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Do Patients Feel Better in Redesigned Hospitals/Rooms?

August 27, 2014
Butaro District Hospital in Rwanda, photo from MASS DESIGN GROUP.

Butaro District Hospital in Rwanda, photo from MASS DESIGN GROUP.

Often ignored by front-rank architects, left to corporate specialists who churn out too many heartless buildings, hospitals are a critical frontier for design, for exterior design as shown in the photos included here, individual room layout, and overall hospital layout.

As an example of the impact of interior changes, after months of testing a new room layout at the University Medical Center of Princeton, patients in the model room rated food and nursing care higher than patients in the old rooms did, although the meals and care were the same.

Some innovations are logical and even seem obvious, and some do have their downside: patients in single rooms are likely to share more information with the medical staff more quickly than those in double rooms, so the Princeton plan opts solely for single rooms, though this increased the building’s overall size, thus forcing a larger separation between certain departments and thereby requiring new methods of internal communications. The new rooms include a sink positioned in plain sight, so nurses and doctors will be sure to wash their hands, and patients can watch them do so. A second sink is in the bathroom, which is next to the bed, a handrail linking bed and bathroom, so patients don’t have to travel far between them and will fall less often.

But the real eye-opener was this: Patients also asked for 30 percent less pain medication. Reduced pain has a cascade effect, hastening recovery and rehabilitation, leading to shorter stays and diminishing not just costs but also the chances for accidents and infections.

Redemption Pediatric Hospital, Monrovia, Liberia. Photo from MASS DESIGN GROUP.

Redemption Pediatric Hospital, Monrovia, Liberia. Photo from MASS DESIGN GROUP.

Health care is a trillion-dollar industry just discovering the medical and economic benefits of better design. “It’s a significant part of our G.D.P.,” noted Christopher Korsh, the principal architect on the Princeton project. “Patients now say they won’t come to a facility because they don’t like it, and if there’s a building that can save 2 percent on the cost of delivering health care, that’s huge. Plus good design really can make you better faster.” Read more…

$1,600 for a Diaper Rash Treatment?

August 20, 2014

compounded drugsAlarmed by a rapid increase in spending on compounded drugs, like a $1,600 baby balm, insurers and others are acting to control their use.

Drug compounding involves a pharmacist making medicines for a patient who cannot be helped by mass-manufactured drugs. Compounded drugs do not require FDA approval, though Congress recently has moved to enact regulatory legislation. They might be used when a patients is allergic to an ingredient in a commercial product, or a patient needs a liquid formulation of a medication rather than it being in pill form.

Pharmacy benefit managers say there is scant evidence that these combinations of ingredients are safe or any more effective than conventional drugs. Express Scripts, the largest PMB, has said it will stop paying for more than 1,000 ingredients used in compounding, cutting spending by its health plan clients on such medicines by 95 percent. It said such spending had grown to $171 million in the first quarter of this year from $28 million in the first quarter of 2012.

When Posting Baby Photos Became Illegal

August 14, 2014

blurred baby photoThough no identifiers such as names or contact information are included, it is illegal for doctors and midwives to post photos of the babies of their patients on their office wall, though this has been a common practice since not long after the advent of photography.

Under HIPAA (the Health Insurance Portability and Accountability Act), baby photos are a type of protected health information, no less than a medical chart, birth date or Social Security number, according to the Department of Health and Human Services. Even if a parent sends in the photo, it is considered private unless the parent also sends written authorization for its posting, which almost no one does. A thoughtful piece in The New York Times mulls over this and is worth the read for those involved with protecting health information. The comments are thought-provoking as well, such as this one:

“Yes, the HIPAA privacy rules do forbid public displays of baby pictures. That’s perhaps too bad, but it’s not life threatening.

“The real problem with the HIPAA privacy regulations is that while they do address a real issue – the use and often abuse of private medical information for non-medical purposes (for example marketing), the rules have brought about a much more serious problem: the frequent inavailability to legitimate health care providers of important medical information regarding patients, information these doctors (and other providers) need to make urgent, life saving, medical decisions.

“The HIPAA rules and data security requirements are well intentioned, but complex and difficult to implement, and the penalties for non-compliance severe. In the real world it’s hard for the custodians of medical data (such as hospitals) to prohibit unauthorized access, while at the same time permitting it for care providers with a real need to know. And sometimes medical care suffers as a result. The security requirements can be particularly troublesome, as it’s hard with present technology to implement data security that is both secure and functional.

“HIPAA regulations will probably some day find the right balance. But we’re not there yet. And medical care is sometimes shortchanged as a result.”

Certainly the IME and peer review industry has been impacted in recent years, as has the larger world of health care and insurance, with ongoing focus and concerns on maintaining data security, to where it is a cornerstone of providing quality services to claimants. As this reader notes, it is important to remember what the purpose of these industries is—providing for the health of the patient—and to ensure our procedures all work to this end.

The Happiness Calculation for Smokers

August 11, 2014

happy smokerHow do you quantify happiness levels? The question has relates to a longstanding requirement — first codified under the Clinton administration — that every set of federal regulations with more than a $100 million effect on the economy needs an analysis to prevent the adoption of regulations with high costs and low benefits.

Now it is being applied to the government’s new tobacco regulations proposed this past April, specifically to a cost-benefit calculation which assumes that the benefits from reducing smoking — fewer early deaths and diseases of the lungs and heart — have to be discounted by 70 percent to offset the loss in pleasure that smokers suffer when they give up their habit.

Is this a problem? Well, yes, according to many, as the proposed regulations could water down the agency’s ability to regulate tobacco products. If the formula for assessing costs and benefits remains unchanged in the final version of the regulations, it could set a dangerous precedent that would constrain public-policy making for years to come.

“This is the single biggest obstacle facing the F.D.A. in executing the job Congress gave it,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group. “There’s no way the F.D.A. can do its job if this is applied.”

An F.D.A. spokeswoman, Jennifer Haliski, said that there was “still a great deal of uncertainty” surrounding the calculation, and that the agency was helping fund research to explore the issue. So far the Food and Drug Administration has received at least 69,000 public comments on the new regulations, some quite high profile. Earlier this month a group of economists, including one Nobel Prize winner, weighed in, asking that the calculation be changed before the ruling takes effect. Read more…

What Happens When Hospitals Buy Clinics?

July 31, 2014

imagesCA3GGAU0One thing that happens is that the prices increase for services at these clinics. According to hospitals, one reason is that because hospitals (unlike individual doctors) must maintain 24-hour emergency room coverage and cannot turn away patients, they need to raise revenue elsewhere to help absorb this expense. Thus hospitals charge higher rates for many items than do private practices. Nationally, hospitals are buying more and more clinics, where they are also charging higher rates.

As the Affordable Care Act attempts to steer people away from pricey inpatient admissions, hospitals have begun buying up doctors’ offices in hopes of increasing their revenue and market share. The number of oncology practices owned by hospitals, for instance, increased by 24 percent from 2011 to 2012.

Cancer drugs often double in price when hospital systems charge for them. A treatment of Herceptin, a breast cancer drug, costs private insurers $2,740 when used in an independent clinic and $5,350 in a hospital outpatient setting, according to an analysis of 2012 claims by PricewaterhouseCoopers’ Health Research Institute. The price of Avastin increased from $6,620 to $14,100 when used in a hospital setting, the Health Research Institute says.

In some instances conflicts have arisen between insurance companies and hospitals over how much to pay for treatment. In one case, the insurer says reverting to lower payments for roughly 20,000 Pennsylvania chemotherapy patients should $200 million a year.

Steven Weiss, spokesman for the American Cancer Society’s Cancer Action Network, said in an e-mail. “For years, patients have paid different prices for the same procedure or drug, depending on where they are treated,” he said, and “long-standing trends like this one continue to threaten patient access to lifesaving care.” Read more…

Munchausen by Proxy and Social Media

July 25, 2014

Munchausen imageby Laura McFarland, Communications Director

As the mother of two small children, this is the kind of article I’d prefer to skip over and never have to know about. This past January Garnett-Paul Spears, aged 5, died from sodium poisoning. His mother, Lacey Spears, has been charged with committing depraved murder and manslaughter in the case.

Munchausen by Proxy Syndrome, a disorder wherein caretakers purposely harm children and then bask in the attention and sympathy, has not been specifically mentioned by the prosecutors though “Spears fits the pattern” of such caregivers as noted by some experts.

Dr. Marc Feldman, a psychiatrist and forensic consultant in Birmingham, Alabama, who wrote the book Playing Sick, said he believes the Internet has contributed to the number of Munchausen by proxy cases, with its quick and easy access to a potentially huge, sympathetic audience. One study estimates there are more than 600 cases a year in the U.S. alone. For example, doctors at Seattle Children’s Hospital found three cases of mothers who falsely blogged that their children were near death and were rewarded with support. In a 2011 case in Great Britain, a childless 21-year-old woman joined an Internet forum for parents, claiming to have five children and chronicling her nonexistent baby’s battle with celiac disease and bacterial meningitis. Most cases rarely end in death; when a death occurs, it’s because of a miscalculation, Feldman said. “It would defeat the purpose to kill the child.” Read more…

Trying to Bring Down Oz

July 22, 2014

snake oilConcerned with the public health impact of Dr. Mehmet Oz’s health advice, in 2013 University of Rochester medical student Benjamin Mazur asked state and national medical associations to take action. However, though for over a hundred years the federal government has passed legislation and created agencies to prevent consumers from being deceived or harmed by “bad medicine,” the situation is a complicated one. For instance, though the Federal Trade Commission has the legal authority to prosecute people who mislead and injure consumers, they can’t do anything about Oz since he’s not actually selling the products he talks about.

With regard to his concerns, Mazur noted: “I’m definitely not the only one.”  Sen. Claire McCaskill, for instance, told Dr. Oz during a Capital Hill hearing: “The scientific community is almost monolithic against you in terms of the efficacy of…three products that you called miracles.”

Mazur explains his concerns:

This issue was brought up by a number of physicians I worked with during my family medicine clerkship. We had all of this first-hand experience with patients who really liked his show and trusted him quite a bit. [Dr. Oz] would give advice that was really not great or it had no medical basis. It might sound harmless when you talk about things like herbal pills or supplements. But when the physicians’ advice conflicted with Oz, the patients would believe Oz.

Mazur is not entirely anti-Oz, of course; as he explains, “I would probably say that he does have the health interest of his viewers in mind. But in the long term, undermining good science and the relationship patients have with their current physicians is probably doing much more harm than good. If they’re not going to listen to advice from physicians—who are providing good, evidence-based advice—if they’re going to listen to other doctors on the show, it’s going to do more harm than good.” Read more…

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