April 13, 2012
By Karl Thallner, Jr.*
For the Elderly, Emergency Rooms of Their Own
Phyllis Spielberger, a retired hat seller at Bendel's, picked at a plastic dish of beets and corn as her husband, Jason, sat at the foot of her hospital bed, telling her to eat. Although she had been rushed to Manhattan's busy Mount Sinai Hospital by ambulance when her leg gave out, the atmosphere she encountered upon her arrival was eerily calm. There were no beeping machines or blinking lights or scurrying medical residents. A volunteer circulated among the patients like a flight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles, and hearing aids. Above them, an artificial sun shined through a skylight imprinted with a photographic rendering of a robin's-egg-blue sky, puffy clouds, and leafy trees. Spielberger, who is in her eighties, was even getting into the spirit of the place, despite her unnerving condition. "It's beautiful," she said. "Everything here is wonderful."
Yet this was an emergency room, one specifically designed for the elderly, part of a growing trend of hospitals trying to cater to the medical needs and sensibilities of aging baby boomers and their parents. Mount Sinai opened its geriatric emergency department, or geri-ed, two months ago, modeling it in part after one at St. Joseph's Regional Medical Center in Paterson, NJ, which opened in 2009. Holy Cross Hospital in Silver Spring, MD, opened one of the first geriatric emergency departments, which it calls a seniors emergency center, in 2008, and its parent organization, Trinity Health System, runs twelve nationwide, primarily in the Midwest, and plans to open six or seven more by June, a spokeswoman said.
Dr. Mark Rosenberg, chairman of emergency medicine at St. Joseph's, said he had consulted on more than fifty geriatric emergency rooms to be opened across the country, from Princeton, NJ, to California, overcoming initial resistance from doctors and nurses who saw assignments to the units as scut work. "They thought it was a bedpan unit, focused on nursing home patients," Rosenberg said. "When they finally realized this was the unit that gave better healthcare to their parents and grandparents, they jumped onboard."
Hospitals also have strong financial incentives to focus on the elderly. People over the age of sixty-five account for 15% to 20% of emergency room visits, hospital officials say, and that number is expected to grow as the population ages. Under the Patient Protection and Affordable Care Act of 2010, the health insurance overhaul passed by Congress in 2010, hospitals' Medicare payments will be tied to scores on patient satisfaction surveys and how frequently patients have to be readmitted to the hospital. (The U.S. Supreme Court is considering whether to overturn another section of the law, and if it does, whether it would have to throw out the entire law.)
Anemona Hartocollis, For the Elderly, Emergency Rooms of Their Own, The New York Times (April 9, 2012).
Pessimistic Doctors Leaving Hospitals
That's a bummer: more than half of physicians are pessimistic about the future of healthcare, with many doctors cynical about government involvement particularly around healthcare reform.
According to a survey by nonprofit The Physicians Foundation, 57% of doctors age forty and younger don't have high hopes, worrying that recent legislation will hurt their practices, according to a company statement. Only 4% were "highly optimistic" about the Patient Protection and Affordable Care Act of 2010.
"I do not feel optimistic because of all the increased regulatory burdens on physicians. There will be an increased shortage of physicians to provide primary care and decreased access to care," said one physician in the survey.
With that negative outlook, only 12% of young hospital-employed physicians would stay in their current position. When compared to office-based physicians, hospital-based physicians are more likely to stay for only two years or less and are significantly less likely to stay for eight or more years, according to the report. If given the opportunity, more than 40% of young primary care physicians would opt to be sole owners or partners in a group, they said.
Karen M. Cheung, Pessimistic Docs Leaving Hospitals, Fierce HealthCare (April 12, 2012).
SocialMed: Patients "Blue Book" Healthcare
With the rise of high-deductible plans and growing out-of-pocket costs, more patients are doing comparison shopping with their healthcare, the way they do with electronics, cars, and other products and services. A few states—New Hampshire and Maine—have launched databases for comparing procedure costs, as has at least one insurer, Cigna. And dot-com companies have also joined the fray.
Just as patients have been comparing doctor ratings on HealthGrades.com and Vitals.com, now they can compare the costs associated with those providers and procedures as well. Sites like NewChoiceHealth.com, HealthcareBlueBook.com, and PriceDoc.com allow patients to see various medical procedure costs side by side, although the latter is targeted mainly to uninsured patients paying in full.
The recently launched MedicalBillExchange.com enables comparison-shopping, but also offers users a chance to earn money to pay those bills. Site creator Nick Newsad calls the approach "medical bill crowdsourcing." Patients upload their bills or explanation of benefits so other users can see how much they're paying. It costs $4 to see a bill and $6 to see an explanation of benefits—and 85% of those charges are given back to the person who initially posted them.
Newsad said that even though the idea of high deductibles was to make patients better healthcare shoppers, not as many have been doing their homework online because it hasn't been easy to find that information. He hopes to change that with MedicalBillExchange.
Other sites offer comparison shopping, with the added benefit of managing all of their medical bills online. CakeHealth.com is especially helpful to patients who are trying to navigate the flood of bills following a hospital visit. Patients log on, connect with their insurer, and receive a breakdown of what's paid and what's owed.
Kristina Fiore, SocialMed: Patients "Blue Book" Healthcare, MedPage Today (April 7, 2012).
Protesters to UVA: Stop Using Cats for Medical Training
Using cats in part of medical training is a practice slowly disappearing at universities and teaching hospitals across the country, and one group wants the University of Virginia (UVA) to join the growing number.
"It's a pretty cruel and inhumane thing to do," protester Jake McDaniel said. "It can be stopped pretty easily." Protesters joined the Physicians Committee for Responsible Medicine (PCRM) outside the Rotunda to get their message out. "This is an inhumane and outdated training method," said Dr. Ulka Agarwal, the chief medical officer for PCRM. "They're behind the curve and they're not up to the standards they need to be competent in intubation training."
UVA uses three cats, each about eight years old, to train pediatric doctors on how to insert breathing tubes in infants. "For me, this is not about cats. This is about babies," UVA Professor of Pediatrics John Kattwinkel said. "We consider the animals to be our partners in this." Kattwinkel and other doctors said their cats are treated humanely. They say the cats are anesthetized before each procedure and suffer little to no pain in the process.
The protesters said 95% of pediatrics programs nationwide use non-animal methods, like mannequins, for training. University doctors said using cats are the best methods and that other schools simply caved to outside pressure based on inaccurate data.
Chris Stover, Protesters to UVA: Stop Using Cats for Medical Training, The Charlottesville Newsplex (April 12, 2012).
Teaching Hospitals Hit by Falling Patient Volumes
Falling inpatient volumes are hitting Massachusetts teaching hospitals, including Boston's Beth Israel Deaconess Medical Center. Chief Executive Officer Kevin Tabb said the state is seeing "flat or down" inpatient volumes, the Boston Herald reported. "We don't believe this is a short-term trend," Tabb wrote last month in a staff memo. "We believe it is the start of a fundamental shift."
The closing of a twenty-four-bed floor is the subject of unrest for union workers, who witnessed recent layoffs of twenty people last month, but spokesman for the Harvard Medical School teaching hospital Jerry Berger said in the article it occasionally opens or closes patient floors during the course of continuous monitoring of patient volume. "All staff from [the floor] five Stoneman were placed in open jobs within the medical center," Berger said in an emailed statement to FierceHealthcare.
According to last month's report from consulting firm PricewaterhouseCoopers, academic medical centers could lose about 10% of their revenue, thanks to lower Medicare disproportionate-share hospital payments or failure to meet new quality standards. To offset potential losses, teaching hospitals must adjust their funding, strengthen their brands, and embrace partnerships through affiliations or acquisitions.
Karen M. Cheung, Teaching Hospitals Hit by Falling Patient Volumes, FierceHealthcare (April 9, 2012).
Is Medical School Admission Squashing Creativity?
What does it take to get into medical school today? High medical college admission test scores. Pre-requisites galore, coupled with a stellar grade point average. Research experience. Clinical experience. Volunteering.
It has become a series of checkboxes, many going through the process gripe. Worse, it's an exercise in conformity. Yesterday at TEDMED, Dr. Jacob Scott shone the spotlight on this system as a root cause of the lack of creativity among people going into medicine.
"You can't take any risks, or you won't get in [to medical school]—you won't get into the club," he told the audience. But, he continued, that means weeding out creativity. Future doctors are being trained to "memorize certainty," rather than think imaginatively.
Want to become a doctor? You can't slip up, or you'll fall behind. You can't rock the boat, or you won't get admitted.
This critique is not unique to medical education, as reflected in a speech by former Yale English Professor William Deresiewicz to the 2009 plebe class of the United States Military Academy at West Point. Skeptical of modern benchmarks of success, Deresiewicz told the young cadets:
It's an endless series of hoops that you have to jump through [to get into college], starting from way back . . . What I saw around me were great kids who had been trained to be world-class hoop jumpers. Any goal you set them, they could achieve. Any test you gave them, they could pass with flying colors. . . . I had no doubt that they would continue to jump through hoops and ace tests and go on to Harvard Business School, or Michigan Law School, or Johns Hopkins Medical School, or Goldman Sachs, or McKinsey consulting, or whatever. And this approach would indeed take them far in life.
Ilana Yurkiewicz, Is Medical School Admission Squashing Creativity?, Scientific American (April 12, 2012).
*We would like to thank Karl A. Thallner, Jr., Esquire (Reed Smith LLP, Philadelphia, PA), for providing this week's update.
AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.
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