Working your way through the large CMS Provider Charge Data file will take a bit of time and effort, but it’s certainly a gold-mine of comparitive costs. Charges for the top 100 DRGs with and without major complications / comorbid conditions, is searchable across locations and organizations. Downloadable as an Excel or comma delimited file.
19 Action News Reporter Bill Safos has covered Amanda Berry’s disappearance since the beginning. He grew very close with the Berry family, and Amanda’s mother, Louwana. In fact, Bill’s shirt and tie were a gift from Louwana. Before she passed away, she bought the clothes for Bill and made him promise that he wear them on “the day Mandy comes home.”
It was a promise Bill was more than honored to keep today.
Bloodless medicine programs have been formed in hundreds of leading hospitals around the globe in the last 20 years. Initially established to meet the needs of patients who decline transfused blood for religious or personal reasons, as healthcare consumers become more educated a growing number of patients are now requesting care without the use of donated blood whenever possible.
What lessons in blood management have we learned during the past two decades?
Transfusion triggers have been lowered.
In 1998 the “10/30 rule” (i.e., RBC transfusion indicated below a hemoglobin concentration of 10 g/dL or a hematocrit of 30%) was standard in most hospitals. “There is now increasing evidence that RBC transfusions are associated with adverse outcomes and should be avoided whenever possible.” 1
Most hospitals now use a transfusion trigger of around 8 g/dL hemoglobin.
The value of treating pre-operative anemia is more recognized
Studies have indicated that nearly 50% of patients entering an OR may be anemic at the time of incision.
An article in The British Medical Journal stated “Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value.” 2
It is important to know your hemoglobin level, just like you know your cholesterol and blood pressure numbers.
Many hospitals are moving toward patient blood management
An advisory committee of the US Department of Health and Human Services issued a letter in 2011 that stated, in part, “Blood transfusion carries significant risk that may outweigh its benefits in some settings and add unnecessary costs. Improvements in rational use of blood have lagged behind improvements in the quality and safety of the products.” 3
Organization-wide patient blood management incorporates lessons learned in managing the care of bloodless medicine patients into improved care for all patients.
- Anemia and perioperative red blood cell transfusion: a matter of tolerance. Crit Care Med 2006 May;34 (5 Suppl):S102-8. PMID:16617252
- Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines Br. J. Anaesth. (2011) 106 (1): 13-22. doi: 10.1093/bja/aeq361
- US Department of Health and Human Services Advisory Committee on Blood Safety and Availability www.hhs.gov/ash/bloodsafety/advisorycommittee/recommendations/reommendations_201106.pdf
Healthcare transparency took a step forward this week. The Association of Health Care Journalists (AHCJ) and the Centers for Medicare and Medicaid Services (CMS) have collaborated to bring HospitalInspections.org online.
The searchable database contains information about serious federal safety rule violations in U.S. hospitals since January, 2011. It does not contain hospital responses to deficiencies cited during inspections. Those can be obtained by filing a request with a hospital or the U.S. Centers for Medicare and Medicaid Services (CMS).
Searching is free.
One example documents a lengthy trail of CMS interviews with hospital personnel related to a patient’s complaint regarding a grievance letter to which she had received no response..
“An interview was conducted with S2 Divisional Director, Regulatory Management on 9/19/12 at 9:05 a.m. She reported the hospital was unable to locate what happened to the grievance letter after it was signed for on the loading dock. Also the hospital has been unable to locate the letter sent by regular mail by the mother of Patient #7.
Review of the policy titled Patient Rights, Complaint, and Grievance Process, policy reference # OrgClin/020, revealed in part, ” …All expressed concerns regarding care or treatment are entered into the approved complaint tracking software program …”
Example: Environment of Care / Fire Safety
“The inspector observed, while accompanied by the Plant Manager during the hours of the inspection from 8:00 am to 9:45 am on 7/24/2012 that the fire doors going into the generator room had the closers removed and the doors were propped open. The doors must be self-closing. If the facility requires the doors to be open, they must be placed on hold opens that will release with activation of the fire alarm.”
The site also has a list of states that post their hospital inspections online.
Kaiser Health Plan reports on a long-festering problem that many hospitals have been reluctant to address: disruptive and often angry behavior by doctors. Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren’t moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions.
Experts say that doctors’ bad behavior is not merely unpleasant; it also has a corrosive effect on morale and poses a significant threat to patient safety.
To be fair to physicians, bad behavior is not limited to them. Administrators, nurses, and others can also subject co-workers and subordinates to what could only be termed as work-place bullying. Physicians, however, impact patient care in ways that others do not. When those caring for a patient hesitate to call a physician about care concerns for fear of being subjected to a wrathful outburst, hospital and medical staff leadership must act.
The Centers for Medicare and Medicaid Services (CMS) issued a proposal to reduce redundancy and increase healthcare efficiency in the February 7, 2013 Federal Register.
The proposed rule opens with this statement: “This proposed rule would reform Medicare regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on health care providers and suppliers, as well as certain regulations under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).”
The comment period is open until April 8, 2013.
The National Association Medical Staff Services Blog offers comments regarding proposed changes to medical staff rules.
MedLaw.com reports on the first payout for a HIPAA violation involving a small data breach:
“The Hospice of North Idaho (HONI) has agreed to pay the U.S. Department of Health and Human Services’ (HHS) $50,000 to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. This is the first settlement involving a breach of unprotected electronic protected health information (ePHI) affecting fewer than 500 individuals.”
The breach stemmed from a stolen laptop.
Walk into your favorite salon or spa and ask what a facial, a haircut, etc. cost and someone will quickly produce that information for you.
Walk into your favorite hospital or doctor’s office and ask what an MRI, a CBC, etc. cost and someone will quickly put you on hold or transfer you to another department. After considerable time you’ll probably be told that “it depends.”
NBC News recently reported on this issue. Martha Bebinger attempted to be a savvy healthcare consumer by shopping around for the cost of an MRI. After much persistence and many phone calls, she got responses that ranged from $600.00 to $5,300.00. After the scan she received a bill for $7,468.00. Since she is insured, all she was required to pay was $25.00. That bill, by the way, did not include the fees charged by the radiologist to interpret the test.
How about a simple lab test – a complete blood count (CBC)? A web site called Clear Health Costs attempts to collect cost information on various tests. According to the site a self-pay CBC in the New York area ranges from $16.00 to $117.00 depending on location. There is also a disclaimer that reminds visitors that if they have health insurance the charges may be considerably different.
Ms. Bebinger’s advice? ”If you really have to pay attention to price because you have a high-deductible or a tiered coverage plan, then do a lot of deep breathing. Be ready for a long journey that will take some patience.”
Another bit of advice – share with your doctor that medical costs are of concern to you. Sometimes an effective, less costly, “Plan B” can be developed that doesn’t involve so many expensive tests.
It’s great to have a skilled physician and a good hospital available when you need them; it’s even better to enjoy overall good health and need them less often.
The web site Nutrition and You offers some easy-to-digest information on the benefits of various fruits. For example, did you know…
Apples are low in calories; 100 g of fresh fruit slices provide only 50 calories. They, however, contain no saturated fats or cholesterol, and are rich in dietary fiber which helps prevent absorption of dietary-LDL or bad cholesterol in the gut.
Red varieties of grapefruits are especially rich in the most powerful flavonoid antioxidant, lycopene. Studies have shown that lycopene protects skin damage from UV rays, and offers protection against prostate cancer.
Research studies have shown that certain substances in kiwi-fruit functions as blood thinner function similar to aspirin; thus, it helps prevent clot formation inside the blood vessels and protect from stroke and heart-attack risk.
Raspberries contain a good amount of minerals like potassium, manganese, copper, iron and magnesium. Potassium is an important component of cell and body fluids that helps controlling heart rate and blood pressure.
Fresh berries are an excellent source of vitamin-C (100 g provide 58.8 mg or about 98% of RDI), which is also a powerful natural antioxidant. Consumption of fruits rich in vitamin C helps the body develop resistance against infectious agents, counter inflammation and scavenge harmful free radicals.
So snack on some delicious, guilt-free fresh fruit!
I work in a hospital and spend a fair amount of time on patient units, which tend to be astonishingly noisy. The environment is often loud, even late in the evening or early in the morning when people who aren’t feeling their best would probably like to be sleeping.
Occasional noisey moments are to be expected, but maintaining a calm atmosphere in patient care areas seems to be an afterthought in most hospitals.
So, just as a reminder to us all, I am re-featuring this earlier post:
When you have overnight guests in your home, chances are you do all you can to make their stay as comfortable as possible. In a sense, patients are guests in our “house,” but often they find their overnight accommodations anything but comfortable and restful. Hospitalized patients often complain “How am I supposed to sleep when…”