MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'access to care'. Sat, 03 Sep 2011 02:48:37 +0100 http://www.medworm.com/index.php?rid=5182205&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F08%2F30%2FCrizotinib-Approval-For-Lung-Cancer-Shows-Our-Miracles-Arent-Getting-Less-Expensive.aspx   Today I would like to share with you some thoughts on the topic of the costs of cancer treatments. It is the result of a moment on Saturday morning while, in the midst of listening to hurricane coverage on television, I was scanning the pages of my morning paper. There in the headlines was the comment that the Food and Drug Administration on Friday-presumably a bit later in the day, since the article was posted online at 8PM-approved a new drug called crizotinib (Xalkori®) for the treatment of lung cancer.   The news didn't get much attention, likely because it was overwhelmed by the hurricane. But at any other time, I suspect it would have been all over the media since this drug in fact represents a breakthrough treatment for some patients with lung cancer (more on th... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=5182205 Tue, 30 Aug 2011 16:00:00 +0100 5182205 http://www.medworm.com/index.php?rid=5118917&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F08%2F10%2FWelcome-to-the-World-Rayna-Analiese-and-Looking-Forward-to-Many-Happy-Birthdays%21.aspx (A letter to my newborn granddaughter)   Good morning, Rayna Analiese. Welcome to the world!   You are a teeny 8 pound 8 ounce bundle of beauty and joy who arrived yesterday afternoon at 1:32 PM CDT--100 years (almost to the very day) after one of your great grandmothers was born.    Grandpa--who is normally not a big lover of babies--went gaga over you. "So cute! So cute!" is about all he could say as he snuggled you in his tall arms--afraid all the while that he might drop this football-size bundle of love.   You have lots of people who love you, and lots more who are going to love you--not to mention all the people who love you who haven't had a chance to meet you in person yet. You have aunts and uncles and great aunts and uncles and grandmothers and grandfathe... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=5118917 Wed, 10 Aug 2011 14:22:00 +0100 5118917 http://www.medworm.com/index.php?rid=5057888&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F07%2F22%2FSocial-Securitys-Compassionate-Allowances-Program-Means-So-Much-To-People-In-Their-Time-Of-Need.aspx Sometimes-if you hang around long enough-you get the opportunity to see some good things happen.  The Compassionate Allowances Program from the Social Security Administration is one of those "good things," and last week I had the opportunity to participate in an event in Washington, DC marking the completion of adding the first 100 diseases to this program.   The basics of the program are fairly straight forward: patients who are diagnosed with one of 100 medical conditions-of which 31 are related to cancer-have their Social Security disability applications accelerated through the review process, meaning the delay in getting them their disability payments is considerably minimized.   That may not sound like much to you, but to people suddenly diagnosed with a life-threatenin... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=5057888 Fri, 22 Jul 2011 15:31:00 +0100 5057888 http://www.medworm.com/index.php?rid=4984637&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F06%2F29%2FFDA-Advisors-Vote-Unanimously-That-Avastin-Approval-Should-Be-Withdrawn-And-You-Could-Hear-The-Pain.aspx The votes are in, and the Food and Drug Administration's Advisory Committee said unanimously that the approval of Avastin (bevacizumab) for the treatment of metastatic breast cancer should be withdrawn.   The decision did not go down quietly, with women loudly voicing their disagreement, and one saying that this shouldn't be happening in the United States of America. I could not sit there and hear the cries without feeling their pain and anguish.   But the FDA advisors were very clear in their assessment: despite treating thousands of women, there was no group of women who appeared to benefit from the drug.  The side effects are real and the potential harms significant, and to have the drug remain on the market could mean that many  women would continue to be... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4984637 Wed, 29 Jun 2011 20:25:00 +0100 4984637 http://www.medworm.com/index.php?rid=4976138&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F06%2F28%2FThe-FDAs-Decision-to-Remove-Approval-for-Avastin-in-Metastatic-Breast-Cancer-is-Caught-Between-Data-and-Emotion.aspx I attended a hearing today held by the Food and Drug Administration outside of Washington DC on the question of whether or not Avastin® (bevacizumab) should retain approval for the treatment of metastatic breast cancer.  As one might expect, the experience ran the gamut from deeply felt emotions to cold hard statistics.   The presentations by patients and physicians for the most part opposed the FDA decision to remove the breast cancer indication, while an occasional person supported the FDA based on their interpretation of the data.  For the patients and their supporters, it was the reality that many of them were alive and well with few symptoms, which they and their physicians attributed to the fact that Avastin® had a significant treatment benefit for their breast... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4976138 Tue, 28 Jun 2011 20:58:00 +0100 4976138 http://www.medworm.com/index.php?rid=4953272&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F06%2F17%2FCancer-Facts-and-Figures-2011-Poverty-is-a-Carcinogen-Does-Anyone-Care.aspx "Poverty is a carcinogen."   Those were the words of Dr. Samuel Broder when he was director of the National Cancer Institute in 1989.     As amply documented in the annual "Cancer Facts and Figures 2011" released today by the American Cancer Society, cancer shows that poverty remains one of the most potent a carcinogen-rivaling tobacco and obesity-as we have ever seen.   We have heard lots and lots about how cell phones and Styrofoam cause cancer.  But do you hear anyone talking about the huge impact of poverty and limited education on cancer?   If you don't hear anything about a true carcinogen that statistics show causes 37% of the deaths from cancer in people between the ages of 27 and 64, then maybe you have the answer to a very important question: If we a... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4953272 Fri, 17 Jun 2011 16:40:00 +0100 4953272 http://www.medworm.com/index.php?rid=4883583&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F05%2Frefusing-to-treat-obese-patients%2F I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients in a previous post, so I won’t belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges. Then I read an article in the Florida Sun Sentinel about how some obstetrician/gynecologists in South Florida are refusing to provide medical care to obese women. Fifteen out of 105 Ob/Gyns refuse to treat patients based upon either weight or BMI. Some won’t take any patients who weigh more than 200 lbs. In the article, other obstetricians without such a policy state that “no doctor should be unable to treat patients just because they are heavy.” The “ability” to treat patients is... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4883583 Tue, 31 May 2011 10:43:57 +0100 4883583 http://www.medworm.com/index.php?rid=4658579&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F03%2F30%2FMedicare-Decides-To-Pay-For-Provenge-Leaving-The-Battle-Over-Cost-And-Value-To-Be-Fought-Another-Day.aspx I bet there was a huge collective sigh of relief about the land among men with prostate cancer, their families, their physicians and especially the company involved when the Centers for Medicare and Medicaid Services (CMS)-which runs the Medicare program-announced their decision this afternoon to cover the new cancer immunotherapy treatment for advanced prostate cancer, called Provenge®, under Medicare.   The stakes are huge: I suspect the market (and cost to Medicare) will run into potentially billions of dollars, yet the benefits for all of that money at first glance seem to be modest.   Ordinarily, the outcome in favor of approval would have been as close to certain as possible.    After all, this new treatment for prostate cancer did increase the survival o... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4658579 Wed, 30 Mar 2011 22:29:00 +0100 4658579 http://www.medworm.com/index.php?rid=4622472&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F03%2F22%2FTobacco-Tourism-Comes-Of-Age-In-Northeast-US.aspx Know what a "dilly" is?  The dictionary describes a "dilly" as something that is remarkable or extraordinary, as in size or quality.    The headline I came across the other day from the Associated Press story is in fact a dilly of a story.  It has some of my colleagues here at the American Cancer Society and our affiliated advocacy organization American Cancer Society Cancer Action Network more than a bit concerned: "NH, RI, NJ Buck Trend, Propose Cigarette Tax Cut."   Hard to believe, but after years of making progress in the fight against big tobacco and helping people to kick the habit or prevent young people from taking up smoking in the first place, now come proposals that would take us backwards, putting more people at risk for their lives all in the nam... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4622472 Tue, 22 Mar 2011 19:58:00 +0100 4622472 http://www.medworm.com/index.php?rid=4570713&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F03%2F10%2FCancer-Survivors-Are-%28Fortunately%29-Very-Much-A-Part-Of-Our-Lives.aspx An article just released by the Centers for Disease Control and Prevention in their weekly publication "Morbidity and Mortality Weekly Report" provides an assessment of the progress we have made in the diagnosis and treatment of cancer.   Clearly, since 1971, we have made substantial advances in the cancer treatment.  We have become a larger and older nation.  We have pushed the threshold for the diagnosis of cancer, with breast and prostate cancers as leading examples.   The result is that we have many millions more people alive with cancer today than was ever the case in our history.   But with the progress also comes cautions about what the data means, and where our journey must go if we are to address some of the key issues reflected in these statistics. &nbsp... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4570713 Thu, 10 Mar 2011 18:40:00 +0100 4570713 http://www.medworm.com/index.php?rid=4549902&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F03%2F04%2FWhy-Is-New-York-Using-Public-Money-To-Support-Unproven-And-Possibly-Unethical-Screening-For-Brain-Tumors-With-Public-Money.aspx Sometimes you see a story that is just too important to pass up--even if the comments I make here are going to get some New York politicians upset with me and possibly with the American Cancer Society.   But when you see something that defies logic and evidence, and involves millions of dollars that could be put to much better and more effective use, then I believe we have the responsibility to say something, even if it is at our peril.   The story is about New York City subsidizing "screening MRI brain scans" to detect brain cancer early as reported in yesterday's New York Times.  And my opinion and that of others is that at the least New York is wasting the taxpayers' money and at worst is promoting an unethical and experimental procedure to its citizens.   Here are ... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4549902 Fri, 04 Mar 2011 14:26:00 +0100 4549902 http://www.medworm.com/index.php?rid=4522248&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2011%2F02%2F25%2FWho-Can-You-Turn-To-When-Insurance-Coverage-Is-Denied-And-There-Is-No-Where-To-Turn-The-Impact-Of-ERISA-Plans.aspx Sometimes we have moments which may help us focus our thinking on an issue, or perhaps clarify our understanding of a problem.  We can ponder large problems, but it is those experiences on a more "micro" basis that brings clarity to our thoughts.   A discussion I had this past week with a couple facing an insurance denial for cancer-related surgery was just such an experience.   I can't go into all the details, but the bottom line for me is that if we don't find some way to bring clarity and rationality to our health care non-system soon, many people are going to find themselves wondering what happened when they needed help the most.   The events as recounted to me were pretty straightforward: a young lady had a strong history of ovarian cancer on both her mother's and... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4522248 Fri, 25 Feb 2011 18:10:00 +0100 4522248 http://www.medworm.com/index.php?rid=4405784&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Fgaming-obamacare%2F Remember my post a few months back about how some large companies were getting waivers so they didn’t have to pay into the new health care system? Things are getting worse.  According to this article on The Hill, the feds just granted new insurance waivers to more than 500 groups, bringing the total number of individuals covered by waivers to 2.1 million. The system just isn’t going to work. Let me get my soapbox out here. [Tap tap tap] Is this thing on? Good. First, there’s still this misconception that the “mandate” to purchase insurance will somehow translate into accessibility of medical care. It doesn’t work that way. I’ve said it before. Purchasing health insurance doesn’t mean that you have access to health care any more than purchasi... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4405784 Thu, 27 Jan 2011 17:24:46 +0100 4405784 http://www.medworm.com/index.php?rid=4337953&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Fcaring-for-morbidly-obese-patients%2F Not sure how I feel about this. Boston Emergency Medical Services debuts an ambulance with a mini-crane and reinforced stretcher to transport patients weighing up to 850 pounds. It cost $12,000 to retrofit the ambulance. My problem is this: I think we need to do our best to provide medical care to all patients. But patients need to take some basal level of responsibility for their own health. If you’re saying that you got to be 850 pounds due to a “glandular problem,” you’re blowing smoke. See this post (hat tip to MDOD) and then come talk to me. Let’s say you want to go hiking in some secluded location or you want to go spelunking far beneath the surface of the earth. When you take those risks, you implicitly accept the chance that if something happens to you... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4337953 Wed, 12 Jan 2011 16:44:18 +0100 4337953 http://www.medworm.com/index.php?rid=4230164&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F12%2Fdeath-panels-and-access-to-care%2F I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access. Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of decreasing the debt. For example, if a family household had overdrawn its checking account by several thousand dollars and their credit cards were maxed out, most people would consider it foolish for the family to purchase expensive cars, to donate large sums of money to charity, to go out to eat at expensive restaurants, or to continue purchasing large amounts of weapons to stockpile in its basement. When in debt, there are two options – earn more money or reduce spending. Usin... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4230164 Sun, 05 Dec 2010 04:49:17 +0100 4230164 http://www.medworm.com/index.php?rid=4225264&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F12%2Fhealthcare-update-12-02-2010%2F Also see the satellite edition of this week’s update over at ER Stories. Problems with Canadian health systems getting worse. “We’re trying to get a Size 13 foot into a Size 8 shoe.” Emergency department overcrowding increasing due to lack of available beds. The president of the Edmonton Emergency Physicians Association described the situation as a “potential catastrophic collapse” of emergency medicine. Edmonton plans to decrease hospital emergency department crowding by moving patients out of the emergency departments sooner once the hospitals meet certain criteria such as the ED being 110% full or there are more than 35% boarding patients in the emergency department. Five times this past year, Dr. Raj Sherman’s 73-year-old father almost died after waiti... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4225264 Thu, 02 Dec 2010 18:23:42 +0100 4225264 http://www.medworm.com/index.php?rid=3994234&cid=t_103927_136_f&fid=35283&url=http%3A%2F%2Fwww.cancer.org%2FAboutUs%2FDrLensBlog%2Fpost%2F2010%2F09%2F22%2FWhat-Norway-Tells-Us-About-Screening-Mammograms-And-Access-To-Care.aspx An article and editorial in today's edition of the New England Journal of Medicine once again calls into question the true value of screening mammography.  And, despite the quality of the study there are still some serious questions that are likely not going to be quickly put to rest.   Mammography remains at the forefront of much discussion and contention among experts and much confusion among the public.  Now comes a new study on the subject which aims to determine how much of a role screening mammograms actually play in reducing deaths from breast cancer in women between the ages of 50 and 74.   To look at that question, the researchers examined the very thorough medical records of women in Norway who underwent screening mammography as part of a nationwide roll-out o... Dr. Len's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3994234 Wed, 22 Sep 2010 21:14:00 +0100 3994234 http://www.medworm.com/index.php?rid=3865271&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F08%2Fmore-visits-less-availability%2F A new study released in JAMA shows that the number of annual emergency department visits between 1997 and 2007 increased from 94.9 million to 116.8 million — nearly twice as much as would be expected for population growth. Also published recently was the Department of Health and Human Services’ 2007 Emergency Department Summary (.pdf file here). Lots of interesting statistics. Most of the increase in ED visits were due to Medicaid patients. One quarter of the 117 million visits to the emergency department in 2007 were made by patients with Medicaid or SCHIP. Seventeen percent of visits were covered by Medicare. In other words, 42% of hospital ED visits (50 million or so) are paid for by the state or federal government. The graph to the right from the San Francisco Chronicle sho... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3865271 Fri, 13 Aug 2010 19:14:53 +0100 3865271 http://www.medworm.com/index.php?rid=3632273&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F06%2Fgovernment-declares-war-on-doctors%2F I was going to include this article in the rest of the Healthcare Update, but pulled it out and made it a separate post after reading this related article in the Christian Science Monitor – “Justice Department declares war on doctors” Five orthopedists sued for antitrust violations and settle case. Workers compensation in Idaho wasn’t paying enough, so these orthopedists allegedly colluded to refuse to treat any workers compensation patients until the state raised the rates that were being paid. In addition, several of the physicians allegedly threatened to stop seeing Blue Cross Blue Shield patients because Blue Cross payments were insufficient. Orthopedists across Idaho even published articles in the newspapers regarding the Blue Cross dispute. Now, as a result o... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3632273 Fri, 04 Jun 2010 17:46:11 +0100 3632273 http://www.medworm.com/index.php?rid=3585616&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Fflorida-verdict-threatens-ems-availability%2F Ambulance service held liable for failing to “do what was necessary” before accepting emergency transport of pregnant patient. I mentioned this case in a previous Healthcare Update. A child was born at 25 weeks gestation – 15 weeks premature – and was not breathing. Babies born at this age have a viability of 50-70%. In other words, up to half of children born at this age of gestation die. The family called 911. The paramedics arrived, performed CPR on the child, and brought the child back to life. I know a lot of physicians who would have difficulty resuscitating such a premature infant. These paramedics should have been commended as heroes for saving this child’s life. Instead, they were sued and found liable for $10 million. The plaintiff attorney stated th... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3585616 Fri, 21 May 2010 13:55:51 +0100 3585616 http://www.medworm.com/index.php?rid=3585617&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Fdr-whitecoat-goes-to-washington%2F Sorry about the sparse posting lately – have been away in Washington at an ACEP conference Just so Matt and others don’t think that all I’m all talk and no action, I’ll let you in on some things that I did at the conference. I attended some excellent lectures about leadership. Colonel Thomas Kolditz gave a great talk about leadership in extreme circumstances. He described his interviews with many soldiers, Iraqi prisoners, sports team captains and their teammates, and various other people in leadership positions to determine what makes a good leader. Why do people follow some leaders and not others? Commitment is important. If a leader doesn’t believe in a mission, neither will the rest of the team. Effective leaders work with the team – they get down i... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3585617 Thu, 20 May 2010 18:20:45 +0100 3585617 http://www.medworm.com/index.php?rid=3314623&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fbrinksmanship%2F I may end up eating my words about this. We’ll see. James Rohack, the current AMA President, made a post at Kevin MD about why patients should care about fixing the pending Medicare payment cuts. Basically his take on the matter was that if the cuts go through, many physicians will stop seeing Medicare patients and that some seniors on Medicare will have difficulty finding medical care. I tend to agree with him. I commented that we should let Congress cut Medicare payments. Stop fighting it. I won’t rehash everything, but suffice it to say that I think we need a crisis in medicine to get things straightened out right now. A Medicare pay cut of 21.2% has been looming over physicians’ heads for several months now. The same pay cut has come up in the past, but, through some ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3314623 Sat, 27 Feb 2010 00:06:23 +0100 3314623 http://www.medworm.com/index.php?rid=3224827&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F01%2Ftax-incentives-for-providing-on-call-care%2F Some states are having difficulty finding enough physicians to provide needed specialty care to patients who come to the emergency department. If a patient needs neurosurgery or trauma surgery and there is no one on staff that is able (or willing) to perform the necessary services, then the patient must be transferred to another facility. Sometimes the waits involved in arranging and performing the transfers can lead to bad outcomes for the patients involved. In a recent Healthcare Update, I mentioned an article about Oklahoma legislation providing tax credits to physicians to provide on-call care. A friend forwarded me an e-mail from ACEP that listed several states which are contemplating tax credits for on-call care. Hawaii has a bill that would provide physicians who provide at least 57... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3224827 Sun, 31 Jan 2010 00:12:25 +0100 3224827 http://www.medworm.com/index.php?rid=3092694&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F12%2Fdialysis-and-the-right-to-health-care%2F According to this Article from the Atlanta Journal Constitution, a court has ruled that at least some health care is not a right. In October, I linked to an article about how Grady Memorial Hospital in Atlanta was closing its dialysis clinics due to the significant financial burden. Grady has agreed to pay for the patients to receive dialysis at a private dialysis clinic until January 3, 2010, but after that, the patients are on their own. After Grady’s announcement, approximately 50 illegal immigrants sued to keep the clinic open, alleging that closing of the clinic “violated their constitutional right to the health care service” and that closing the clinic amounted to “medical abandonment.” The court held that the plaintiffs had neither a state nor a federal... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3092694 Wed, 16 Dec 2009 16:02:25 +0100 3092694 http://www.medworm.com/index.php?rid=3089292&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F12%2Fgood-policy-or-tempting-fate%2F Remember this skit from I Love Lucy? Lucy and Ethel worked on an assembly line and were responsible for wrapping all of the chocolates that came down the conveyor belt. At first, things were easy, but as more and more chocolates came faster and faster, eventually Lucy and Ethel became overwhelmed and the whole process fell apart. The result was a classic comedic moment. In emergency medicine, things aren’t so funny. The chocolates are our patients. At times, patient flow is manageable. At other times, patient volume becomes so high that we have difficulty providing good medical care. When things get too busy, usually there is a relief valve called “bypass”. Hospitals have to meet certain criteria to go on bypass, but once a hospital declares bypass, no ambulances may brin... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3089292 Tue, 15 Dec 2009 10:29:24 +0100 3089292 http://www.medworm.com/index.php?rid=3083030&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F12%2Fhealthcare-update-12-12-2009%2F Healthcare insurance does not equal healthcare access. Physicians are suing the state of Florida because more than 1.2 million children on Medicaid are not receiving access to critical medical care. Some children covered under Medicaid are unable to find any orthopedists willing to fix their broken bones. More than 750,000 children received no dental care because “reimbursement rates are among the lowest in the country” and 30% of Florida counties have fewer than two dental providers willing to treat Medicaid patients. A Florida official stated that “We have a system that is growing by-double digits, where providers are paid less and less each year. Access is limited, outcomes are not measured … I’d say that’s a bad system.” Oh, and Florida’s... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3083030 Sat, 12 Dec 2009 18:29:34 +0100 3083030 http://www.medworm.com/index.php?rid=3048110&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F12%2Fthe-demise-of-american-health-care%2F A couple of news headlines paint a bleak picture about the future of healthcare in this country. First are some comments made by US Republican Senator George LeMieux. During a news briefing (video here), LeMieux expressed a concern that Obama’s healthcare plan would amount to “Medicaid for the masses” and would put all Americans on a government run or government controlled health care. The Palm Beach Post News also ran a story regarding a speech given by Senator LeMieux where he stated that the cost of the bill over the next 10 years was grossly understated due to “funny math”. He estimated the true cost of the bill to be more than $2.5 billion over 10 years rather than the projected $849 million. LeMieux stated that in order to decrease costs, the bill intend... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3048110 Tue, 01 Dec 2009 20:13:55 +0100 3048110 http://www.medworm.com/index.php?rid=2934677&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F10%2Fno-spinning-lights-for-you%2F If you’re in the Fort Worth, Texas area and you call an ambulance for your influenza symptoms, your ride to the hospital may not have the red spinning lights on it. In order to respond to the threefold increase in ambulance calls from patients with influenza-like symptoms, Medstar Ambulance Service is considering a change in policy where patients are evaluated after a call and then told that they “don’t need to go to the hospital.” If the patients still insist on transport, they won’t be taken to the hospital by ambulance. Instead, Medstar will arrange a taxi ride – and not necessarily to the hospital, either. Patients might get taken to an emergency clinic instead. Oh, and when they’re discharged they’ll still have to find a ride home. (Sour... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2934677 Wed, 28 Oct 2009 13:50:58 +0100 2934677 http://www.medworm.com/index.php?rid=2838923&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fhow-payments-affect-care%2F This study showed that in multiple trauma patients, CT scans picked up on 98.5% of fractures while cervical x-rays only picked up 43% of fractures. It is uncommon to pick up ligamentous injuries on x-rays or CT scans – generally need an MRI for those. If physicians choose to do a CT scan on an unconscious or poorly responsive patient, according to the “permissible” diagnosis codes, in most cases hospitals have to hope that either an injury or some type of cancer shows up on the CT scan. Otherwise, the CT scan won’t be reimbursed and the hospital eats the cost. What are the other options in multitrauma patients? We could just do only x-rays of the cervical spine, and, if negative, tell patients that everything is OK because the government won’t pay for CT scans... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2838923 Mon, 28 Sep 2009 11:52:06 +0100 2838923 http://www.medworm.com/index.php?rid=2832151&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Feffects-of-saving-money%2F In 2008, St. Johns Hospital and Mary Immaculate Hospital in Queens had a total of 119,883 outpatient department visits. In February 2009, the two hospitals went bankrupt and closed. In June 2009, the New York City Office of Policy Management published a paper showing that once St. Johns and Mary Immaculate Hospitals closed their doors, the patients that previously went to those hospitals didn’t just vanish. Instead, the patients flocked to other nearby hospitals which were already operating at capacity. Guess what happened? Those nearby hospitals – such as Jamaica Hospital in Queens, are now “overwhelmed.” According to the report, Jamaica Hospital’s daily census went up 50% — from 350 visits per day to “well over” 500 visits per day. On May 2... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2832151 Fri, 25 Sep 2009 15:07:43 +0100 2832151 http://www.medworm.com/index.php?rid=2788585&cid=t_103927_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fmedical-malpractice-and-access-to-care%2F Below is a point-counterpoint that was published in this month’s EP Monthly print magazine. Many thanks to Max Kennerly for putting up a valiant fight in a losing effort I will add links supporting facts for both arguments when I get a little more time. Feel free to pick up in the comments section where we left off. ———————————————————————— Opening Argument A 2006 American College of Surgeons report argued, “the single most  important factor shaping the [emergency] surgical workforce today is  declining reimbursement,” a euphemism for one of the most cutthroat  industries in America. Last month, Bayonne Hospital Center sued Ho... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2788585 Thu, 03 Sep 2009 11:43:37 +0100 2788585 http://www.medworm.com/index.php?rid=1888581&cid=t_103927_136_f&fid=36165&url=http%3A%2F%2Fpurpleride.blogspot.com%2F2008%2F10%2Fone-law-for-all-of-us.html Here is an article about a wealthy MM patient, Fred Baron, who received an experimental drug for myeloma after the manufacturer, Biogen, was lobbied by family friends Lance Armstrong, Bill and Hilary Clinton, John Lerry, and Senator Ted Kennedy.I'm not sure how I feel about this. I certainly understand how any family would use whatever means it could to obtain a treatment that they feel may be life saving.The durg, Tysabri, generic name natalizumab, is approved for treatment of Multiple Sclerosis and Crohn's disease. There is a clinical trial underway studying the use of the drug for MM, but Mr. Baron did not meet the criteria for the trial.It does seem unfair however that "Joe-six pack", average Joe, or Joe the plumber can't have the same access.Both our presidential candidates are going ... The Beast... blogs http://www.medworm.com/rss/comments.php?id=1888581 Sat, 18 Oct 2008 13:03:00 +0100 1888581