Caesarean Deliveries Vary Widely, Study Finds
By SABRINA TAVERNISE
The rate of Caesarean deliveries, the most common operating-room procedure performed in the United States, varies drastically among hospitals across the country, a new study has found, ranging from 7 percent of all births at the hospital with the lowest share of Caesarean deliveries to 70 percent at the hospital with the highest rate.
The study, published on Monday in the journal Health Affairs, was based on federal data of more than 800,000 deliveries at 593 hospitals in 2009. Conducted by researchers at the University of Minnesota in Minneapolis and the University of British Columbia in Vancouver, the study did not identify the hospitals because their names were not included in the data.
Caesarean deliveries are often performed to improve birth outcomes in high-risk pregnancies, but they can also be performed for the convenience of the mother or the doctor. The rate has increased significantly in recent years, to 33 percent of all births in 2011, up from 21 percent in 1996, the study said, citing numbers from the Centers for Disease Control and Prevention.
“Frankly I did not expect to see variations of this magnitude,” said Katy B. Kozhimannil, an assistant professor of health policy and management at the University of Minnesota School of Public Health. “It begs a closer look at how we structure and finance childbirth in the United States.”
Researchers decided to test rates for low-risk pregnancies because they expected that such deliveries would show less variation. In fact, those rates varied even more widely. For deliveries of single babies carried to term who were not breech and were born to mothers who had never had a Caesarean before, the rates varied from a low of 2 percent to a high of 36 percent.
Horror Care: How Private Health Care is Shortening Our Lives
By Paul Buchheit
Steven Brill's article in Time Magazine about the cost of private health care is likely to make most of his readers very angry. Angry about the prices we pay, about the lives that are devastated, and about the fact that we're one of the few developed countries without adequate health care for its citizens.
Economists have told us that the profit motive of privatization comes with an "invisible hand" that automatically corrects inequities in the market. It hasn't worked that way for health care. The personal stories recounted below, and some additional facts to complement them, make it clear that an essential human need has been turned into a product that benefits a few people at the expense of many others.
$15,000 for Blood Tests
Brill's article begins with the story of a 42-year-old Ohio man named Sean Recchi, who traveled to MD Anderson Cancer Center in Houston for treatment of non-Hodgkin's lymphoma. He and his wife Stephanie had paid $469 a month, or about 20% of their income, for insurance that covered $2,000 per day of hospital costs. His financial troubles started when MD Anderson told him, "We don't take that kind of discount insurance."
But he had to go to the hospital. His wife recalled that he was "sweating and shaking with chills and pains. He had a large mass in his chest that was..growing. He was panicked."
Stephanie asked her mother to write a check for $48,900.
Sean waited for 90 minutes while the hospital confirmed that the check had cleared. He was also required to advance MD Anderson $7,500 from his credit card. The total cost for the initial treatment and chemotherapy was $83,900, including a $15,000 charge for lab tests for which a Medicare patient would have paid a few hundred dollars, $283 for an x-ray that Medicare categorizes as a $20 charge, and $1.50 for a generic version of a Tylenol pill.
Hospital Boss $1,845,000 -- Medicare Boss $170,000
Republican goal to balance budget could mean deep cuts to health programs
By Lori Montgomery,
Anxiety is rising among House Republicans about a strategy of appeasement toward fiscal hard-liners that could require them to embrace not only the sequester but also sharp new cuts to federal health and retirement programs.Letting the sequester hit was just the first step in a pact forged in January between conservative leaders and Speaker John A. Boehner (R-Ohio) to keep the government open and the nation out of default. Now comes step 2: adopting a budget plan that would wipe out deficits entirely by 2023.
The strategy runs counter to warnings from prominent Republicans such as Louisiana Gov. Bobby Jindal against becoming “the party of austerity.” Just as GOP lawmakers are tacitly endorsing sequester cuts to the Pentagon, long a sacred cow, they fear the balanced-budget goal will force them to abandon a campaign pledge not to reduce Medicare benefits for those who are now 55 and older.
“I know a number of people who have real concerns about where this is going,” said Rep. Peter T. King (R-N.Y.), who said Medicare cuts targeting people as old as 58 are under discussion.
“One of the last presidents to balance the budget was Herbert Hoover,” King added darkly, referring to the penny-pinching Republican blamed for deepening the Great Depression.
GOP leaders say the strategy has been necessary to persuade their right wing to postpone a fight over the debt ceiling until this summer and to support a bill on the floor this week to fund the government through the end of September. The payoff, they say, will be a budget framework that holds the promise of paying down the national debt without higher taxes.
“There’s plenty of political peril associated with this. Whether we as a conference have the stomach to look at Medicare and Social Security spending will be the make-or-break part of the deal,” said Rep. Tom Cole (R-Okla.), a senior member of the House Budget Committee. “But I think setting an ambitious goal was wise. If we can’t do it, the country can’t do it.”
http://www.washingtonpost.com/business/economy/republican-goal-to-balance-budget-could-mean-deep-cuts-to-health-programs/2013/03/04/94632f92-840b-11e2-9d71-f0feafdd1394_print.html
Maine Democrats make case for expansion of Medicaid
The state's Democratic leaders will exert public pressure on Gov. LePage to give up his resistance and follow other Republican governors.
By Steve Mistler smistler@pressherald.com
State House Bureau
State House Bureau
AUGUSTA – Gov. Paul LePage has said that he doesn't plan to participate in a federally funded plan to expand health care coverage for low-income Mainers. But the issue likely isn't settled for Democratic leaders in the Legislature, who are working to persuade LePage to join Republican governors who have abandoned their resistance to the Affordable Care Act and agreed to participate in the law's Medicaid expansion.
The expansion would make 55,000 more people eligible for MaineCare, the state'sMedicaid program, according to an analysis by the Kaiser Family Health Foundation.
Those people would be "able-bodied" parents, and adults who have no children and earn up to 133 percent of the federal poverty level -- just over $20,500 a year for a two-person household.
The federal government would pay 100 percent of the state's costs for the expansion from 2014 to 2016. In subsequent years, reimbursements would gradually decline to 90 percent of the state's costs.
From 2014 to 2016, the federal payout to states is projected at $1 trillion, assuming that every state participates.
Hospitals crack down on tirades by angry doctors
Posted March 05, 2013, at 9:15 a.m.
At a critical point in a complex abdominal operation, a surgeon was handed a device that didn’t work because it had been loaded incorrectly by a surgical technician. Furious that she couldn’t use it, the surgeon slammed it down, accidentally breaking the technician’s finger. “I felt pushed beyond my limits,” recalled the surgeon, who was suspended for two weeks and told to attend an anger management course for doctors.
The 2011 incident illuminates 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.
“We’re talking about a very small number of physicians, but the ripple effect is profound,” said Charles Samenow, an assistant professor of psychiatry at George Washington University School of Medicine, who evaluates doctors with behavioral problems.
For generations, bad behavior by doctors has been explained away as an inevitable product of stress or tacitly accepted by administrators reluctant to take action and risk alienating the medical staff, particularly if the offending doctors generate a lot of revenue. Recently at one Virginia hospital, according to University of Virginia School of Nursing dean Dorrie Fontaine, a veteran operating-room nurse with 30 years’ experience walked into her supervisor’s office and quit after a surgeon screamed at her — his usual reaction to unwelcome news — when she told him that a routine count revealed that an instrument was missing. Hospital administrators shrugged off the episode, saying, “Well, that’s the way he is.”
But that time-honored tolerance is waning, Samenow and other experts say, as a result of regulations imposed in 2009 by the Joint Commission, the group that accredits hospitals. These rules require hospitals to institute procedures for dealing with disruptive behavior, which can take passive forms such as refusing to answer pages or attend meetings. The commission has called for a “zero tolerance” approach. Such behavior is not unique to doctors; researchers have found that nurses act out, too, mostly to other nurses, but that their behavior is less likely to affect patients.
Corrosive Effect On Morale
Growing attention to the problem, which appears to be most common among surgeons and other specialists who do procedures, has spawned a cottage industry of therapists who provide anger management counseling, which is sometimes billed as “executive coaching.” Programs are flourishing at Vanderbilt, the University of Virginia, the University of California at San Diego and, most recently, George Washington University.
Most doctors who enroll are middle-aged men sent by hospitals or state medical boards that have ordered them to shape up.
http://bangordailynews.com/2013/03/05/health/hospitals-crack-down-on-tirades-by-angry-doctors/print/
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