My GI Doc’s Hand is Out
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Now that we have all given thanks, and now that the day of mob shopping is thankfully behind us, now begins the season of giving. I mean, charitable giving. Many of us are thinking about which organizations and causes we want to support financially and about writing those checks before the end of the year.

So it is not surprising at all that every day’s mail brings more and more solicitations to my home, as well as so many telephone solicitations, from innumerable worthy causes: the ASPCA, United Way, Planned Parenthood, and many other organizations and groups that we support and that would like our support.

What was surprising was getting a fundraising solicitation from my gastroenterologist.

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The $35 Solution
Pulse-Oximeter

So much has been written about the excesses of health care and ways to reform, cut, improve or save the system. I have a more modest proposal: Read the medical bill and get annoyed, like I did.

A year ago, our firm switched to a health savings account (HSA) system. Previously, we had fully paid for our employee’s health insurance. Under the new system, each employee has an HSA account and pays for health care services up to a specified dollar amount per year, the deductible, out of that account. Once the individual reaches the deductible limit, insurance pays for all further services needed. At our firm, the partners decided to pay the amount of each employee’s deductible. For the employee, this means no out of pocket costs. Meanwhile, the price of our firm’s overall health insurance costs annually went down.

I haven’t come to the proposal yet; but the HSA system led me to my proposal.

Now, when I go to the doctor, the bill still goes to my insurance company – that way, they can track how much of my deductible I have used – and then I get a statement for the amount I must pay for that doctor visit. I send a check in to the doctor’s office and keep a copy for my records.

Since our move to an HSA system, I am far more keenly aware of what health care costs. That is part of the point of this approach. If health care consumers are brought into closer contact with the business of medicine – by actually writing a check each time a health care service is provided – then the consumer may exercise some restraint in how health care dollars are spent.

Well, I have been brought into closer contact with the business of medicine and I am not happy.

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The Truth Opaque
Surgical-Instruments

The retained surgical sponge case is probably the most classic example of clear-cut medical malpractice. When a surgeon or nurse leaves a surgical sponge or instrument inside a patient’s body during surgery, Pennsylvania law recognizes that this is an error so obviously beneath accepted standards of care that the usual rules requiring a Plaintiff to have a medical expert are relaxed.

We would all like to think that these kinds of medical mistakes are uncommon. The Pennsylvania Patient Safety Authority (PSA), in a startling report issued recently, tells us otherwise. Here is a link to the report. http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Sep;9(3)/Pages/106.aspx.

In 2011, there were a shocking 452 reported cases involving a retained sponge, medical instrument, surgical needle or other item, according to the PSA’s September 2012 advisory, “Update on the Prevention of Retained Surgical Items.” The Advisory also reports on various measures different organizations have recommended to suggest clearer hospital guidelines. The hope is that more coherent hospital policies will reduce this incidence of retained surgical items.

For a number of reasons, I don’t believe guidelines and policies alone are sufficient to address this problem.

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Caveat Patients
Hospital-scene

For as long as I can remember, Consumer Reports has been the name most closely associated with straight up ratings of innumerable consumer products and services from dishwashers to cameras to, well, you name it. Last week, Consumer Reports issued its first-ever review of hospitals across the country with a focus on patient safety.

If you’re a patient or you might someday be a patient, if you’re a physician or a nurse or a hospital administrator or, frankly, if you’re breathing, these results should be disturbing.

Consumer Reports (CR) explains that its review is based on the “most current data available,” including “information from government and independent sources on 1,159 hospitals in 44 states.” That sounds pretty good, except that CR was only able to reliably consider data on 18 percent of hospitals. Clearly, 18 percent is not good.

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