where we spend 20% of our state budget on …

ideas for quality improvement that could be done at a community hospital

1. The return of the Morbidity and Mortality conference, but with a twist--When I was in medical school and residency, if any hospital admission went spectacularly wrong, we had an M and M conference.  The major players had to research the medical record, draw a timeline of what happened, and discuss their reasoning and actions with regard to the case.  Everyone came. It was like a gladiator show. There was blood. There were tears. And everybody at the conference thought about what they would have done differently to make the whole thing come out better.  There is nothing wrong with a traditional M and M conference, other than the fact that should there be a malpractice case it would potentially lead to embarrassment or successful prosecution. What I would propose would be C and Q conference which would explore the cost and quality of any spectacularly complex case. The bill would be projected on the wall, and the various actions would be evaluated and discussed in terms of their adhe…

tort reform--the key to unlocking health care reform gridlock?

Democrats and Republicans are talking about health care reform. This is good.  Tort reform absolutely needs to be a part of this discussion.

I watched a brief snippet of Bill Reilly interviewing John Stewart, and Reilly asked Stewart why, if Obama wanted to compromise with Republicans on health care reform, did he not agree to make tort reform part of the package. This is, I would surmise, a big issue for Republicans.

According to John Stewart and other Democrats, the primary reason for not including tort reform in the health care reform bill is that the CBO (Congressional Budget Office) has estimated that tort reform would only save 11 billion dollars in a year, a measly 0.5% of the overall health care budget.  This is based on an estimated small effect on utilization of health care resources and a significant effect on the cost of malpractice insurance, taking into account also the savings seen in states where tort reform has occurred.

This vast underestimate of cost savings is an i…

reading the Internal Medicine News

Once a month I get a large journal in the mail which I don’t pay for.  It is called the Internal Medicine News.  Authors write about reports from meetings or new ideas posed by scientists, but without the scientific rigor of a real journal article. It is possible to review all sorts of topics in a short amount of time, and some of the information is even true.

Diabetics don’t necessarily have an increased risk of heart attacks: researchers looked at the results of a Cat scan of the arteries around the heart of over 800 diabetics and found that 40% of them were absolutely fine. Cool. This is something I have found too. Some diabetics who I think should really have heart disease are absolutely fine, with no narrowing of the coronary arteries at all. But the authors add that maybe we should do this Cat scan on all diabetics to see who is who, even though studies of this test show that it is close to useless and we know it exposes people to radiation at a level that does cause cancer. The …

Documentation: another reason for radical tort reform

In medicine we always seem to use a word with many syllables where a couple of words that people can actually understand would do. Thus the word "documentation". In the practice of medicine, since I have been practicing it, we spend lots of time writing stuff down.  The amount of this writing or typing or dictating or computer point and clicking that we do has gradually increased, and is now eating up the time that we could use to do other important things, like take care of patients, for instance.

In my own practice I spend over half of my time creating some sort of record of what is going on with my patients' care.  Most of it is necessary, and if I were to reduce the time that I spent in documentation, it would be by streamlining the process, maybe by using a better computer system. Most of the words on paper or words on a screen are valid communication, though the detail in which I keep my records is primarily to satisfy insurance companies and the legal system shoul…