Patients who document their end-of-life wishes using a special medical form get the specific care they want in their final days, according to a study published online in the Journal of the American Geriatrics Society.The study by researchers at Oregon Health & Science University looked at the growing use of the voluntary form, called Physician Orders for Life-Sustaining Treatment, or Polst. The document lets patients request or refuse certain medical treatments such as CPR or intensive care. The study is the largest on the topic so far and the first to look at preferences stated in the form and where people actually die.
As hospital, physician, and health insurance markets consolidate and change in response to health care reform, some commentators have called for vigorous enforcement of the federal antitrust laws to prevent the acquisition and exercise of market power. In health care, however, stricter antitrust enforcement will benefit consumers only if it accounts for the competitive distortions caused by the sector’s long history of government regulation. This article directs policy makers to a neglected dimension of health care competition that has been altered by regulation: the product. Competition may have failed to significantly lower costs, increase access, or improve quality in health care because we have been buying and selling the wrong things. Competition policy makers—meaning both antitrust enforcers and regulators—should force the health care industry to define and market products that can be assembled and warranted to consumers while keeping emerging sectors such as mHealth free from overregulation, wasteful subsidy, and appropriation by established insurer and provider interests.
This article examined the effects of state regulation and civil class-action litigation on corporate compliance with nurse staffing and quality standards, corporate strategies to manage staffing and quality, and corporate financial status of a large for-profit nursing home chain. A historical case study was used to examine multiple public data sources, focusing on facilities in California from 2003 to 2011 during and after regulatory actions and litigation. The results showed that the state issued numerous deficiencies for violations of the nurse staffing and quality standards with minimal impact on quality compliance with state law. A class action jury trial found the chain violated the state’s minimum staffing standard on one-third of the total days during a six-year period and awarded a $677 million verdict. A court settlement and supervised injunction resulted in compliance with minimum staffing and some improvement in quality measures, but quality levels remained below the average California facilities. The litigation also had some negative financial impact on Skilled’s California facilities and parent company. Civil litigation had more impact on the chain than the regulatory oversight.
The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of the world is not using ICD-10-Clinical Modification set, which has 68,000 codes. Only we, in the US, are considering that. The Canadian version of ICD-10 has about 16,000 codes, but the physicians do not use those codes for billing and reimbursement. They use a more limited code set of about 600 three-digit codes. Let me repeat this: The WHO version of ICD-10 that the rest of the world uses about 16,000 codes. Our version, developed jointly by the CDC and the American Hospital Association has 68,000 codes.
Forty-five of 50 states – 90 percent – fail to adequately make price information available to their consumers even as the Affordable Care Act, employers and insurance companies push for greater transparency, according to a new analysis.
In their “Report Card on State Price Transparency Laws,” the nonprofit Health Care Incentives Improvement Institute and Catalyst for Payment Reform, gave 45 states a failing grade with the highest grades awarded to Maine and Massachusetts, which each received a “B.” No states received an “A.” States with high grades generally share information about inpati
New Jersey has been losing hospitals for more than two decades; 26 have closed in that time, many in poor, urban neighborhoods that are left with an empty shell where a hospital once stood.
But in recent years, a few developers have purchased some of these abandoned structures, reopening them as private medical complexes that offer many of the services the hospitals once provided.
Examining the same categories, Baptist conducted a financial analysis of two years worth of 835 and 847 data across 3 inpatient and 2 oupatient facilities, involving more than 1 million claims. “The amount of data we had was far more impactful when you actually slice and dice it,” said revenue cycle director Jeri Pack, adding that it found the most commonly used ICD-9 diagnosis codes will “explode” 5 times and procedure codes 20 times when ICD-10 takes hold, representing a $1.1 million reimbursement variation.
Health-care organizations increasingly are having trouble protecting data because medical equipment, such as dialysis and imaging machines, can be serviced through the Internet. That often is so the machines’ software can be administered or updated remotely. There also are many more entry points where cybercriminals potentially can enter a health-care facility to try to access electronic medical records or billing systems, which have credit-card data.
The push to digitize medical records means that a treasure trove of data is online for hackers to target.
Armed with administrator passwords, for example, it would be easy to gain entry into the network of a health-care facility and install malicious software designed to capture passwords to the medical-records database, said John Pescatore, a director at the SANS Institute, a cybersecurity research and educational organization. He didn’t given any example in which such a breach had occurred….
Medical records sell for about $60 apiece on the black market, while credit-card information typically goes for about $20, said Sam Glines, the CEO of NorseCorp. Medical records are “more valuable because you can do more with it, including Medicare fraud and prescription fraud,” he said.
“The bad guys in the cyberuniverse have definitely set their sights on health-care records,” said Larry Ponemon, chairman of the Ponemon Institute, a privacy and data-protection research firm.
The Cost of ImplementingICD‐10forPhysicianPractices–Updating the 2008 Nachimson Advisors Study: AReportto theAmerican Medical Association (February 12, 2014)
Typical Small Practice: $56,639 ‐ $226,105
Typical Medium Practice: $213,364 ‐ $824,735
Typical Large Practice: $2,017,151 ‐ $8,018,364
Two policies would address the shortfall of kidneys in the U.S.: instituting a priority-scoring system for donors and their kin and paying donors.
Israel pioneered the former in 2012. Prioritizing organ allocation by donor status—a system that economist Alex Tabarrok termed “no give, no take”—incentivized people to register as organ donors. It also removed a hurdle to living donation: The incentive to abstain because of a hypothetical (What if my son needs a kidney?) went away since the policy guarantees that a donor’s kin will be prioritized in the event that they need a transplant. The results? Both living and deceased donations have gone up, and the number of people who have died on the waitlist fell by 30% between 2010 and 2013.
To obviate the kidney shortage, we should heed the recommendation of Nobel Prize-winning economist Gary Becker and others by making it legal to compensate donors. Currently, the National Organ Transplant Act bans the “sale” of any human organs in the U.S. Those who oppose compensation object to its ramifications for donors and society. They argue that the poor will be exploited, and that people should give out of the goodness of their hearts.
But these lofty sentiments ignore the fact that 18 transplant candidates die each day. As the legal scholar Richard Epstein has put it: “Only a bioethicist could prefer a world in which we have 1,000 altruists per annum and over 6,500 excess deaths over one in which we have no altruists and no excess deaths.”