HCR Tidbits

By John Ballard

Bits that caught my eye. Healthcare reform no longer generates sparks but it's moving along okay. I really like that Swedish notion that the best hospital bed is the one that's empty because it means the system is keeping more people healthy. Seems odd to Americans.

?VA to expand family support, mental-health services. This one jumped out at me because one of my caregiving assignments is a veteran who will require care for the rest of his life due to the removal of a brain tumor believed to have been caused by exposure to a chemical agent in Iraq. 

President Obama signed the Caregivers and Veterans Omnibus Health Services Act on Wednesday, calling the legislation a "major step forward in America's commitment to families and caregivers who tend to our wounded warriors every day." The bill, estimated to cost $3.7 billion over five years, expands veterans' care for women, the homeless and those who live in rural areas. It also provides help to family members who give up their jobs to become caregivers for severely wounded Iraq and Afghanistan veterans.

Caregivers will "receive a stipend and other assistance, including lodging when you travel for your loved one's treatment," the President stated. "If you need training to provide specialized services, you'll get it. If you need counseling, you'll receive it. If you don't have health insurance, it will be provided," Obama said. "And if you need a break, it will be arranged--up to 30 days of respite care each year."

In addition, veterans of the wars in Iraq and Afghanistan, including National Guardsmen and reservists, will receive expanded mental health and counseling services and have access to hospitals outside the VA network for treatment of brain injuries. The law also eliminates co-payments for "catastrophically disabled" veterans, and increases health-related housing and transportation assistance for veterans living in rural areas. And to better to meet the needs of women veterans, the law includes enhanced maternity care and mental-health services for survivors of sexual trauma, plus a commitment to research the effects of war on women's physical, mental and reproductive health.

Meanwhile, investigators have determined several patient deaths at Marion VA Medical Center in southern Illinois in 2006 and 2007 were linked to surgical mistakes by undertrained physicians. As a result, the Department of Veterans Affairs has announced a new rating system that will classify the "surgical complexity" of procedures as complex, intermediate or standard-and puts corresponding limitations on the types of surgeries some hospitals can perform.

Based on its criteria, the VA has authorized 66 hospitals to conduct "complex" inpatient surgeries, 33 hospitals to conduct "intermediate" inpatient surgeries and 13 to conduct "standard" inpatient surgeries. This means that some hospitals will have to defer overly complex cases elsewhere, though the VA will still pay for the operations.

More links at the source to AP and other versions of the story.

?SPOTLIGHT: Sales reps face rising tide of inaccessible docs.
Imagine that. Doctors with less time for drug sales people. I'm not commenting on this because I can't think of anything to say that doesn't come out snarky. Readers can draw their own conclusions.

Pharma sales reps are finding an increasingly hostile world out there. The fraction of doctors willing to meet reps regularly has dropped significantly. And the group unwilling to see reps at all has grown even faster. According to a new report from marketing consultants ZS Associates, only 58 percent of doctors can be described as "rep accessible"--i.e., they meet with at least 70 percent of sales folk who drop by. That's down from 71 percent last year, a drop of almost 13 percentage points, or an 18 percent decline. Meanwhile, inaccessible doctors now account for 9 percent of the total, up from 6 percent last year. That's a 50 percent increase.

?Reality of physician-ownership ban hitting home for hospitals

This one isobviously rubbing a lot of fur in the wrong direction. I'm sure there are compelling arguments on all sides but I come down on the side of having doctors choose between being physicians or business managers. The conflict-of -interest concerns of the AMA are not imaginary.

This issue will not be resolved unless and until everyone understands the difference between professional compensation (which should reward medical professionals as high as the market will allow) and corporate profits, which contribute nothing to healing. 

Again, more links at the source.

Health reform's ban on physician-owned hospitals has so far halted construction on 27 facilities, according to Molly Sandvig, executive director of the Physician Hospitals of America. Another 40 or so physician-owned hospitals are either pushing ahead with construction or have transferred ownership to hospitals, which alleviates the need to be up and running by the Dec. 31 deadline, she adds.

As for the nation's 260 existing physician-owned hospitals, the new law limits expansion and construction, restricts new investments and requires new annual reports to the government, with fines for hospitals that don't disclose physicians' ownership stake on the hospital's website and advertisements.

One of the casualties of the restrictions is McBride Orthopedic Hospital in Oklahoma City, highlighted in an editorial in the Washington Examiner by Rob Bluey, director of the Center for Media and Public Policy at the Heritage Foundation. According to Bluey, the hospital canceled plans for two new operating rooms and a four-bed intensive care unit to supplement its existing 40 acute care beds, 40 rehab beds and six operating rooms as soon as the law was signed. The multi-million dollar project promised to bring competition and more healthcare choices to the community, he says.

And then there's Indiana Orthopaedic Hospital, with 42 inpatient beds and 10 operating rooms on a main campus in Indianapolis. The hospital had spent about $300,000 toward a $47 million expansion and was two-thirds finished with an outpatient facility before halting the construction amid well-founded fears of a federal hold, John Dietz, a spine specialist and chairman of the hospital, told HealthLeaders Media last month. "From the overall perspective, this legislation throws ice water on some of the most valuable and innovative hospitals in the country; they are completely shut off [from the funding]," he said. "These physicians--like us--represent 1 percent ownership-and they have completely turned around many of these hospitals. And that's going on throughout the country."

While supporters of the ban, including the American Hospital Association, say it's necessary to avoid conflicts of interest, physician-owners contend that their vested interest in their hospitals run much deeper than finances. "Our goal is to serve the people sitting in the big hospitals with more dignity and respect--and to get them prompt care," Dr. Yasin Kahn, chief executive of Westfield Hospital in Allentown, Pa., told Bluey, adding that his hospital takes pride in a lower nurse-to-patient ratio than the community hospital and an just a 15-minute wait for the emergency room.

?Colon Cancer Risks Slashed With Single, Five-Minute Procedure
This report is from the UK via Bloomberg, but will appear in The Lancet.
The list of overused tests yielding only marginally helpful results are colonoscopies, which I most recently was instructed to undergo again in the next three years, down from the usual five year interval which was pro forma until recently. The difference between a sigmoidoscopy and a colonoscopy is about two or three feet of colon which are not involved in the former. Next time this matter comes up with a doctor I plan to argue for a sigmoidoscopy unless there are clinical indications that an examination of the entire colon is indicated. The chances of finding colon cancer in that distant region which is not evident in the sigmoid colon are exceedingly small and I'm prepared to take that risk.

A single, five-minute procedure to detect and remove growths from the colon slashes cancer rates by one-third and reduces deaths by 43 percent, researchers said.

The 16-year study involving more than 170,000 people in the U.K. found a simple procedure known as sigmoidoscopy may have lifelong implications for preventing the second-biggest cancer killer worldwide, said lead researcher Wendy Atkin from Imperial College London. More than 1 million people are diagnosed with colorectal cancer each year, and 600,000 die from it. The study results appear today in the medical journal Lancet.

Atkin, a professor of surgery and oncology, said everyone in the U.K. should be offered the exam at age 55, when pre- cancerous polyps are present and not yet deadly. Britons are now given a test that detects blood in the stool to diagnose cancer, a less effective approach that doesn�t prevent disease. The U.S. recommends blood tests, sigmoidoscopy every five years, or more invasive exams known as colonoscopies once a decade.

�It�s extremely rare to see the results of a clinical trial that are as compelling as this one,� said Harpal Kumar, chief executive officer of the charity group Cancer Research UK, at a briefing in London yesterday. �It�s a no-brainer that this has to be introduced. Thousands of lives could be saved every year and tens of thousands of families could be spared the diagnosis of bowel cancer.�

The approach could ultimately save money for the National Health Service by reducing the number of people undergoing treatment for bowel cancer, Atkin said. The researchers didn�t calculate the cost of the procedure, she said. Rolling it out nationwide would require additional training and expanded facilities to accommodate the demand, she said.

The procedure is done using a flexible tube slightly larger in diameter than a ballpoint pen that is threaded through the rectum and the bottom third of the colon, where two-thirds of colorectal cancers and pre-cancerous growths develop. When a growth is detected, it�s either burned off or removed in an additional step that can take four more minutes, researchers said. While it�s not painful and doesn�t require sedation, patients must give themselves an enema before treatment.

In this case the US approach to preventing colon cancer is a model of excellence which the UK should have been doing for some time.But something tells me that our approach has as much to do with generating revenue as preventing cancer. After all, every malignant  discovery is like gold to oncologists. I don't know why we call it FREE enterprise because it's anything but free.