CAN ANYBODY REIN IN THESE “COWBOY DOCTORS”? A team of professors from Harvard and Dartmouth have concluded that physicians who provide intensive treatments that aren’t evidence-based are responsible for wasteful spending equal to as much as 2 percent of the gross national product, up to 35 percent of end-of-life Medicare expenditures and as much as 13 percent of overall Medicare expenditures. As reported by Zara Zhang in the September/October issue of Harvard Magazine, these so-called “cowboy doctors” “are relying on their own beliefs,” though “clinical evidence showed little or no marginal benefits derived from the extra procedures,” such as implanting a defibrillator to counter severe heart failure. One of the study’s authors suggests that some physicians see themselves as interventionists who say, “I just can’t accept that this patient is dying and there’s nothing I can do. I’ve got to do something.” Zhang quotes another researcher: “If doctors restrict themselves to performing what is evidence-based, we can save hundreds of billions of dollars a year.”
FOLD-OUT BEDS THAT CAN SUPPORT 750-POUND VISITORS and motorized lifts than can handle patients up to 1,000 pounds are part of the new 17-floor, 862-room tower at Parkland Hospital in Dallas. The tower, like many other health care facilities being built around the country, was designed with America’s growing number of obese patients in mind. The New York Times’ Maxine Levy reported Monday that “every bathroom has a 4-foot-wide doorway, a heavy-duty, floor-mounted commode and an extra-large shower with a large seat.” Doors into rooms are 6 feet wide so that bigger wheelchairs and beds can fit through. Chairs can accommodate up to 400 pounds and the padded cushion of a loveseat can fold out into a bed for those 750-pound overnight visitors.
ARE STATE INSURANCE COMMISSIONERS TOO SOFT? That’s the complaint some policymakers and consumer advocates are voicing after several commissioners have approved hefty rate increases in their states. For instance, as The Wall Street Journal reported Wednesday, BlueCross BlueShield of Tennessee recently was granted a 36.3 percent rate hike. Insurers contend that they need higher rates to cover sicker patients who have recently gained coverage under the Affordable Care Act. President Obama has called on state insurance commissioners to more actively negotiate on rate requests. Apparently, not everyone is heeding that request.
THEY CALL THEM “VIOLENCE INTERRUPTERS” and they’re working with the trauma team at Truman Medical Centers in Kansas City, Mo., to avert retaliation after shootings, stabbings or assaults. When such an act occurs, the trauma team immediately calls in these “nonmedical peacebrokers,” who come from some of the city’s toughest neighborhoods and have experienced violence themselves, Christopher J. Gearon reported Monday for U.S. News & World Report. They’re trained in conflict resolution and mediation and try to “buy time” with victims, their friends or family members, or anyone who might want to retaliate for a violent act, “talking them down and helping them to understand the consequences of their actions.” Between 2012 and 2014, the percentage of trauma patients stabbed, shot or with intentional, penetrating wounds has dropped from 31 to 25 percent, or about one a day rather than multiple incidents per day.