Preventive Healthcare

[Neser Boha]

Bear in mind, folks, that iatrogenesis is the 4th most prolific killer in the USA.

We know that it pays to get checkups for certain things at certain ages, and certainly if you're prone (genetically) to some diseases it probably pays to get checked out per medical advise.

But I do think that some Americans are hypocondriacal, and medical care isn't without risk.

If you're not sick, don't got to the doctor is my advise.

That is a pretty bad advice. Everyone should have at least annual check-ups. What can go wrong during a routine medical check-up?

 

[xotoxi]

3. Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes!

I don't believe this AT ALL.

17% is far too high. There is not a 17% complication rate for any surgery.

Plus, the 30 day readmission is far less likely to be a "hospital mistake" then it is to be an "expected complication".

That data was from "A Prescription for American Health Care"
John C. Goodman, President Center for Policy Analysis
Ph.D, Columbia University, from a speech given at Hillsdale College, February 18, 2009

But if that is not satisfactory,


"The Clinic readmitted 23.6 percent of its heart attack patients, compared with a national rate of 19.9 percent. For heart failure, the Clinic's readmission rate was 29.1 percent, compared with 24.5 percent nationally. For pneumonia, the Clinic was at 23.2 percent, compared with a national rate of 18.2.

Other area hospitals did not fare as poorly in the three areas of readmissions. Most were within the national norm in most categories. University Hospitals Case Medical Center scored worse than average in heart failure readmissions (27 percent), and was within the norm in the other areas. UH's Bedford Medical Center had worse rates of readmissions for heart failure and pneumonia."
High percentage of hospital patients readmitted, report says; Clinic rates worse than average - cleveland.com

And are you claiming that those readmissions were "hospital mistake"?

CONCLUSION: 44% of patients were readmitted to hospital two years after CABG. The most common reasons for readmission were angina pectoris and congestive heart failure. Four clinical markers predicted readmission: clinical history; acute operation status; postoperative complications; and clinical findings and medication four to seven days after operation.
Predictors of hospital readmission two years after coronary artery bypass grafting.

Again...readmission two years after cardiac bypass surgery is "hospital mistake"? I guess the "mistake" was that they were successful in keeping the patient alive, thus opening themselves up to a readdmission.

Twenty-six (14.4%) patients were readmitted within 30 days of hospital discharge. Readmitted patients were older (t=2.12, df=179, P=0.035), and more likely to be unmarried (χ2=5.80, df=1, P=0.016), live alone (χ2=8.33, df=1, P=0.004), have a history of hypertension (χ2=2.731, df=1, P=0.098) and have higher anxiety before surgery (t=1.67, df=175, P=0.097).
Elsevier

Thanks for proving that readmission was not due to "hospital mistake" but that those who were readmitted were sicker, older, and had fewer resources and assistance to remain healthy after their discharge.

Seems like some people feel that maintaining an individual's health is not the individual's responsibility, but rather the responsibility of the medical community.

 

[editec]

Bear in mind, folks, that iatrogenesis is the 4th most prolific killer in the USA.

We know that it pays to get checkups for certain things at certain ages, and certainly if you're prone (genetically) to some diseases it probably pays to get checked out per medical advise.

But I do think that some Americans are hypocondriacal, and medical care isn't without risk.

If you're not sick, don't got to the doctor is my advise.

That is a pretty bad advice. Everyone should have at least annual check-ups.

Really?

You think my 19 year old son needs an annual checkup? Why?

What can go wrong during a routine medical check-up?

Misdiagnosis. Infection from bad medical procedure.

Basically what I'm saying is until you reach a certain age, unless you're feeling unwell, going to the doctor is a waste of your time and HC dollars.

 

[Neser Boha]

Really?

You think my 19 year old son needs an annual checkup? Why?

Viz. what Auditor007 wrote... he might have a developing degenerative disease that will turn for the worse later in his life. He might have cancer, he might have... I don't know. I actually feel uncomfortable naming diseases he might have and if he gets treated for them early on might actually save his life/health.

I'm sorry, there is just no argument against preventive healthcare.

Misdiagnosis. Infection from bad medical procedure.

Basically what I'm saying is until you reach a certain age, unless you're feeling unwell, going to the doctor is a waste of your time and HC dollars.

All that can happen. Also, you can get hit by a car when you're crossing a road.

Of course, if you want to save money 'right now', don't have your son annually checked. If you want to make sure that in the future you don't have even higher bills (or he doesn't), encourage him to do so.

 

[PoliticalChic]

I don't believe this AT ALL.

17% is far too high. There is not a 17% complication rate for any surgery.

Plus, the 30 day readmission is far less likely to be a "hospital mistake" then it is to be an "expected complication".

That data was from "A Prescription for American Health Care"
John C. Goodman, President Center for Policy Analysis
Ph.D, Columbia University, from a speech given at Hillsdale College, February 18, 2009

But if that is not satisfactory,


"The Clinic readmitted 23.6 percent of its heart attack patients, compared with a national rate of 19.9 percent. For heart failure, the Clinic's readmission rate was 29.1 percent, compared with 24.5 percent nationally. For pneumonia, the Clinic was at 23.2 percent, compared with a national rate of 18.2.

Other area hospitals did not fare as poorly in the three areas of readmissions. Most were within the national norm in most categories. University Hospitals Case Medical Center scored worse than average in heart failure readmissions (27 percent), and was within the norm in the other areas. UH's Bedford Medical Center had worse rates of readmissions for heart failure and pneumonia."
High percentage of hospital patients readmitted, report says; Clinic rates worse than average - cleveland.com

And are you claiming that those readmissions were "hospital mistake"?

CONCLUSION: 44% of patients were readmitted to hospital two years after CABG. The most common reasons for readmission were angina pectoris and congestive heart failure. Four clinical markers predicted readmission: clinical history; acute operation status; postoperative complications; and clinical findings and medication four to seven days after operation.
Predictors of hospital readmission two years after coronary artery bypass grafting.

Again...readmission two years after cardiac bypass surgery is "hospital mistake"? I guess the "mistake" was that they were successful in keeping the patient alive, thus opening themselves up to a readdmission.

Twenty-six (14.4%) patients were readmitted within 30 days of hospital discharge. Readmitted patients were older (t=2.12, df=179, P=0.035), and more likely to be unmarried (χ2=5.80, df=1, P=0.016), live alone (χ2=8.33, df=1, P=0.004), have a history of hypertension (χ2=2.731, df=1, P=0.098) and have higher anxiety before surgery (t=1.67, df=175, P=0.097).
Elsevier

Thanks for proving that readmission was not due to "hospital mistake" but that those who were readmitted were sicker, older, and had fewer resources and assistance to remain healthy after their discharge.

Seems like some people feel that maintaining an individual's health is not the individual's responsibility, but rather the responsibility of the medical community.

I believe the original statement was "because of a problem connected to the original surgery."

Thanks for admitting that the statement is correct unless you try to alter it.

 

[xotoxi]

Misdiagnosis. Infection from bad medical procedure.

Basically what I'm saying is until you reach a certain age, unless you're feeling unwell, going to the doctor is a waste of your time and HC dollars.

I assume that you must drive your car without changing the oil until the engine seizes up and you need it replaced.

It saves money on oil changes.

 

[KittenKoder]

3. Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes!

I don't believe this AT ALL.

17% is far too high. There is not a 17% complication rate for any surgery.

Plus, the 30 day readmission is far less likely to be a "hospital mistake" then it is to be an "expected complication".

Actually, 17% is a conservative figure, of those I know (real life and all) more than 50% of those are re-admitted for complications (not counting those who did not need surgery). Medicare is a good example of what happens with government run health care. I am one of those examples.

 

[Emma]

I believe the original statement was "because of a problem connected to the original surgery."

Thanks for admitting that the statement is correct unless you try to alter it.

I believe the original statement was " Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes! "

 

[xotoxi]

I believe the original statement was "because of a problem connected to the original surgery."

Thanks for admitting that the statement is correct unless you try to alter it.

You believe correctly...but incompletely.

Let me remind you:

3. Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes!

You are blaming the surgical complication is a "hospital mistake".

Or did I somehow misinterpret your sentence "The result is that a hospital makes money on its mistakes!"


I don't fault you for your error. You're human, and human's make mistakes.

 

[KittenKoder]

I believe the original statement was "because of a problem connected to the original surgery."

Thanks for admitting that the statement is correct unless you try to alter it.

You believe correctly...but incompletely.

Let me remind you:

3. Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes!

You are blaming the surgical complication is a "hospital mistake".

Or did I somehow misinterpret your sentence "The result is that a hospital makes money on its mistakes!"


I don't fault you for your error. You're human, and human's make mistakes.

Actually, what PC said was quite well worded, she did not imply they did it on purpose, it was a "mistake". They are paid for their mistakes by Medicare, it does not make them want to make mistakes, it makes them care less about their mistakes.

 

[Emma]

Actually, what PC said was quite well worded, she did not imply they did it on purpose, it was a "mistake". They are paid for their mistakes by Medicare, it does not make them want to make mistakes, it makes them care less about their mistakes.

Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.

On July 31, 2008, in the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision. The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.

The 10 categories of HACs include:

1. Foreign Object Retained After Surgery

2. Air Embolism

3. Blood Incompatibility

4. Stage III and IV Pressure Ulcers

5. Falls and Trauma

• Fractures
  
• Dislocations
  
• Intracranial Injuries
  
• Crushing Injuries
  
• Burns
  
• Electric Shock

6. Manifestations of Poor Glycemic Control

• Diabetic Ketoacidosis
  
• Nonketotic Hyperosmolar Coma
  
• Hypoglycemic Coma
  
• Secondary Diabetes with Ketoacidosis
  
• Secondary Diabetes with Hyperosmolarity

7. Catheter-Associated Urinary Tract Infection (UTI)

8. Vascular Catheter-Associated Infection

9. Surgical Site Infection Following:


Coronary Artery Bypass Graft (CABG) - Mediastinitis

Bariatric Surgery:

• Laparoscopic Gastric Bypass
  
• Gastroenterostomy
  
• Laparoscopic Gastric Restrictive Surgery
  
  Orthopedic Procedures
  
  
• Spine
  
• Neck
  
• Shoulder
  
• Elbow

10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

• Total Knee Replacement
  
• Hip Replacement

Payment implications will begin October 1, 2008, for these 10 categories of HACs.

Hospital-Acquired Conditions Hospital-Acquired Conditions (Present on Admission Indicator)

The IPPS rule adds conditions, including one NQF never event, to the list of conditions that have been determined to be reasonably preventable through proper care. Beginning last year, as required by the Deficit Reduction Act of 2005 (DRA), CMS began selecting hospital-acquired conditions (HACs) that were determined to be reasonably preventable. If a condition is not present upon admission, but is subsequently acquired during the hospital stay, Medicare will no longer pay the additional cost of the hospitalization. The patient is not responsible for the additional cost. Rather, the hospital is being encouraged to prevent an adverse event and improve the reliability of care it is giving to Medicare patients.



In last year’s final rule, CMS listed eight preventable conditions for which it would not make additional payments. In this year’s proposed rule, CMS identified nine potential categories of conditions, but based on public comments, is finalizing three of these. The new additional conditions in this year’s final rule include:



· Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity

· Certain manifestations of poor control of blood sugar levels

· Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

 

[PoliticalChic]

I believe the original statement was "because of a problem connected to the original surgery."

Thanks for admitting that the statement is correct unless you try to alter it.

You believe correctly...but incompletely.

Let me remind you:

3. Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes!

You are blaming the surgical complication is a "hospital mistake".

Or did I somehow misinterpret your sentence "The result is that a hospital makes money on its mistakes!"


I don't fault you for your error. You're human, and human's make mistakes.

Ah, my humorous friend!

Embarrass you though it may, I must raise the curtain on a logical failure of your argument.

You seem incensed that hospitals are blamed for the fact that many must be readmitted after various surgeries.

The rage seems well out of proportion to the subject at hand, unless your family fortune is based on ownership of a number of hospitals. Is it?

If not, and, hypothetically you were correct, and there are very few readmissions after surgery, why would you be opposed to the "warranties for surgery" idea?

So let's see. You are opposed to 'warranties for surgery,' but claim that warranties are unnecessary because there are very few readmissions that would fall under the warranty? Is that your position?

 

[xotoxi]

I believe the original statement was "because of a problem connected to the original surgery."

Thanks for admitting that the statement is correct unless you try to alter it.

You believe correctly...but incompletely.

Let me remind you:

3. Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes!

You are blaming the surgical complication is a "hospital mistake".

Or did I somehow misinterpret your sentence "The result is that a hospital makes money on its mistakes!"


I don't fault you for your error. You're human, and human's make mistakes.

Actually, what PC said was quite well worded, she did not imply they did it on purpose, it was a "mistake". They are paid for their mistakes by Medicare, it does not make them want to make mistakes, it makes them care less about their mistakes.

Why do you consider a complication to be a "mistake"?

I'm allergic to aspirin - I blow up like a balloon.

The first time that aspirin was prescribed to me...was that a mistake?

If you define a complication as a mistake, then we are just dealing with semantics.

 

[xotoxi]

I believe the original statement was "because of a problem connected to the original surgery."

Thanks for admitting that the statement is correct unless you try to alter it.

You believe correctly...but incompletely.

Let me remind you:

3. Another free market idea aimed at better quality is have warranties for surgery as we do for cars. 17% of Medicare patients who enter a hospital re-enter within 30 days because of a problem connected to the original surgery. The result is that a hospital makes money on its mistakes!

You are blaming the surgical complication is a "hospital mistake".

Or did I somehow misinterpret your sentence "The result is that a hospital makes money on its mistakes!"


I don't fault you for your error. You're human, and human's make mistakes.

Ah, my humorous friend!

Embarrass you though it may, I must raise the curtain on a logical failure of your argument.

You seem incensed that hospitals are blamed for the fact that many must be readmitted after various surgeries.

The rage seems well out of proportion to the subject at hand, unless your family fortune is based on ownership of a number of hospitals. Is it?

If not, and, hypothetically you were correct, and there are very few readmissions after surgery, why would you be opposed to the "warranties for surgery" idea?

So let's see. You are opposed to 'warranties for surgery,' but claim that warranties are unnecessary because there are very few readmissions that would fall under the warranty? Is that your position?

Warranties for surgery? When were we ever talking about that?

 

[PoliticalChic]

Actually, what PC said was quite well worded, she did not imply they did it on purpose, it was a "mistake". They are paid for their mistakes by Medicare, it does not make them want to make mistakes, it makes them care less about their mistakes.

Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.

On July 31, 2008, in the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision. The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.

The 10 categories of HACs include:

1. Foreign Object Retained After Surgery

2. Air Embolism

3. Blood Incompatibility

4. Stage III and IV Pressure Ulcers

5. Falls and Trauma

• Fractures
  
• Dislocations
  
• Intracranial Injuries
  
• Crushing Injuries
  
• Burns
  
• Electric Shock

6. Manifestations of Poor Glycemic Control

• Diabetic Ketoacidosis
  
• Nonketotic Hyperosmolar Coma
  
• Hypoglycemic Coma
  
• Secondary Diabetes with Ketoacidosis
  
• Secondary Diabetes with Hyperosmolarity

7. Catheter-Associated Urinary Tract Infection (UTI)

8. Vascular Catheter-Associated Infection

9. Surgical Site Infection Following:


Coronary Artery Bypass Graft (CABG) - Mediastinitis

Bariatric Surgery:

• Laparoscopic Gastric Bypass
  
• Gastroenterostomy
  
• Laparoscopic Gastric Restrictive Surgery
  
  Orthopedic Procedures
  
  
• Spine
  
• Neck
  
• Shoulder
  
• Elbow

10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

• Total Knee Replacement
  
• Hip Replacement

Payment implications will begin October 1, 2008, for these 10 categories of HACs.

Hospital-Acquired Conditions Hospital-Acquired Conditions (Present on Admission Indicator)

The IPPS rule adds conditions, including one NQF never event, to the list of conditions that have been determined to be reasonably preventable through proper care. Beginning last year, as required by the Deficit Reduction Act of 2005 (DRA), CMS began selecting hospital-acquired conditions (HACs) that were determined to be reasonably preventable. If a condition is not present upon admission, but is subsequently acquired during the hospital stay, Medicare will no longer pay the additional cost of the hospitalization. The patient is not responsible for the additional cost. Rather, the hospital is being encouraged to prevent an adverse event and improve the reliability of care it is giving to Medicare patients.



In last year’s final rule, CMS listed eight preventable conditions for which it would not make additional payments. In this year’s proposed rule, CMS identified nine potential categories of conditions, but based on public comments, is finalizing three of these. The new additional conditions in this year’s final rule include:



· Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity

· Certain manifestations of poor control of blood sugar levels

· Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

Nice post. Very thorough.

Is the premise that the Bush Administration instituted these cost-cutting measures?

And are they currently in effect, meaning are hospital requests for payment being declined?

And how is it being determined that the various problems are hospital-caused, meaning are the hospitals responsible for notifying the agency?

And would this be somewhat of a companion piece with this part of the Stimulus Bill:
"WASHINGTON – The Federal Coordinating Council for Comparative Effectiveness Research recommended that the Department of Health and Human Services prioritize certain types of interventions and populations when allocating $400 million in funding for comparative effectiveness research.

The council recommended that HHS target funding on areas such as medical and assistive devices, procedures and surgery, behavioral change, prevention and delivery systems.

The panel identified "priority populations" to target with CER, including racial and ethnic minorities, persons with disabilities or multiple chronic conditions, the elderly and children.

The council also said HHS should invest in data infrastructure and improve ways to disseminate research findings.

HHS Secretary Kathleen Sebelius will use these recommendations – along with additional ones to be issued by the Institute of Medicine – to develop a specific plan for $1.1 billion in CER funding provided by the American Recovery and Reinvestment Act. The research plan must be complete by July 30, 2009."
Federal council recommends comparative effectiveness research priorities | Healthcare Finance News

And, finally, is the point of your post that Dr. Goodman's suggestion for free market recommendations is already in effect?
And you find it efficacious?

 

[PoliticalChic]

You believe correctly...but incompletely.

Let me remind you:



You are blaming the surgical complication is a "hospital mistake".

Or did I somehow misinterpret your sentence "The result is that a hospital makes money on its mistakes!"


I don't fault you for your error. You're human, and human's make mistakes.

Ah, my humorous friend!

Embarrass you though it may, I must raise the curtain on a logical failure of your argument.

You seem incensed that hospitals are blamed for the fact that many must be readmitted after various surgeries.

The rage seems well out of proportion to the subject at hand, unless your family fortune is based on ownership of a number of hospitals. Is it?

If not, and, hypothetically you were correct, and there are very few readmissions after surgery, why would you be opposed to the "warranties for surgery" idea?

So let's see. You are opposed to 'warranties for surgery,' but claim that warranties are unnecessary because there are very few readmissions that would fall under the warranty? Is that your position?

Warranties for surgery? When were we ever talking about that?

Post #15, in which you said:
"I don't believe this AT ALL.

17% is far too high. There is not a 17% complication rate for any surgery.

Plus, the 30 day readmission is far less likely to be a "hospital mistake" then it is to be an "expected complication".

You were commenting on the warranty suggestion by Dr. Goodman.

 

[xotoxi]

And are they currently in effect, meaning are hospital requests for payment being declined?

Yes.

And how is it being determined that the various problems are hospital-caused, meaning are the hospitals responsible for notifying the agency?

Self-reporting, claims, and proper documentation.

If the problems are not documented on admission, and they are present at discharge, the hospital is not paid.

 

[xotoxi]

Ah, my humorous friend!

Embarrass you though it may, I must raise the curtain on a logical failure of your argument.

You seem incensed that hospitals are blamed for the fact that many must be readmitted after various surgeries.

The rage seems well out of proportion to the subject at hand, unless your family fortune is based on ownership of a number of hospitals. Is it?

If not, and, hypothetically you were correct, and there are very few readmissions after surgery, why would you be opposed to the "warranties for surgery" idea?

So let's see. You are opposed to 'warranties for surgery,' but claim that warranties are unnecessary because there are very few readmissions that would fall under the warranty? Is that your position?

Warranties for surgery? When were we ever talking about that?

Post #15, in which you said:
"I don't believe this AT ALL.

17% is far too high. There is not a 17% complication rate for any surgery.

Plus, the 30 day readmission is far less likely to be a "hospital mistake" then it is to be an "expected complication".

You were commenting on the warranty suggestion by Dr. Goodman.

Actually, I didn't even read the first sentence. I just started reading at "17%..." and commented on that.

As for warrantees for surgery, I have never heard of this and don't know any of the proposed specifics, so I can't comment on it one way or another.

 

[editec]

Misdiagnosis. Infection from bad medical procedure.

Basically what I'm saying is until you reach a certain age, unless you're feeling unwell, going to the doctor is a waste of your time and HC dollars.

I assume that you must drive your car without changing the oil until the engine seizes up and you need it replaced.

It saves money on oil changes.

My goodness,I cannot believe how MD dependent some of you folks are.

The human body is nothing like your car, folks.

We know that if you don't change your oil you car is going to sieze up.

Are you trying to tell us that if a healthy person never goes to the MD he'll die?

 

[PoliticalChic]

Warranties for surgery? When were we ever talking about that?

Post #15, in which you said:
"I don't believe this AT ALL.

17% is far too high. There is not a 17% complication rate for any surgery.

Plus, the 30 day readmission is far less likely to be a "hospital mistake" then it is to be an "expected complication".

You were commenting on the warranty suggestion by Dr. Goodman.

Actually, I didn't even read the first sentence. I just started reading at "17%..." and commented on that.

As for warrantees for surgery, I have never heard of this and don't know any of the proposed specifics, so I can't comment on it one way or another.

Have a good day.