Acronym Tag

Very nice tag, hat tip GruntDoc

• SOB
• WAD
• DFO

Mandated Charity

Model in Utah May Be Future for Medicaid | NYT | 2.24.05

SALT LAKE CITY - Anyone looking for clues as to how the Bush administration might overhaul the Medicaid system should come to Utah and read the fine print of Tony Martinez’s health insurance plan.

Mr. Martinez, 56, was homeless and without any health coverage a year ago. Now, under an experimental plan of partial insurance devised under Michael O. Leavitt when he was governor of Utah, Mr. Martinez can see a doctor or go to the emergency room for only a small fee.

But he and his wife, Lisa, are not covered at all for the potentially catastrophic costs of extended hospitalization or specialty medical treatment, from dermatology to oncology. For those services, they must rely, as they did when they were homeless, on charity. …

In Utah, Mr. Leavitt’s plan departs from the traditional Medicaid program on two main fronts. First, it spreads out a lower, more basic level of care to more people, and reduces coverage for some traditional beneficiaries by imposing co-payments for services. And second, it relies on the generosity of doctors and hospitals to provide specialty services free of charge. …

Incredible! Will take a rather homogenous state like Utah, one-third the population of Los Angeles county, and use that as the “test bed” and role model for Medicaid reform. The problem with this scenario is they didn’t bother to put the canary in the mine to see it would survive. What will this do?

Lets see:

• More will be covered with basic services (for less, remember Medicaid reform is all about decelerating the cost over time)
• Specialty care and catastrophic/extended care will be shifted to the private sector
• EMTALA will serve as an ever greater stick for governmental unfunded mandates
• What Medicaid dollars went to specialty care and catastrophic/extended care will directly affect those providers of services—driving up the demand for those left on the field and able to play
• There is a host of unintended consequences just waiting to pop up

Ripe for the Picking

A New Medical Worry: Identity Thieves Find Ways To Target Hospital Patients | WSJ | 2.22.05

A sudden tear in his aorta required Robert Parker to undergo emergency open-chest surgery. As he recovered in the intensive-care unit of a California hospital, a Nevada criminal began seeking credit using Mr. Parker’s name and Social Security number. That information was at the front of his medical file, which was visible to hospital personnel. …

Just this weekend, the University of Chicago Hospitals reported that a former employee had stolen identity information from as many as 85 patients. In recent years, rings of thieves stole the identities of more than 15 such patients in Iowa, 30 in Minnesota and nearly 50 in Indiana. During the past two years, the state of Michigan has prosecuted more than 20 cases involving medical-patient identity theft, many involving multiple victims, Michigan Attorney General Mike Cox says. …

Hospital patients are vulnerable in part because they are unlikely to detect anything amiss. Some may never leave the hospital. A team of alleged identity thieves arrested in 2003 in New Jersey were targeting the terminally ill, according to police.

The biggest vulnerability of hospital patients is that their Social Security numbers often double as a medical identifier. For identity thieves, “Social Security numbers are the key to the golden kingdom,” says Mari Frank, a California attorney specializing in identity theft. …

I had the very same thing happen (as a patient) three years ago—had my social security number (SSN) listed in two places on the demographic record (one as a thinly disguised insurance policy number). Within months several credit applications made, one large purchase, and several attempts occurred. The hospital could not be convinced they were the source until their employee was arrested with the very demographic record I knew was the source. Now one of my sons was in the same hospital last week (never having been a patient there before; therefore, a completely new record had to be created)—there again my SSN appeared on the very same demographic record with a new insurance policy and no attempt to disguise the SSN as the policy number. Fortunately, he didn’t know his SSN.

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Civil Code Sections 1798.85-1798.86 and 1786.60

The law, which took effect beginning July 1, 2002, and must be fully effective no later than July 1, 2005, applies to individuals and non-governmental entities. Under the law’s provisions, companies may not do any of the following:

• Post or publicly display SSNs,
• Print SSNs on identification cards or badges,
• Require people to transmit an SSN over the Internet unless the connection is secure or the number is encrypted,
• Require people to log onto a web site using an SSN without a password, or
• Print SSNs on anything mailed to a customer unless required by law or the document is a form or application.

The law has a phased-in compliance schedule:

• All subject entities except financial institutions and those involved in providing or administering health care or insurance:
  • 7/1/02: must comply with all requirements for new accounts. May continue former practices on existing accounts, but must comply with requirements within 30 days upon written request from customer.
• Financial institutions:
  • 9/28/02: must comply with all requirements for new accounts, except ban on mailing certain documents with SSNs. May continue former practices on existing accounts, but must comply with requirements within 30 days upon written request from customer.
  • 7/1/03: must comply with all requirements for new accounts.
• Entities providing or administering health care or insurance:
  • 1/1/03: must comply with all requirements except ban on putting SSNs on identification cards, for individual policyholders.
  • 1/1/04: must comply with all requirements, including identification card requirement, for new individual and group policyholders.
  • 7/1/05: must comply with all requirements for all individual and group policyholders in existence prior to 1/1/04.

Also see here.

Content Wars

High-Tech Tension Over Illegal Uses | WP | 2.21.05

In 2002, a young software programmer in Seattle named Bram Cohen solved a vexing Internet problem: how to get large computer files such as home movies or audio recordings of music concerts to travel rapidly across cyberspace.

Among the benefits of the invention, called BitTorrent, was that millions of users could quickly see lengthy amateur videos documenting the devastation of the December tsunami in the Indian Ocean, helping to spur an outpouring of charitable aid.

But BitTorrent also is wildly popular because the technology makes it easier to freely trade Hollywood movies and television shows, putting it in the cross hairs of the entertainment industry.

Increasingly, that same tension surrounds a dazzling new generation of high-tech products and services…

The future I see. Also here.

Class Action Fairness Act of 2005

Congress Changes Class Action Rules | WP | 2.17.05

Congress today handed President Bush a major second-term victory, passing legislation he had advocated during his reelection campaign to restrict class-action lawsuits.

The bill, the Class Action Fairness Act of 2005, passed the House today by a vote of 279-149, after having sailed through the Senate last week in a 72-26 vote. Bush is expected to sign it into law Friday.

The measure would shift most large class-action lawsuits involving parties from different states to federal courts, removing them from the jurisdiction of state courts that historically have been more receptive to such suits. The legislation had been strongly pushed by business groups, which argued that class-action lawsuits were enriching trial lawyers, who often filed them in certain jurisdictions known for sympathetic judges and juries. …

Under the new law, class-action suits seeking more than $5 million would move to federal court if fewer than a third of the plaintiffs were from the same state as the primary defendant. If the primary defendant and more than a third of the plaintiffs were from the same state, the case could still be heard in state court. …

S.5 | 2.11.05

A bill to amend the procedures that apply to consideration of interstate class actions to assure fairer outcomes for class members and defendants, and for other purposes.

H.R.516 | 2.17.05

To amend the procedures that apply to consideration of interstate class actions to assure fairer outcomes for class members and defendants, to outlaw certain practices that provide inadequate settlements for class members, to assure that attorneys do not receive a disproportionate amount of settlements at the expense of class members, to assure prompt consideration of interstate class actions, to amend title 28, United States Code, to allow the application of the principles of Federal diversity jurisdiction to interstate class actions, and for other purposes.

Pass & Save

King/Drew Passes Key Inspection | LAT | 2.16.05

Three days before a deadline to cut off federal funds, the troubled L.A. County hospital avoids the loss of $200 million.

More coverage here.

Where there’s a will, there’s an enema…

Woman Denies Sherry Enema Charge | Reuters | 2.10.05

HOUSTON (Reuters) - A Texas woman indicted last month for allegedly giving her husband a lethal sherry enema said he was an enema addict who did it to himself, a newspaper reported Thursday.

Tammy Jean Warner said late husband Michael Warner had an alcohol problem and enjoyed giving himself wine or sherry enemas because his body would absorb the spirits more quickly that way.

“That’s the way he went out and I’m sure that’s the way he wanted to go out because he loved his enemas,” she told the Houston Chronicle.

Michael Warner, 58, died on May 21 and was found to have a blood alcohol level of 0.47 percent, or nearly six times the level considered too drunk to drive in Texas. …

“It all started back when he was a child,” Mrs. Warner explained. “His mother used to give him enemas all the time, and he started to depend on them.”

“He did coffee enemas, he did Castile soap, Ivory soap,” she said. “He had enema recipes.”

Mrs. Warner, a former bartender who got married to Warner in October 2002, is also charged with destroying his will, but she denied the charge, the Chronicle said. …

Wits’ End

Workplace violence: A survey of emergency physicians in the State of Michigan | Annals of Emergency Medicine | 2.15.05

Results …Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%).

Conclusion Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.

Mordan Claude | Beyond This Horizon | 1942

Well, in the first place an armed society is a polite society. Manners are good when one may have to back up his acts with his life. For me, politeness is a sine qua non of civilization. That’s a personal evaluation only. But gunfighting has a strong biological use. We do not have enough things that kill off the weak and the stupid these days. But to stay alive as an armed citizen, a man, has to be either quick with his wits or with his hands, preferably both. It’s a good thing.

Robert A. Heinlein (1907-1988)

A study about wits’ end?

Another Front

Bill would limit nurses’ hours | Boston Globe | 2.15.05

Senator Edward M. Kennedy proposed legislation last week that calls for up to $10,000 in civil penalties against hospitals that force nurses to work extra hours after completing a shift.

Under the bill, nurses would be allowed to work overtime voluntarily, but their employers could not require that they work extra hours after a shift unless an official state of emergency is declared by the federal, state, or local government. …

The bill also would give the US Department of Health and Human Services authority to investigate nurses’ overtime complaints and to fine violators. The department could also increase fines against repeat violators. …

Kennedy’s bill was filed about seven months after a 2004 study by the University of Pennsylvania School of Nursing revealed that nurses who worked 12.5 hours or longer were three times more likely to make errors than nurses who worked a regular shift of about 8½ hours. …

Two fronts in the nurse staffing war:

• Mandatory Ratios
• Non-Mandatory Overtime

Times Changin’

Greater risk seen with older doctors | Boston Globe | 2.15.05

A provocative study from Harvard Medical School suggests that, as a group, older doctors know less, provide lower-quality care, and may expose patients to greater risks than physicians recently out of medical school, a conclusion that an accompanying editorial declares should be ”a wake-up call to the medical profession.”

Older doctors were less likely to know or follow current treatment standards on everything from surgery to treating children’s fevers, the Harvard team found in their analysis of nearly 40 years of research into factors that shape healthcare quality. One study found that heart attack patients were 10 percent more likely to die in the care of a doctor 20 years out of medical school compared with a recent graduate. …

The problem is not just the volume of new information or people’s tendency to forget facts over time, said Niteesh K. Choudhry, 33, the lead author of the study in today’s Annals of Internal Medicine. The basic philosophy of medicine has shifted over the past 30 years from one in which doctors relied heavily on their own experience to make decisions to a new paradigm in which doctors depend more on research published in medical journals. Doctors who were not trained in ”evidence-based medicine” may be slower both to adopt new approaches and to abandon outdated ones, he suggested. …

Dr. Alan C. Woodward, president of the Massachusetts Medical Society and a 1977 medical school graduate, said the trend toward tougher requirements for certification has already begun, noting that in his field, emergency medicine, doctors for the past two years have been required to take an annual online exam to remain board-certified. Because such measures are so new, ”You haven’t seen the impacts yet” on the quality of medicine, he said. …

Systematic Review: The Relationship between Clinical Experience and Quality of Health Care | Annals of Internal Medicine | 2.15.05

Study Selection: Studies that provided empirical results about knowledge or a quality-of-care outcome and included years since graduation or physician age as explanatory variables.

Data Synthesis: Overall, 32 of the 62 (52%) evaluations reported decreasing performance with increasing years in practice for all outcomes assessed; 13 (21%) reported decreasing performance with increasing experience for some outcomes but no association for others; 2 (3%) reported that performance initially increased with increasing experience, peaked, and then decreased (concave relationship); 13 (21%) reported no association; 1 (2%) reported increasing performance with increasing years in practice for some outcomes but no association for others; and 1 (2%) reported increasing performance with increasing years in practice for all outcomes. Results did not change substantially when the analysis was restricted to studies that used the most objective outcome measures.

Limitations: Because of the lack of reliable search terms for physician experience, reports that provided relevant data may have been missed.

Conclusions: Physicians who have been in practice longer may be at risk for providing lower-quality care. Therefore, this subgroup of physicians may need quality improvement interventions.

Editor’s Notes | Annals of Internal Medicine | 2.15.05

Implications

• This review should provoke careful study of the relationship of physician experience and the quality of care. It also raises concerns about the adequacy of continuing professional education in medicine.

For the times they are a-changin’

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