Workers' Compensation: Patient

Showing posts with label Patient. Show all posts

Thursday, December 26, 2013

You may not be better off after knee surgery

Today's post is shared from cnn.com

(CNN) -- Patients who underwent simulated knee surgery fared just as well as those who got the real deal, according to a new study that's raising eyebrows about the most common orthopedic procedure performed in the United States.

The findings, published Thursday in the New England Journal of Medicine, add to a string of papers suggesting that arthroscopic partial meniscectomy fails to help many patients. The operation typically is performed to relieve knee pain, whether from wear or from an injury.

But other doctors say it's still too soon to draw sweeping conclusions.

The study, which was conducted in Finland, followed 146 patients between the ages of 35 and 65 with symptoms of degenerative wear and tear of the meniscus, a disk-shaped piece of cartilage that acts as a shock absorber between the shinbone and thighbone. They had no detectable arthritis, suggesting that any pain was due to a problem with the meniscus.

About half the patients underwent an arthroscopic meniscectomy, in which a surgeon inserts a blade through a tiny incision in the knee, and essentially shaves down the rough, frayed edges of the meniscus.

The other half underwent an elaborately staged "sham" surgery, in which the doctor made an incision and poked around without any actual manipulation, shaving or cutting.

A year later, there was no significant difference in the knee pain reported by patients in each group. Nearly two-thirds on each side said they were happy with the results, and most said...

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Saturday, December 14, 2013

Fee Schedules and Value

Medical costs are a major cost to the nation’s workers’ compensation system. Trying to cap them by schedules is a problem. What type of schedule becomes a political football, sometimes causing chaos. The free market certainly has it advantage though. Employee should as the right to choose their doctor and doctors should be flexible to charge the “going rate” for their communities. NJ operates without a fee schedule, but lacks the free selection component. Access and free choice will go along way to balancing out costs. Demand for participation will increase and employers and workers will both be winners. Today's post is shared from http://daviddepaolo.blogspot.com .

And it isn’t surprising that the Workers’ Competition Research Institute reported Thursday that states without medical fee schedules in their workers’ compensation systems have seen the most rapid increases in prices for outpatient hospital and professional services, while states with fee schedules based on fixed amounts generally fared better.

"States without fee schedules saw faster price growth than states with fee schedules, and, for states with charge-based fee schedules, we saw prices for hospital outpatient services growing faster than states with fixed prices," said Rebecca Yang, the author of WCRI's 2nd Edition of its Outpatient Cost Index and the Fifth Edition of its Medical Price Index for Workers' Compensation, in a webinar yesterday.

...

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Wednesday, December 11, 2013

Characterizing the quality of supportive cancer care can guide quality improvement of veterans

Objective  To evaluate nonhospice supportive cancer care comprehensively in a national sample of veterans.
Design, Setting, and Participants  Using a retrospective cohort study design, we measured evidence-based cancer care processes using previously validated indicators of care quality in patients with advanced cancer, addressing pain, nonpain symptoms, and information and care planning among 719 veterans with a 2008 Veterans Affairs Central Cancer Registry diagnosis of stage IV colorectal (37.0%), pancreatic (29.8%), or lung (33.2%) cancer.
Main Outcomes and Measures  We abstracted medical records from diagnosis for 3 years or until death among eligible veterans (lived ≥30 days following diagnosis with ≥1 Veterans Affairs hospitalization or ≥2 Veterans Affairs outpatient visits). Each indicator identified a clinical scenario and an appropriate action. For each indicator for which a veteran was eligible, we determined whether appropriate care was provided. We also determined patient-level quality overall and by pain, nonpain symptoms, and information and care planning domains.
Results  Most veterans were older (mean age, 66.2 years), male (97.2%), and white (74.3%). Eighty-five percent received both inpatient and outpatient care, and 92.5% died. Overall, the 719 veterans triggered a mean of 11.7 quality indicators (range, 1-22) and received a mean 49.5% of appropriate care. Notable gaps in care were that inpatient pain screening was common (96.5%) but lacking for outpatients (58.1%). With opioids, bowel prophylaxis occurred for only 52.2% of outpatients and 70.5% of inpatients. Few patients had a timely dyspnea evaluation (15.8%) or treatment (10.8%). Outpatient assessment of fatigue occurred for 31.3%. Of patients at high risk for diarrhea from chemotherapy, 24.2% were offered appropriate antidiarrheals. Only 17.7% of veterans had goals of care addressed in the month after a diagnosis of advanced cancer, and 63.7% had timely discussion of goals following intensive care unit admission. Most decedents (86.4%) were referred to palliative care or hospice before death. Single- vs multiple-fraction radiotherapy should have been considered in 28 veterans with bone metastasis, but none were offered this option.
Conclusions and Relevance  These care gaps reflect important targets for improving the patient and family experience of cancer care.

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Tuesday, December 10, 2013

Rehospitalization Rates Fell In First Year Of Medicare Penalties

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday. This drop occurred during the first year that Medicare financially penalized hospitals for their readmission rates, and the government seized on the decrease as evidence the incentives are having an effect.

revolving door300

The government is targeting rehospitalizations as a significant indicator of gaps in medical quality in the nation’s hospitals. While some elderly patients inevitably return to the hospital, the government and some researchers believe many of those returns are avoidable if hospitals monitor patients after their release to ensure they get appropriate medications and follow-up visits with doctors.
In the first year of the program, which began in August 2012, Medicare fined 2,213 hospitals—about two-thirds of those it evaluated— for higher than anticipated readmission rates. Last August, Medicare issued a second year of penalties against 2,225 hospitals. The maximum penalties created by the health law have risen from 1 percent of regular Medicare payments to 2 percent, and they will increase for a third and final time next August to 3 percent.
The new data reported by Medicare show that readmission rates for the first eight months of 2013 dropped below 18 percent, half a percentage point below 2012’s rate of 18.5 percent. From 2007 to...

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Wednesday, December 4, 2013

Rare Cancer Treatments, Cleared by F.D.A. but Not Subject to Scrutiny

Today's post was shared by The New York Times and comes from www.nytimes.com

When federal regulators permitted the sale of an unproved device that uses intense heat to combat cancer, they did so for a compelling reason, to give hope to some women desperately ill with cervical cancer.

Over the next two years, however, the few hospitals that purchased the $500,000 device did not take part in a study of patients that the manufacturer agreed to perform as a part of the machine’s approval. Cancer experts also said they were surprised that the Food and Drug Administration had approved the machine in the first place.

The reason: The group of woman for whom the F.D.A. approved the treatment — those with advanced cervical cancer who are too ill for chemotherapy — is so small. “I see, like, one patient like this a year,” said Dr. Junzo P. Chino, a cancer expert at Duke University.

A look at the F.D.A.’s decision to approve the device, which is called the BSD-2000, opens a window onto a little-known regulation known as the humanitarian device exemption.

The program, even its critics agree, is based on the best intentions. Because companies have little incentive to run costly trials for products used by small groups of patients, the exemption requires a producer only to show that a device is safe and has a “probable” benefit, rather than prove its effectiveness, the usual standard.

The rule, which is similar to one governing drugs for extremely rare diseases, also does not require the F.D.A., companies or...

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Wednesday, November 20, 2013

New obesity treatment guideline released

Obesity is now been classified as disease. With such a designation of Worker's Compensation systems will be impacted by request for benefits in order to diminish obesity is a pre-existing and coexisting diagnosis. Treatment plans will need to be included for the reduction of weight in order to treat certain diseases by protocols including medication.Today's post was shared by RWJF PublicHealth and comes from www.bostonglobe.com

A new guideline for obesity treatment, released last week by the American Heart Association and American College of Cardiology, provides a solid road map for doctors challenged with helping overweight patients achieve a healthier weight.
Insurance coverage for weight-related counseling, such as helping patients plan new menus with fewer calories or outline a realistic fitness program, could improve under this new recommendation. More importantly, the panel of physicians and weight researchers outlined which interventions are the most effective based on clinical trials.
Doctors should treat patients who are obese — a BMI of 30 or above (180 pounds or more for a 5-foot-5 person — as well as those who are overweight with a BMI between 25 to 30 (150 to 180 pounds for a 5-foot-5 person) if they have certain heart disease risk factors such as type 2 diabetes, the guideline states. People at a healthy weight, or who are overweight without any health problems, should keep their weight steady.
“It’s not just about body weight, but whether excess body weight is associated with medical conditions,” said Dr. Timothy Church, director of preventive medicine research at Pennington Biomedical Research Center, who was not involved in writing the guideline.

Doctors can offer drugs or bariatric surgery to help reverse obesity, but they should first try providing patients with intensive counseling to help them exercise and eat right.

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Sunday, November 17, 2013

California sends misinformation to 246,000 new Medicaid enrollees

Today's post was shared by Kaiser Health News and comes from www.sacbee.com

LOS ANGELES -- California has mistakenly sent letters to 246,000 low-income residents, warning they may need to find new doctors next year under the state's newly expanded Medicaid program.
The error frustrated counties and community health centers, which have repeatedly assured patients they can keep their providers when the Affordable Care Act takes effect in 2014. The patients are part of the state's "bridge to reform" program, which was designed to cover uninsured, poor Californians until they became eligible for Medicaid, known as Medi-Cal here.
The program launched in 2011 and more than 600,000 people across the state enrolled in county-based health coverage. Many of them formed relationships with doctors and started seeking regular care. But county and clinic administrators said the incorrect mailing this month has put the counties' efforts in jeopardy.
The mix-up occurred as people are scrambling to figure out how the health law impacts them, and as private policy holders have been receiving letters canceling their insurance plans.
"The whole key to the success is that people seamlessly transition to Medi-Cal," said Sean South, an associate director at the California Primary Care Association. "It is vitally important that we don't confuse them."
But that's what happened when the incorrect letters started going out on Nov. 1, said clinic and county officials.
Patients immediately began calling and showing up with questions about the letter, said Eva Serrano, a...

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Wednesday, November 13, 2013

Professionalism and Caring for Medicaid Patients — The 5% Commitment?

Today's post was shared by NEJM and comes from www.nejm.org

Interview with Prof. Sara Rosenbaum on the health care safety net, Medicaid expansion, and access to care.

Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry.1 Physicians practicing in higher-income areas are less likely to accept new Medicaid patients.2 Physicians who do accept new Medicaid patients may use various techniques to severely limit their number — for example, one study of 289 pediatric specialty clinics showed that in the 34% of these clinics that accepted new Medicaid patients, the average waiting time for an appointment was 22 days longer for children on Medicaid than for privately insured children.3
Physicians have good reasons for not accepting Medicaid patients, as I learned from direct experience as a member of a nine-physician primary care practice in California. We accepted Medicaid patients, but it was difficult. Medicaid's payment rate was very low — we lost money on each Medicaid visit. When referrals were necessary, we often had to personally ask specialists to accept our patient....

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Sunday, November 3, 2013

A Vital Measure: Your Surgeon’s Skill

Today's post is shared from the nytimes.com

To those of us in training, the hospital was cursed. At least when it came to a certain operation.
We dreaded being asked to scrub in at these operations because we knew we would be forced to hold patient parts until our fingers went numb and arms quivered. The surgeons hunted, stabbed and slashed their way through the procedure; and whenever their knife would go a little too far, or their knot would slip, or their stitch pull, we braced ourselves for their fury…and for the inevitable extra time it would take for them to correct their errors.
The patients, many of whom had come in to the hospital walking and talking, ended up lingering for weeks afterward with infections, open wounds and other complications.
But everything changed when a new surgeon came on board. Built like a rugby player, he shocked us first with his speed, and then his results. The once unbearable day-long slog became a morning’s work; and instead of spending weeks in the hospital, his patients went home after eight days.
In the operating room, his bear paw hands turned delicate, teasing out tissues, caressing vessels and nimbly knotting thread as fine as human hair. There was not a single wasted movement; and each step blended seamlessly with the next, giving those of us who had the fortune to observe the sense that we were watching not surgery, but a well-choreographed ballet.
“It’s like you’re just standing there holding the needle or...

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Friday, November 1, 2013

Two Kinds of Hospital Patients: Admitted, and Not

Today's post was shared by The New Old Age and comes from newoldage.blogs.nytimes.com

Judith Stein got a call from her mother recently, reporting that a friend was in the hospital. “Be sure she’s admitted,” Ms. Stein said.
As executive director of the Center for Medicare Advocacy, she has gotten all too savvy about this stuff.
“Of course she’s admitted,” her mother said. “Didn’t I just tell you she was in the hospital?”
But like a sharply growing number of Medicare beneficiaries, her mother’s friend would soon learn that she could spend a day or three in a hospital bed, could be monitored and treated by doctors and nurses — and never be formally admitted to the hospital. She was on observation status and therefore an outpatient. As I wrote last year, the distinction can have serious consequences.
The federal Centers for Medicare and Medicaid Services tried to clarify this confusing situation in the spring with a policy popularly known as the “two-midnight rule.” When a physician expects a patient’s stay to include at least two midnights, that person is an inpatient whose care is covered under Medicare Part A, which pays for hospitals. If it doesn’t last two midnights, Medicare expects the person to be an outpatient, and Part B, which pays for doctors, takes over.
It’s rare to have hospital and nursing home administrators, physicians and patient advocates all agreeing about a Medicare policy, but in this case “there’s unanimity of dislike,” said ...

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Wednesday, October 23, 2013

Questioning Statins for Older Patients

Limiting medication can reduce overall patient care costs. The efficacy of controlling cholesterol in the "very old" population is now being discussed. Today's post was shared from the NYTimes.com.

Should older adults take statins if they have elevated cholesterol but no evidence of heart disease? It’s a surprisingly controversial question, given the number of seniors taking statins.

Recently AMDA, a professional group representing physicians working in nursing homes, highlighted the issue in a list of five questionable medical tests and treatments. The list was drawn up as part of the national “Choosing Wisely” campaign, which alerts consumers to inappropriate or overused medical interventions, an effort that caregivers would do well to follow.

The standout item on the AMDA list: “Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.” That means anyone older than 70, according to the medical society.

Dr. Hosam Kamel, an Arkansas geriatrician who is vice chair of AMDA’s clinical practice committee, said that there is scarce scientific evidence supporting the use of statins by 70- or 80-year-olds without pre-existing cardiovascular disease. Only a handful of studies have focused on outcomes (heart attacks, strokes, premature death) in this older population.

Most of the data on the benefits of statin use come from larger studies that looked at adults of varying ages. The results...

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Tuesday, October 22, 2013

The Great Coronary Angioplasty Debate: Giving Patients the Right to Speak | The Health Care Blog

Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com

By Nortin Hadler, MD
Earlier this month, the editors of THCB saw fit to post my essay, “The End of the Era of Coronary Angioplasty.”
The comments posted on THCB in response to the essay, and those the editors and I have directly received, have been most gratifying. The essay is an exercise in informing medical decisions, which is my creed as a clinician and perspective as a clinical investigator.
I use the recent British federal guideline document as my object lesson. This Guideline examines the science that speaks to the efficacy of the last consensus indication for angioplasty, the setting of an acute ST-elevation myocardial infarction (STEMI). Clinical science has rendered all other indications, by consensus, relative at best. But in the case of STEMI, the British guideline panel supports the consensus and concludes that angioplasty should be “offered” in a timely fashion.
I will not repeat my original essay here since it is only a click away. The exercise I display is how I would take this last consensus statement into a trusting, empathic patient-physician discourse. This is a hypothetical exercise to the extent that little in the way of clear thinking can be expected of a patient in the throes of a STEMI, and not much more of the patient’s caring community.
So all of us, we the people regardless of our credentials, need to consider and value the putative efficacy of angioplasty (with or without stenting) a priori. For me, personally, there is...

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Friday, October 18, 2013

Huge Differences by Region in Prescribing to Elderly, Study Finds

Researchers find that a higher proportion of seniors are prescribed antidepressants, dementia drugs and other medications in some parts of the country than others. Click to explore the researchers' findings.

Elderly Americans are prescribed medications in inexplicably different ways depending on where they live,according to a new report from Dartmouth researchers.

Th emostdepressed older patients—or at least the ones being medicated -- live in parts of Louisiana and Florida. There’s a cluster with dementia around Miami. And the seniors who have the most trouble sleeping? They live, perhaps unsurprisingly, in Manhattan.

The study by the Dartmouth Institute for Health Policy and Clinical Practice examined geographic variations in the drugs elderly Medicare patients received in 2010. Researchers mapped where patients got medications they clearly needed and where they got drugs deemed risky for the elderly. They also looked at difference sin the use of so-called discretionary drugs, which they say are but of uncertain benefits.

The report’s findings underscore those of a ProPublica investigation in May, which found that some doctors who treat Medicare patients often prescribe drugs that are dangerous or inappropriate for certain patients. ProPublica also found that the federal officials who run Medicare have done little to scrutinize prescribing patterns in their drug program,known as Part D, or question doctors whose practices differ from their peers.
Officials...

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Friday, October 4, 2013

11 Barriers to Hand Hygiene Compliance

Today's post was shared by votersinjuredatwork and comes from www.beckersasc.com

Time pressure is one of the biggest reported barriers to hand hygiene compliance among healthcare workers, according to a study in Infection Control and Hospital Epidemiology.
Of 123 healthcare workers in a Thai hospital, compliance with the World Health Organization's "five moments" of hand hygiene was 23.2 percent by direct observation and 82.4 percent by self report. In a survey, the participants identified 11 barriers to compliance:

•   I hurry/emergent patient conditions — 45.5 percent
•   I don't see any dirt/I think it's not dirty — 24.4 percent
•   I forget — 19.5 percent
•   I'm busy/too many patients — 15.4 percent
•   It is inconvenient — 13.8 percent
•   I don't care — 8.1 percent
•   I'm lazy — 5.7 percent
•   I wear gloves/no direct contact with patients — 4.9 percent
•   There are adverse effects of soap/cleanser — 4.9 percent
•   It wastes time — 4.1 percent
•   My hands are clean — 2.4 percent
These reasons may help guide future hand hygiene interventions, according to the study.

Thursday, October 3, 2013

Nurses Prone to Injuries With Heavier Patients

Today's post was shared by votersinjuredatwork and comes from abcnews.go.com

Loretta Pierce is only 46, but she has already retired from nursing in favor of a desk job.

After years of lifting heavy patients and equipment that resulted in a herniated disc, she said she knew her body just couldn't handle the work anymore.

"I'm almost fearful as a nurse of going back to taking care of patients unless I have proper equipment," said Pierce, who worked in organ recovery, the intensive care unit and the emergency room. "It's kind of sad when you have to end your nursing career because you can't physically do the job anymore because your body's so beat up."

Nursing aides, orderlies and attendants suffer more musculoskeletal injuries than people in any other profession – including firefighters, according to the latest data from the Bureau of Labor Statistics. Registered nurses also edure more of these injuries than the average worker.

Even worse, patients are getting heavier -- especially in the Midwest where Pierce spent her career, she said. She recalled taking a patient to a dock to weigh him because no scale was available in the hospital that could do the job.

Still, she'd never think of saying "no" to helping a fellow nurse move a patient, no matter the toll on her body.

"It's kind of ingrained in you when a colleague asks for help, you go and you help. You don't even think twice because they're in trouble," said Pierce, who works in Nebraska. "We're a team. You don't leave a man down."

The American Nurses Association has been pressing for...

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Thursday, December 26, 2013

You may not be better off after knee surgery

Saturday, December 14, 2013

Fee Schedules and Value

Wednesday, December 11, 2013

Characterizing the quality of supportive cancer care can guide quality improvement of veterans

Tuesday, December 10, 2013

Rehospitalization Rates Fell In First Year Of Medicare Penalties

Wednesday, December 4, 2013

Rare Cancer Treatments, Cleared by F.D.A. but Not Subject to Scrutiny

Wednesday, November 20, 2013

New obesity treatment guideline released

Sunday, November 17, 2013

California sends misinformation to 246,000 new Medicaid enrollees

Wednesday, November 13, 2013

Professionalism and Caring for Medicaid Patients — The 5% Commitment?

Sunday, November 3, 2013

A Vital Measure: Your Surgeon’s Skill

Friday, November 1, 2013

Two Kinds of Hospital Patients: Admitted, and Not

Wednesday, October 23, 2013

Questioning Statins for Older Patients

Tuesday, October 22, 2013

The Great Coronary Angioplasty Debate: Giving Patients the Right to Speak | The Health Care Blog

Friday, October 18, 2013

Huge Differences by Region in Prescribing to Elderly, Study Finds

Friday, October 4, 2013

11 Barriers to Hand Hygiene Compliance

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Thursday, October 3, 2013

Nurses Prone to Injuries With Heavier Patients

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