Are We Willing to Accept a Two-Tier Hospital System?

Yesterday, I wrote about the hospital-building boom and suggested that we may not need it—and more to the point, we may not be able to afford it.

In my description of how hospitals are adding costly amenities like waterfalls and all-private-rooms in order to woo well-heeled, well-insured patients, I suggested that the money might be better invested in computerized medical records or Level I trauma units. (In some parts of the country, trauma units are spaced so far apart that if you are in a car accident, there is a real danger that the unit will be too far away to be of any help.)

Barry Carol responded, agreeing that safety should come first, but also arguing that the private rooms help prevent infections. As for the waterfalls, he noted that “while they may make good journalistic copy as illustrative of frills,” given the high cost of hospital construction “they probably get lost in the rounding as a cost factor.” See his comment here.

Because Barry had raised a number of good points, and because the hospital boom is such a large and crucial subject, I decided to return to it today while responding to his comment.

Barry—

I’m afraid the waterfalls are more than good copy for journalists.. Similar amenities are being included in hospital construction across the country–and it adds up.

Continue reading

The Hospital Building Boom: Can We Afford the Waterfalls?

In Money-Driven Medicine: The Real Reason Health Care Costs So Much I talk about the nationwide hospital building boom—and ask two questions: Can we afford it? Do we need it?

In many regions, suburban hospitals have been reaching for big-city business. “What we have to do to maintain our position in the markets is to keep adding services,” explained Westchester Medical Center CEO Ed Stolzenberg. “That’s the whole reason we went into liver transplants.”

Did the resident of Westchester Country (just outside of New York City) need a local hospital doing liver transplants? Just how many transplants would a Westchester hospital do? Would such patients be better off at a high-volume medical center in Manhattan where “practice makes perfect”?

Those questions didn’t seem to come up.  The CEO knew that transplants would raise the hospital’s image.

Across the nation, as not-for-profit hospitals set out to invest in new construction and equipment, decisions seemed to be market-driven—but  not necessarily driven by the local population’s medical needs.  Instead, they were powered by the hospital’s need for market-share.

Continue reading

Employers and Healthcare: “Which Frogs A-Leaping?”

At “Healthcare Renewal” (hcrenewal.blogspot.com) Brown University’s Dr. Roy Poses recently posted a thought-provoking piece about the Leapfrog Group, an employer group that has made its reputation pushing for higher quality care.  Poses points out that nearly 30% of the members of Leapfrog are healthcare corporations, and notes that this might skew their view of healthcare’s goals:
 

“One would expect that companies who make money by providing health care goods and services may have different ideas about health care costs and quality than companies who do not do any health care related business” said Poses in his post.

IF YOU’D LIKE TO COMMENT ON
THIS POST, PLEASE
CLICK HERE
TO E-MAIL MAGGIE WITH YOUR THOUGHTS.

Continue reading

Inside the FDA

I was speaking to a source inside the FDA recently and he explained that since the FDA has committed to reviewing applications for approval of a new drug within 10 months, drug-makers have been submitting “shabbier” applications that contain less evidence about risks and benefits.

“For the drug-maker it’s a gamble. The company is betting that, because we want to make the 10-month deadline, we won’t send the application back,” said the source. And often, he acknowledged, the drug-maker is right. “If you find a problem or there is something missing and it doesn’t seem terribly material, there is a tendency to overlook it. Because if you don’t it will just delay the whole process.”

In the past, he adds, a company submitting an application knew that if the application wasn’t up to snuff, the FDA would send it back. But those standards have fallen: “Now we send it back [only] if it’s really crappy.”

We also talked about direct-to-consumer advertising and why many in the pharmaceutical industry resisted the suggestion that they wait two years before trying to sell a new drug directly to the public. “There is a saying in the industry,” he confided, “[that] you want to get doctors accustomed to using a new drug while it still ‘works’—while it’s still the latest and the greatest.”

In other words, drug-makers want doctors to begin using the drug before everyone discovers that it is not quite the miracle cure that some hoped it would be. Knowing that it takes time to discover the risks of a drug, doctors might not be so quick to take up the absolute newest thing on their own. That’s why companies like to go to consumers who they hope will push their doctors into trying the new products before all the risks are known.

IF YOU’D LIKE TO COMMENT ON
THIS POST, PLEASE
CLICK HERE
TO E-MAIL MAGGIE WITH YOUR THOUGHTS.

Preventing Hospital Errors by Howard C. Berkowitz

I have asked Howard Berkowitz to guest-blog on hospital errors.

Howard is in an unique position to write on this topic because he consults on
medical information systems for hospitals and also has been a long-time
patient. Over the years, he has taken an unusually detailed decision-making role
in his own care for heart diseases and diabetes which, he says, “has kept me
going, with bad heart genetics, at least 17 years more than my father.”

Howard also reports that “when no one else would coordinate my mother’s complex
cancer care, I did so…and I know what it is to preserve the semblance of
life, when only pain remains. Complex pain management is also one of my
interests; too few doctors know that pain should always be controllable.”

As a result of his own health problems and his parents’ illnesses, he has spent
more time in hospitals than anyone would ever want to endure. But unlike
most of us, he understood what was going on. Originally trained in microbiology
and biochemistry, Howard was doing independent research in antibiotic
resistance and working in a clinical laboratory while in high school. He
confesses that, for his 10th birthday, he asked his mother for a copy of the
Merck Index of Chemicals and Drugs. Subsequently, he built the first clinical
computer system for
Georgetown University Hospital,
developed virological systems for Electronucleonics’ “hot lab” and developed
cardiac care simulators and for the
George Washington University School of Medicine,
Office of Computer-Assisted Instruction. He also developed the first automated blood
bank laboratory tools for the Red Cross.


Full disclosure—he has two patents in process for hospital communications and staff management dedicated to keeping them informed, in real time, of patient needs.
His post follows below.

IF YOU’D LIKE TO COMMENT ON
THIS POST, PLEASE
CLICK HERE
TO E-MAIL MAGGIE WITH YOUR THOUGHTS.

Continue reading

Preventing Hospital Errors Part II by Howard C. Berkowitz

Given the medical community’s reluctance to step up and admit to mistakes, Medicare has decided to get tough, saying that it will stop reimbursing  hospitals for the thirteen adverse advents listed below. Before discussing the list, let me suggest that not all of these events are within a hospital’s control. I’ve rated the mishaps on the list from 1 to 4, with “1” indicating something that, I agree, should never happen, and “4” referring to something that, in my experience, a hospital may not be able to prevent.

    The 13 Things That Should Never Happen in a Hospital
   1. Catheter-associated urinary tract infection [2]
   2. Bed sores [1]
   3. Objects left in [THE PATIENT”S BODY] after surgery [1]
   4. Air embolism, or bubbles, in bloodstream from injection [1]
   5. Patients given incompatible blood type [1]
   6. Bloodstream Staphylococcus (staph) infection [2]
   7. Ventilator-associated pneumonia [2]
   8. Vascular-catheter-associated infection [2]
   9. Clostridium difficile-associated disease (gastrointestinal infections) [3]
  10. Drug-resistant staph infection [3]
  11. Surgical site infections [3]
  12. Wrong surgery [1]
  13. Falls [4]

IF YOU’D LIKE TO COMMENT ON
THIS POST, PLEASE
CLICK HERE
TO E-MAIL MAGGIE WITH YOUR THOUGHTS.

Continue reading