We neglected to note another bill, with the substance of the legal changes. Go to the same links for the Senate or Assembly and read, if you dare: S.3668 or A.6842.
It's a couple hundred pages, so it may take a while to connect.
By the way, if you've never looked at something like this, you might want to take a glance just to get a sense of what it's like. Go through and pick a section at random and actually read it. Never mind the politics and the negotiating, the shear logistics of putting something like this together are often daunting. And it usually happens when the staff who do the drafting are already exhausted.
Lack of communication of test results and other clinical information
There's a mathematical formula here someplace. It's simply matter of probabilities. Absent a very timely, effective (and, we hope efficient) system for passing information automatically with each handoff, the cumulative effect of lost, distorted, or misinterpreted information compounds with each handoff.
Let's assume that the first node of the system (say a physician) has perfect information regarding the patient. The greater the number of nodes and the greater the number of handoffs, the greater the risk that the last node will have less than perfect or timely information. Of course, the last node might be the same as the first node (i.e., physician to lab and back to physician). That's just the kid's game of telephone.
Let's assume that in each handoff the probability of passing information perfectly to the next node (say a lab) is 99 percent. Then the probability that the third node (two handoffs) will have perfect information is 98.01 percent (1 percent lost at each handoff). By the time, we get to the fifth node (4 handoffs), the probability that we have perfect information is 96.06 percent.
Now let's assume that the probability of passing information perfectly to the next node (say a lab) is 95 percent. Then the probability that the third node (two handoffs) will have
perfect information is 90.25 percent (5 percent lost at each handoff).
By the time, we get to the fifth node (4 handoffs), the probability
that we have perfect information is 81.45 percent. Now assume that this is your healthcare personally
None of this takes into the account the:
Probability that cases which require more handoffs are likely to be more complex, the uncertainty regarding the information to be greater, and the patients more at risk. Nor does it take into account that the less than perfect information conveyed at a handoff could not merely be lost, but wrong in a way that worsens the patient's condition.
Cost of ensuring that information is passed cleanly and quickly at each handoff
Risk to the entire system of weak information handoffs at a particular point in the process, especially early in the process.
Likelihood that passing information between organizations (say a nursing home to a hospital and back) is slower and more prone to loss and distortion than passing information within a single organization
Designing good information flows is the heart of designing effective organizational systems and processes. This is not mere documentation for legal self-protection. It's good medical care.
CareFirst, the Maryland/Washington, D.C., Blue Cross health plan has started a program to pay physicians for installing and using electronic patient records.
The effort is tied into Bridges to Excellence. Rather than focusing on the diabetes or cardiac care options in that program, CareFirst chose to focus on the "Physician Office Link," by way of records and information systems. Here's the BTE release with some more background.
Want to plow through a couple hundred pages of legislation?
Determined to finish on time for a change, New York's State Legislature has an agreed upon a Budget Bill ... agreed between the houses that is. The Governor is still not pleased and retains the option to item veto whatever the Legislature adds.
Go here and look for A554C or here and look for S554C. If you're at this site, you're probably looking for the Health and Mental Hygiene bill. But if civic duty or curiosity compels, look at some of the others too. If it's your first time, it'll probably come across as dry, as in arid. But there's real stuff in there.
When I just checked the "C" version wasn't up yet. But it should be fairly soon.
I've avoided posting on the recent release of the Social Security and Medicare Trustee's annual reports. It's the wonky part of me that feels compelled to actually read them before doing so. Here are the summaries and here's where you can get the reports.
What will catch your eye first is the longer range projections. But note how soon Medicare overtakes Social Security, accounting for a larger portion of gross domestic product (GDP). It's less than twenty years.
Note also the long range projection of Medicare costs as a percent of GDP (13.7). We talked last year at this time about projections and forecasting that far into the future is a dicey thing. But spending 13.7 percent of the nation's economy on Medicare? That's quite a chunk. Even if one assumes that the proportion of GDP spent on the rest of healthcare remained constant (a highly dubious proposition), one-quarter of our economy would be spent in healthcare.
There's nothing intrinsically bad about any particular percentage of GDP being spent on healthcare generally or Medicare in particular. And we should assume that if and as we become more prosperous, we will spend more. However, there is a threshold or a range of thresholds at which the rest of the economy pushes back hard. That's going to happen long before these projects come to pass. Indeed, it's already begun.
What a surprise, right? The "Medicare Modernization Act," that gives us the new pharmaceutical benefit may cost the states money.
The simple version:
Lots of Medicaid clients are also Medicare clients.
Lots of these "dually eligible" folks are sick and use lots of pharmaceuticals.
This is especially so for those in nursing homes
So when the Federal government created the new pharmaceutical benefit, it recognized that it would be paying for drugs that were previously being paid for under Medicaid. That would simply have shifted the cost from states to the Federal government
To offset that effect, the new law includes a provision (tenderly called the "clawback") that establishes a formula by which the states pay the Federal government
Turns out the formula works against some states generating a net cost. It may even create the biggest disadvantage for states that had created the most cost-effective programs.
There may even be Constitutional issues regarding the Federal government's requiring states to pay for a Federal benefit in which they do not otherwise participate.
Maybe the Governors could take some lessons from county officials in New York.
The doc then goes into hiding. The patient, Ms. Cregan was from Ireland leading the Irish Medical Council to express concern about the
regulations governing the establishment and operation of cosmetic
surgery clinics in Ireland.
So we wander over to New York's Physician Profiling System and we look up Dr. Michael Evan Sachs, license number 131958 (issued in 1977).
And we find one judgement from 2001 and 32 settlements from 1995 to 2003. All of the payments are "average" or "below average."
And in particular we look for any restrictions on this practice. Here's what we find, updated a mere five days before the surgery on Ms. Cregan:
Dr. Sachs shall be precluded from performing complex nasal
procedures except when assisting, or assisted by, a surgeon who is
either Board-Certified by the American Board of Plastic Surgery, Inc.
or Board-Certified by the American Board of Otolaryngology and who has
completed a fellowship in facial-plastic surgery, and who has at least
ten years of experience and expertise in performing such complex
procedures. For purposes of this limitation, the term "complex nasal
procedures" shall mean those requiring multiple operations (more than
two planned procedures) and serial reconstructive procedures, include
those involving congenital malformations.
This limitation shall not preclude him from performing, without such
assistance, routine nasal-septal procedures, including but not limited
to routine nasoplasties, open rhinoplasties, and cartilage or synthetic
grafts for structural and functional purposes.
We find the same text at the State's Office of Professional Conduct and we find that he did not contest the charge of negligence in a prior case nor challenge three years of probation. We also find the legal Consent Agreement(PDF) stipulating the restrictions on his practice and indicating negligence on multiple treatments of a single patient. It's legalese and not revealing. You try to imagine what's between the lines.
Neither regulatory oversight, nor professional colleagues, nor the threat of lawsuits and high liability premiums (which probably were considered just a part of doing business), prevented this loss. Yes, there might have been a prior condition (though, if so, it would have been nice to know wouldn't it). But even if that's the case, doesn't it seem like there might be a pattern here?