OH, GOOD GRIEF: OPERATING ROOM STAFF TEXTING their sweeties during surgery? Really? Shefali Luthra, writing in The Atlantic Monday, cites tales of OR clinicians who hide phones in drawers and check them when they think no one’s noticing. As one surgeon understates, that “does lead to distraction.” Luthra refers to a 2011 case in which a Texas anesthesiologist allegedly sent text messages and emails while monitoring a patient and didn’t notice for nearly 20 minutes that the woman’s oxygen levels had dropped. The patient died in surgery. Her family sued and settled out of court. Now, Luthra reports, a group of physicians and medical groups are “calling for clear rules on whether and how [mobile phones] can be used.” Some hospitals have already implemented policies and “more and more hospitals are playing catch-up,” says one expert. He warns that an outright ban could be too restrictive given that mobile phones do allow quicker access to patient information and lab results, as well as communication with colleagues in other parts of the hospital during surgery. But how do you know somebody’s not really posting to Facebook? Too bad we can’t rely on common sense.
THE AP’S MATTHEW CRAFT FILED A WAKE-UP REPORT Monday about the skyrocketing costs of long-term care even as the number of older and “old-old” Americans explodes, along with incidents of frailty, dementia and a whole catalogue of chronic illnesses. Nursing home costs climbed at twice the rate of overall inflation over five years, according to insurer Genworth Financial. One year in a private room now runs a median $91,000 a year, while one year of visits from home-health aides runs $45,760. The Employee Benefit Research Institute says about 60 percent of Americans between 55 and 64 have retirement accounts, but the median balance is just $104,000. Medicare doesn’t cover long-term stays and many nursing homes don’t accept Medicaid patients. “If you have money, you’re going to use all of that money,” Craft quotes the daughter of a woman who had to be taken out of a nursing home because of the cost. “Just watch how fast it goes.” This has got to be one of the biggest challenges now facing health care and the nation.
“IT’S PROBABLY THE STUPIDEST THING I CAN IMAGINE in the world of health care: not to invest in screenings when you’re going to wind up paying for the treatment,” said Christopher Hansen, president of the American Cancer Society Cancer Action Network, during a House of Representatives briefing last Thursday. A panel of health experts stressed that better disease prevention and earlier detection are the keys to reining in health care costs, and they identified three areas that would have the biggest impact: obesity, cancer and tobacco use. Shannon Firth, writing for MedPage Today,noted that the United States spends about $35 billion on public health and prevention on the federal, state and local levels, about $20 billion less than needed, according to a study by advocacy groups. Panelists cited examples of how beefed-up public health efforts could save big bucks. Richard Hamburg of the Trust for America’s Health said that if each state lowered the average body mass index of its population by 5 percent, millions of Americans would avoid serious illness such as diabetes, hypertension, arthritis and obesity-related cancers. That would save the nation billions in health care costs. Another example: a public education campaign called The Truth helped discourage 450,000 children from smoking cigarettes, resulting in health care savings of $1.9 billion to $5.4 billion in two years.
PENALTIES FOR BEING UNINSURED will jump significantly this year and next, under the Affordable Care Act. That could prompt greater numbers of healthy people to enroll in insurance exchanges, which should stabilize the risk pool and help moderate premium increases, writes Caitlin Owens Tuesday in the National Journal. Obamacare foes have cited relatively low enrollment and rising premiums in slamming the law. Fines for being uninsured will climb from $95 or 1 percent of income, whichever is greater, in 2014 to $325 or 2 percent of income this year, and $695 or 2.5 percent of income in 2016.
HEALTH CARE IS IN THE THROES of a “productivity paradox,” according to Roy Smythe writing last Friday on Forbes.com. New information technology — namely the electronic health record — promises to improve how we move patients through the health care experience and document their encounters. However, most physicians today say they’re less efficient — they’re seeing fewer patients and actually spending more time documenting visits. Smythe cites similar slowdowns that occurred when electricity and later computers first arrived on the scene. In both cases, he writes, businesses were hamstrung by the slow diffusion of the technology, their attempts to use it alongside pre-existing technology and “the misconception that the new technology should be used in the same context as the old one.” The good news, Smythe adds, is that in the two decades following the adoption of both electricity and computers, productivity accelerated significantly. The secret: People stopped trying to use new technology in old ways, “assisting in a complete overhaul of the business process and environment, and the spawning of new processes, tools and adjuncts that capitalized” on them.