Too Long

You know you have been in the ER too long when:

• Vending machines in the waiting room become a very important diagnostic tool.
• Where Cheetos “stainings” provides clues to illness and injury.
• When M&Ms are washed down with a liter of CoLyte.

Fraud; Antioxidants

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• Whistle-Blowers’ Haul Is Targeted
  The move to rein in the False Claims Act — as the whistle-blower law is known — is part of conservatives’ larger effort to limit corporations’ exposure to legal challenges. The effort has generally taken the form of seeking to place limits on access t
  (tags: qui_tam tort_reform false_claims)
• New Report Says Coffee Is a Top Source Of Healthy Antioxidants
  Coffee not only helps clear the mind and perk up the energy, it also provides more healthful antioxidants than any other food or beverage in the American diet, according to a study released Sunday.
  (tags: health)
• Louisiana probes docs’ deals with image clinics
  “The fact that the alleged arrangements exclude Medicare and Medicaid patients tells me that the companies believed the practice could be problematic under the federal Stark and antikickback laws. But state officials are starting to enforce their own anti
  (tags: Stark false_claims physicians)
• New Orleans physician faces fraud charges
  “The fact that the alleged arrangements exclude Medicare and Medicaid patients tells me that the companies believed the practice could be problematic under the federal Stark and antikickback laws. But state officials are starting to enforce their own anti
  (tags: false_claims)

Walter Reed; Podcasts; VoIP; Desktop Web Servers

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• Commission Votes to Close Walter Reed Army Medical Center
  A federal panel voted Thursday to close the District’s historic Walter Reed Army Medical Center and to move 9,000 military and civilian defense jobs from Arlington and Alexandria to military bases outside the Beltway despite concerns about the traffic pro
  (tags: hospitals)
• New Software Makes Podcasts Mobile
  The software from Los Angeles-based Pod2Mob promises to enable mobile phone users to hear podcasts on their handsets, too.
  (tags: podcasting)
• Internet Phone Cos. May Cut Off Customers
  Providers of Internet-based phone services may be forced next week to cut off tens of thousands of customers who haven’t formally acknowledged that they understand the problems they may encounter dialing 911 in an emergency.
  (tags: communication VoIP)
• GoogleOS? YahooOS? MozillaOS? WebOS?
  The next killer app: desktop Web servers
  (tags: web2.0 google yahoo mozilla internet)

CHW; Pharmaceutical Benefits

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• Off critical list, CHW is ready to ramp up its operations
  Nursed back to financial health from $1 billion in losses prior to 2001, Catholic Healthcare West is again focusing on growth, advancing plans to broaden its reach and strengthening ties with its doctors.
  (tags: hospitals)
• Reading Fine Print, Insurers Question Studies of Drugs
  As the cost of drugs in the U.S. approaches $250 billion a year, pharmaceutical companies are running up against a growing breed of detective trained to see through marketing spin. Working for insurers, state Medicaid programs and nonprofit bodies, these
  (tags: pharmaceuticals insurers)

Cost/Quality Credentialing; Medicare Lobbying

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• Aetna to rank specialists by cost, quality
  Aetna’s move comes at a time when its competitors also are experimenting with tiered networks as a way to cut employer costs and offer members more information about physicians and the cost of medical care.
  (tags: health_cost quality)
• At Last, a Way To Compare Medical Costs
  Others note that while the prices of most itemized medical services don’t vary tremendously from doctor to doctor, the overall cost of treating a patient can — which is why Aetna’s price disclosures are only a first step in bolstering health-care consume
  (tags: health_cost quality)
• Medicare Law Prompts a Rush for Lobbyists
  Almost every week the federal government issues new rules or guidelines to carry out the 2003 law, which provides a drug benefit starting in January. To keep track of the new rules and to decipher their meaning is a full-time job for hundreds of lawyers a
  (tags: medicare health_cost)

Hosptialist to Laborist

Some health systems explore laborists idea | USA Today | 8.9.05

Practice takes pressure off doctors and helps lower costs of malpractice insurance

When Legacy Health System of Portland, Ore., announced that it would open a second hospital 15 miles away in Vancouver, Wash., it met with some unexpected grumbling — from obstetricians.

Schedules worked out among groups of community obstetricians allowed most doctors to have a few nights off between being “on call” to deliver babies. A second hospital would double coverage needs and could result in doctors having patients in both simultaneously.

“I was greeted with hostility,” says a wry Duncan Neilson, chief of women’s services at Legacy.

But then Neilson thought, why not hire doctors who will work only in the hospital, mainly delivering babies?

By hiring what have been called “laborists” and paying their malpractice insurance costs, the hospital could take the pressure off community doctors and possibly help with two related problems. Nationwide, fewer doctors, including obstetricians, want to serve “on call” for hospital emergency rooms. And rising malpractice insurance costs are causing some obstetricians to retire or cut back on OB services.…

Subspecialization by venue? How did the corporate practice of medicine come about? By having big carrots:

• better control of on-call obligations
• shifting malpractice insurance to the “deeper pocket”
• better control of office practice

Low Hanging Fruit

Still Not Ready in The ER | WP | 8.5.05

One of the fundamental responsibilities of government is to coolly and dispassionately assess health threats against the populace and take decisive action to counter these threats.…

Across the United States, underfunded emergency rooms and trauma centers lack sufficient beds to meet their daily mission, much less absorb large numbers of victims from a terrorist attack. Few ambulance personnel know how to assess a blast scene or properly evaluate multiple casualties from a bombing.…

It is ironic that our government’s single-minded focus on “bioterrorism” has left us less well prepared to handle either an emerging biological threat (such as SARS or avian influenza) or a terrorist strike (which will most likely involve the use of explosives). Unless we quickly rethink our priorities and broadly allocate resources to meet the most plausible threats to the U.S. population, our only option will be a “faith-based initiative.”

Pray that nothing happens.

Excellent editorial of the state of unpreparedness. As with much of federal expeditures, what is the lowest hanging or the tip most easily seen gets the funding. Funding the ability to surge the spectrum of healthcare resources is where the true battle is and where the hope of any true victory lies. Our first response, may be our last response.