Insurance companies profiting from Americans avoiding the hospital

It seems that Americans' use of doctors and clinics has dropped with the economy still at a low point, health insurers say, in a trend that keeps the companies' costs down and could bolster their profits further this year. This is crazy, so when we all don't have money the health insurance companies rake in the profit BUT still increase our monthly premiums.

Thanks to this health insurers are posting first-quarter profits well above analyst forecasts earlier this year.

The companies have been factoring increases into their pricing for their plans, but executives at an investor conference this week said utilization continued to stay low. Why.... so you make more money and decide to incresae premiums to make EVENR MORE MONEY.... Greedy!!

"Medical costs have not come back to trend levels we anticipated," UnitedHealth Group Inc, CEO Stephen Hemsley told the conference, held by Sanford Bernstein.

"But to date whether it's driven by economic trends or whatever, the medical costs continue to trend to be more moderate," Hemsley said...... Wow, this guy puts me to sleep with every word out of his mouth.... all I hear is blah, blah, blah......

In the past, McCallister said, some (so just a hadnful??) health insurers have failed to anticipate a rebound in medical costs, and priced plans too low -- hurting results and investor confidence.
"The utilization is still relatively softer than we would have expected, no one knows when and if it is going to come back," McCallister said. "We're basically assuming that it's coming back because we're not going to miss that uptick."

Some analysts have suggested that the lower-than-expected utilization is a more fundamental change rather than a fleeting one. Due to structural changes in healthcare plans over the years, such as higher co-pays and other fees, consumers have steadily borne more of the healthcare costs.

"Typically, when people come back to work they then use health care services," Gellert said. "But in California if you're at 11.5 percent unemployment, I'm not sure that's the time you think about getting off your job and doing elective procedures."

I guess when you're having problems paying the mortgage getting botox or breast implants just don't seem that important.  I can understand why elective surgeries are down.

5 solutions to alarm fatigue in todays hospitals

When my wife had a baby the monitors kept not registering the baby's heartbeat and nobody seemed to care.  When they changed shifts and the new nurse came in to check the connections he instantly decided on an emergency C section.  This is a MAJOR problem.  This incident was a  perfect example of alarm fatigue. Was the equipment unreliable? Did nurses not have time to constantly adjust or readjust faulty equipment? How can we fix this problem?  Let me tell you 5 ways that can help:

1. Simpler monitors that are easier for even the patient to understand
Example - Fukuda Denshi Patient Monitors measure, record and display a patient’s vital signs, including heart rate, blood pressure and respiration. Patients most often wear simple measuring tools, such as blood pressure arm cuffs and oxygen finger clips, though the new system is also compatible with more invasive direct line equipment.

Even the colorful display screens are a help to staff, who report they can read data easily from the new monitors. The touch screen interface allows staff to quickly input or retrieve patient information. Since the system is networked, staff can check on a patient’s status from any of the monitors throughout the facility, from the operating room to the medical surgical wing to the emergency room. Respiratory department director Scott Briggs, CRT, says he appreciates that he can now keep track of patients throughout the hospital even while he works with individual patients in his office.

A network of remote transmitters and receivers allows patients to travel the entire length of the hospital with mobile monitors.

2. Create a secure phone app for the doctors and nurses
Imagine an iPhone app that allows nurses and doctors to see all of the patients info at a glance from anywhere they are.  They already have systems that integrate with the iPad or iPhone.  Create a custom app made just for hospitals to give every one access to anyone vitals at the touch of a button.

3. Create mobile based systems that begin reporting even when the ambulance is in transit
The Management of Fasmicro and Microscale Embedded are proud to announce that our Mobile-Based Integrated Heart Monitoring System will be ready by June 2011. This product will enable doctors and hospitals obtain heart beat or professionally ECG signals of patients remotely.  It will also monitor blood pressure, temperature and other medical data.

4. The use of wireless monitors to prevent cable disconnects:
In a paper written by Washinton University Departments titled: Reliable Clinical Monitoring using Wireless Sensor Networks: Experiences in a Step-down Hospital Unit, it revealed that the sensing reliability could be
significantly improved through oversampling and by implementing a disconnection alarm system that incurs minimal intervention cost. A retrospective data analysis indicated that the system provided sufficient temporal resolution to support the detection of clinical deterioration in three patients who suffered from significant clinical events including transfer to Intensive Care Units. These results indicate the feasibility and promise of using wireless sensor networks for continuous patient monitoring and clinical deterioration detection in general hospital units.

Collecting vital signs in general hospital units poses unique challenges that are poorly addressed by existing commercial telemetry systems. In contrast to cardiac or epilepsy care which require high data rate EKG, EEG, or acceleration measurements, the collection of vital signs1 requires low data rates.

In spite of the numerous patient monitoring systems that have been developed, they are seldom evaluated with real users and real-world deployment. The evaluation of most systems does not focus on reliability and is usually performed in laboratories rather than in healthcare environments. However, there are a few notable exceptions. The MEDiSN and SMART projects focus on monitoring patients waiting in emergency rooms.

5.  Reduce False Alarms
I think this is the biggest of all of them.  As stated in the medical article "Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms" the sheer number of false alarms desensitizes the staff to any alarm. Cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur.

A 2006 American College of Clinical Engineering survey of more than 1300 health care professionals showed that a large percentage of respondents believed that what are commonly called “nuisance” alarms occur frequently (81%), disrupt patient care (77%), and can reduce trust in alarms, causing clinicians to disable them (78%). In other studies, researchers have reported a high percentage (86%–99.4%) of false-positive alarms produced by physiological monitors, stating that alarms result in a change in the management of the patient less than 1% of the time.

Nurses in intensive care units stated that the primary problem with alarms is that they are continuously going off and that the largest contributor to the number of false alarms in intensive care units is the pulse oximetry alarm. “Smart alarms,” which analyze multiple parameter changes in a patient’s condition, may be a solution, but not all monitors currently in use have such features.

False flatline Medical Alarm

If you want to learn more about the background of alarm fatigue click here at "A Patriotic Nurse".

Should state medical boards do more to punish bad doctors?

State medical boards failed to discipline 55 percent of the nation's doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked, according to an analysis by Washington-based Public Citizen. Would this have kept Michael Jackson alive?

Dr. Conrad Murray failed to notify the Nevada State Board of Medical Examiners that his child support payments were in arrears as required when he renewed his medical license in 2007 and 2009, according to the California board’s public letter of reprimand, filed Friday and made public Monday.

The letter noted that Murray’s actions constituted a violation of California law concerning “unprofessional conduct,” grounds for a reprimand.




State Medical Boards not doing enough?


A public reprimand is a lesser form of discipline doctors can negotiate for minor violations to avoid formal charges.

Murray has pleaded not guilty to involuntary manslaughter charges in connection with Jackson’s death.

Jackson died June 25, 2009, of an overdose of the surgical anesthetic propofol, which Murray has acknowledged using to treat his insomnia. Murray’s lawyers have suggested Jackson injected or drank a fatal amount of the drug when the physician wasn't looking. Prosecutors contend that Murray violated the standards of medical care by administering the drug improperly and concealing his actions after the singer died.

The group, Public Citizen, founded by Ralph Nader, came up with the figure by analyzing the public-use file of the National Practitioner Data Bank from its inception in 1990 to 2009. (The data bank was established by Congress in 1986 so doctors would not be able to hide malpractice, or actions by hospitals, licensing boards or professional societies. Although names in the databank are not open to everyone, they can be accessed by hospitals, and some medical practices and government agencies.)

During those two decades in Missouri, 96 out of 181 doctors with at least one clinincal-privilege action had no action taken against their license -- or about 53 percent. In Illinois, that was true of 215 of 328 doctors, or 66 percent.

"One of two things is happening, and either is alarming," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group and overseer of the study. "Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed."

The Public Citizen report notes that a doctor "must have serious deviations of behavior or performance to warrant clinical privilege actions."

Public Citizen previously reported that from 1990 to 2007, nearly half of hospitals had never made a databank report.

Now, the group says that of 10,672 physicians listed in the NPDB for having clinical privileges revoked or restricted by hospitals, just 45 percent of them also had one or more licensing actions taken against them by state medical boards.

That means 55 percent of them - 5,887 doctors - escaped any licensing action by the state. The study examined the NPDB's Public Use File from its inception in 1990 to 2009.

Public Citizen said it sent the report to Kathleen Sebelius, Secretary of the Department of Health and Human Services, for further investigation, and notified the 33 medical boards that had the worst records in disciplining these doctors.

Here is a case where the state board is not doing enough:

Authorities say Dr. Tyrrell prescribed more than one 1,000 Demerol and Oxycontin pills to 35-year-old Tammy Daniels last year. Investigators say Daniels died of an overdose after crushing and injecting Demerol.

The Oklahoma state medical board has now suspended Dr. Mickey Tyrrell's medical license for 30 days, and temporarily restricted his practice to pre-natal and obstetrics.

Dr. Tyrrell also has to pay a $25,000 fine and do 200 hours of community service.

The medical board did not put any restrictions on his ability to write prescriptions.

Is this enough?

Is it medical malpractice when the equipment or supplies are defective?

Medical malpractice? “Would you consdier it medical malpractice to leave a patient in unearthly pain for 16 out of 18 hours? Maybe. The hospital has a duty to their patients to provide them with the proper care. It’s evident they did not check the pain pump for one such lady. Medical malpractice to use defective equipment? Possibly. It is the hospitals responsibility to use equipment in good working order,” this Dr said. “Additionally, with defective medical equipment and devices, some states have charitable immunity laws which protect/insulate hospitals from liability. This is something that needs to be looked into with every defective equipment claim.”

Generally speaking, it must be shown that
1. a significant injury occurred to the patient,
2. the doctor or hospital staff performed in a way that was not up to the standard of care expected from such a medical professional, AND
3. the lack of care or medical mistake directly caused the injury suffered by the patient.

House never cares about medical malpractice

This case is like a surgeon using a defective hip replacement implant. When it gives out, the patient may sue for medical malpractice, as the surgeon should have known the implant was defective. It is a situation that needs to be taken to a New Hampshire injury lawyer to find out what legal rights are applicable, what may be done to recover or mitigate expenses and whether or not med mal is present.

“There are instances where a bad outcome with a doctor is not the result of medical malpractice. There are also many instances where a plaintiff does not want to sue the doctor, but is okay with suing the maker of the medical product that failed. This gives the victim another option to recover compensation for their injuries,”

Michael Jackson's death was not an accident

Right before Michael Jackson was to debut his "This is It" comeback tour, it seems a doctor decided to take his life, or so the authoriteis believe. Authorities contend Murray gave Jackson a lethal dose of the powerful anesthetic propofol and other sedatives in the bedroom of his rented mansion before he died on June 25, 2009. Deputy District Attorney David Walgren said in his opening statement that Jackson was already dead when Murray summoned help and tried to conceal his administering of propofol to the pop star, ordering a bodyguard to collect items before paramedics were called.

Michael Jackson's casket at his funeral in 2009

Later in the hearing, Ortega testified that Jackson had gone home early from rehearsals on June 19.

A judge stripped Dr. Conrad Murray of his medical licence Tuesday after ruling that prosecutors have sufficient evidence to try him for manslaughter in the death of pop star Michael Jackson.

Los Angeles County Superior Court Judge Michael Pastor said testimony presented during a six-day hearing into Murray’s treatment of the singer had convinced him that allowing the cardiologist to keep his licence “would constitute an imminent danger to public safety.”

Evidence presented by prosecutors, the judge said, showed “a direct nexus in connection between the acts and omissions of Dr. Murray and the homicide in this case,” the judge said.

Pastor’s decision to send the case to trial was widely expected, including by Murray’s attorneys, but his defence had strongly contested the loss of his licence, calling it a “nuclear option” that would destroy the 57-year-old doctor’s ability to support his family and mount a criminal defence.