12 Nov

Handling the delicate balance as an ER patient

Below is an article from KevinMD.com on the balance of waiting and advocating for patient care when visiting the Emergency Department of your local hospital.

 | PHYSICIAN | NOVEMBER 8, 2013

Sometimes it’s difficult to practice what I preach. But I try.

A couple of weeks ago, I spent the evening in the emergency room with our youngest son (don’t worry – he’s fine). I hate going to the ER, but every once in a while circumstances necessitate it. I called doctor friends in the relevant specialty, as well as our son’s pediatrician, to confirm the need for the trip. They said to go. So we went. And this particular ER encounter did not make me like the patient side of an emergency department any more than before.

We were there for an issue that is time-sensitive — it’s certainly on the list of things that need super-quick evaluation. It took longer than it should have to get through triage and into the actual ER (maybe 20 minutes or so), but to the hospital’s credit, once we were actually in the room, the ER resident saw us almost immediately, realized the potential urgency, and had the attending doctor come right away. They ordered the necessary test, called the department to make sure it would be done immediately, and let us know that my son was the next person on the list and would go up promptly.

We waited about fifteen minutes. I checked with the nurse, who informed me that “they’re on their way” to get my son for the test. We waited some more. After another fifteen minutes or so, I checked with the nurse again. The same reply: “They’re on their way.” Another ten minutes went by. I got the resident’s attention and asked him if he could call up and see what was happening. He told me that he didn’t have a way to call anyone else. Another ten minutes. Went to check with the nurse again, who at this point gave me a really annoyed look and repeated that “they’re on their way.”

Honestly, the only way that they could possibly have been “on their way” that whole time was if they had been coming from Ohio.

We waited far longer than we should have for the test that determined whether a surgical emergency existed. It should have been done immediately, but it took significantly longer than an hour to obtain. And my polite advocating for my son did not seem to be fruitful. One of my specialist friends called and texted several times to check up on us, and kept urging me to push harder to get that test done.

I pushed. And it was very frustrating. I kept my composure and stayed polite, but I was seething inside. The nurse made another phone call. And it worked.

When the woman came to transport my son, I don’t think it would have been possible for her to move any more slowly. She was perfectly pleasant but showed absolutely no sense of urgency. I smiled and helped her push the bed so that we could make better time.

Emergency departments are grossly overused. They are filled with people who have had sinus congestion for two weeks or lower back soreness for a month, symptoms which should be addressed in a physician’s office. I understand the frustration of ER personnel and the at-times jaded attitudes of the staff. But it is the job of the healthcare workers to get beyond the workplace frustrations and to look at each situation through the eyes of the patients and their families.

Yes, there are people who use emergency room resources when they’re not needed. But most of us go out of our way to avoid emergency rooms. When we’re there, it means we’re really concerned about something. Assuming people are being polite, medical personnel should not show annoyance. A person transporting a patient for a “STAT” test should look like she’s hurrying. Residents should know what phone numbers to call to expedite what needs to be expedited.

The test turned out normal. No need for surgery. A little rest would do the trick. The fact that it then took another hour-and-a-half to be discharged was merely an annoyance, not a worry.

But believe me, I get it. When I tell my clients and my readers to advocate for themselves and their loved ones, I know it’s hard. I know it’s a delicate balance between making sure you get what you need and not annoying people in the process. But it has to be done. And hospitals are working on seeing things from the patients’ side. The gentle reminders and the self-advocacy help them get there.

The bill for the ER visit arrived in our mail today. That’s a subject for another day…

Abigail Schildcrout is founder, Practical Medical Insights, and blogs at DocThoughts.

07 Nov

Big gaps in info on concussions

concussion image

is it a concussion?

Published on Contemporary Pediatrics (http://contemporarypediatrics.modernmedicine.com)
Publish date: NOV 05, 2013
By: Lisa Hack

As a result of gaping holes in what is known about the actual incidence of concussions in young athletes and the effects of these traumatic brain injuries, the Institute of Medicine and National Research Council are calling for a national system to track sports-related concussions in children and adolescents aged 19 years and younger.

In a report called “Sports-Related Concussions in Youth: Improving the Science, Changing the Culture,” the researchers say that although it is unclear how many children and teenagers suffer concussions, largely because many go undiagnosed, nearly 250,000 young people aged 19 years and younger were treated in emergency departments for concussions and other sports-related brain injuries in 2009, which is up from 150,000 in 2001.

Girls may be at particularly high risk. The report finds that young women and girls have a higher rate of concussions than boys in the sports they both play, including soccer and basketball. Although the rate of concussions in cheerleading remains low compared with that in other sports, it is increasing faster than the rate for any other sport played by young women at the high school or college level—at a rate of 26% each year over the decade from 1998 to 2008.

For boys and young men in high school and college, rates of concussion are highest for football, followed by ice hockey, lacrosse, and wrestling. For girls and young women, rates are highest for soccer, lacrosse, and then basketball. However, at the college level, women’s ice hockey has one of the highest reported rates of concussion.

The American Academy of Pediatrics recently issued a clinical report about why it may be necessary for students recovering from concussion to take a break from, or to make alterations in, the learning environment, and that pediatricians may be integral in requesting such changes. For example, children may have difficulty learning new tasks or remembering previously learned ones. Bright lights, screens, and noisy hallways or cafeterias may pose problems. These students may require a shortened school day, a reduced workload, or more time to complete tasks or tests.

04 Nov

Top Hospitals Opt Out of Obamacare

Top Hospitals Opt Out of Obamacare

Americans who sign up for insurance on the state exchanges may not have access to the nation’s top hospitals, Watchdog.org reports.

October 30, 2013

University Hospitals Case Medical Center, Cleveland, Ohio, Best Hospitals, Honor RollThough top-ranked hospitals like Case Medical Center accept plans from dozens of private insurers, if you buy your insurance on the Obamacare exchanges your options for treatment may be limited.

The Obama Administration has been claiming that insurance companies will be competing for your dollars under the Affordable Care Act, but apparently they haven’t surveyed the nation’s top hospitals.

Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies. Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare.

[CHART: Which Top Hospitals Take Your Insurance Under Obamacare?]

“This doesn’t surprise me,” said Gail Wilensky, Medicare advisor for the second Bush Administration and senior fellow for Project HOPE. “There has been an incredible amount of focus on the premium cost and subsidy, and precious little focus on what you get for your money.”

Regulations driven by the Obama White House have indeed made insurance more affordable – if, like Health and Human Services Secretary Kathleen Sebelius, you’re looking only at price. But responding to Obamacare caps on premiums, many insurers will, in turn, simply offer top-tier doctors and hospitals far less cash for services rendered.

Watchdog.org looked at the top 18 hospitals nationwide as ranked by U.S. News and World Report for 2013-2014. We contacted each hospital to determine their contracts and talked to several insurance companies, as well.

The result of our investigation: Many top hospitals are simply opting out of Obamacare.

Chances are the individual plan you purchased outside Obamacare would allow you to go to these facilities. For example, fourth-ranked Cleveland Clinic accepts dozens of insurance plans if you buy one on your own. But go through Obamacare and you have just one choice: Medical Mutual of Ohio.

And that’s not because their exchanges don’t offer options. Both Ohio and California have a dozen insurance companies on their exchanges, yet two of the states’ premier hospitals – Cleveland Clinic and Cedars-Sinai Medical Center – have only one company in their respective networks.

A few, like No. 1-rated Johns Hopkins in Maryland, are mandated under state law to accept all insurance companies. Other than that, the hospital with the largest number of insurance companies is University Hospitals Case Medical Center in Cleveland with just four. Fully 11 of the 18 hospitals had just one or two carriers.

“Many companies have selectively entered the exchanges because they are concerned that (the exchanges) will be dominated by risky, high-using populations who wanted insurance (before Obamacare) and couldn’t afford it,” said Wilsensky, who is also on the board of directors of UnitedHealth. “They are pressed to narrow their networks to stay within the premiums.”

Consumers, too, will struggle with the new system. Many exchanges don’t even list the insurance companies on their web sites. Some that do, like California, don’t provide names of doctors or hospitals.

The price differences among hospitals “can be pretty profound,” said Joe Mondy, spokesman for Cigna insurance. “When you are doing a cost comparison with doctors, you should look up the quality of the hospital as well. Hospital ‘Y’ could be great at pediatrics and not great at surgery.”

Insurers operating in the exchanges are apparently hesitant to talk about the trade-off between price and quality. Two of the nation’s largest insurers – Wellpoint and Aetna – refused to respond to a dozen calls and emails placed over the course of a week.

Wellpoint and Aetna’s decision to not educate the public on its choices doesn’t sit well with two experts.

“There is no reason to keep that quiet. It’s not going to be a good secret for very long when people want to use the plans,” Wilensky said.

“In many cases, consumers are shopping blind when it comes to what doctors and hospitals are included in their Obamacare exchange plans,” said Josh Archambault, senior fellow with the think tank Foundation for Government Accountability. “These patients will be in for a rude awakening once they need care, and get stuck with a big bill for going out-of-network without realizing it.”

All of this represents a larger problem with the Affordable Care Act, said Archambault, who has extensively studied the law.

“It reflects deeper issues in implementation,” he said. “Some hospitals and doctors don’t even know if they are in the network.”

Just look at Seattle Children’s Hospital, which ranks No. 11 on the U.S. News & World Report best pediatric hospital list. When Obamacare rolled out, the hospital found itself with just two out of seven insurance companies on Washington’s exchange. The hospital sued the state’s Office of Insurance on Oct. 4 for “failure to ensure adequate network coverage.”

“Children’s is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest,” a hospital press release said. ” Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation.”

And for doctors in Texas, “Basically, we don’t know,” said Stephen Brotherton, president of the Texas Medical Association. “We can’t find out. At this point, it’s part of the various unknowns with the marketplace. There are ways you can be on plans and not even realize it.”

 

Tori Richards is a writer with Watchdog.org. Contact her at tori@watchdog.org or on Twitter: @newswriter2.