Guest guest Posted October 6, 2011 Report Share Posted October 6, 2011 Your Daily Posterous Spaces Update October 6th, 2011 Hospitals Might Be Heading Into Trouble: Forbes<http://ptmanagerblog.com/hospitals-might-be-heading-into-trouble-forbe> Posted about 18 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=74172744> Hospitals Might Be Heading Into Trouble<http://www.forbes.com/sites/zinamoukheiber/2011/10/05/hospitals-might-be\ -heading-into-trouble/#> * * * Bush wrote this post. He is the chief executive officer and chairman of athenahealth, a seller of cloud-based electronic health records and practice management services.* *A Hospital House of Cards?* I am increasingly concerned about the long-term solvency of hospitals these days. It seems to me like they are on a<http://blogs-images.forbes.com/zinamoukheiber/files/2011/10/JonBushpic1.jpg>bu\ ying binge that will pull the whole nation into a hangover, and no one is tuned into this. In fact, it reminds me to terrifying degree of the urgent rush by Fannie and Freddie to get Americans into houses they couldn’t afford. Only this time it’s health care hanging in the balance, and this time I’m not sure those congressional panels will have as much “bail-out” money to play with. What’s at stake is two-fold: one, some level of financial ruin that could tax all of us; and two, a healthcare marketplace that offers less access and choice for patients, and all the bad stuff that comes when you take choice off the table. *Covetousness: I Hospital Will Take You Doc in Good Times and Bad…* At root here is the age-old covetousness that hospitals have felt for doctors, and doctors, at times, for hospitals. The appeal to hospitals rests in the referrals from the doctors. They go out and buy physician practices, bring them into the fold and place a bet on growth on the backs of these new referral sources. Once doctors send patients into a hospital owned network —no matter how expensive or inconvenient it may be to the patient or her health insurer – the patient goes. We last saw these marriages in the early 90s, and the inevitable divorces that followed when (shocker alert) doctors now on salary became less productive. Well, hospitals are at it again. They are scooping up as many doctors as they can find or that knock on their doors with an eye on owning the channel. In fact, today over 50% of America’s doctors are employed by hospital systems (a number that has doubled in the past year). *The Great Irony of the HITECH Act – Docs are More Ready and Willing to be Coveted Than Ever* The catalyst for docs willingness to be courted is ironically the government’s HITECH mandate to digitize health care. The government made doctors an offer they couldn’t refuse: go become a “meaningful user” of electronic medical records (term undefined at the time) and get a bonus. Don’t, and see your Medicare rates cut. Of course, the only EMRs that doctors know about are the legacy software-based systems that they looked at and rejected fifteen years ago. Already making less than ever before, they are faced with the prospect of being told go buy one of these dogs (legacy EMR products), lay out a bunch of cash (gov: “we’ll get you back”), slow down your practice in learning the new technology (RAND survey suggests 18% less productivity, and recall many docs are admitted luddites) and make even less money. The urgency and the confusion of the mandate has lead docs to go where they always have when a really expensive thing needs doing, the hospital. Decades back when the aforementioned hospital/doc marriages were vogue, there was a “buy your charts” clause in the deal (hospitals used to literally buy all the doc’s paper charts at a huge premium to justify the big buyout prices they paid for practices). This time it’s a “buy me an EMR” clause. *The Rub – A Broken Business Model: Software is Disabling Not Enabling* But there’s a problem even with consensual covetousness – it comes at great upfront cost. Good thing then that hospitals, like corporations, can borrow at historically low rates right? Because they’re doing that in droves. But therein lies the rub. The stars appear aligned for the hospital systems – willing docs and cheap dollars. Both driving these health systems to borrow more now than in the past. Yet the reality is that borrowing at favorable rates is only marginally better than at unfavorable rates, if you are funding a business model that your IT not only can’t enable, but drags down. By our estimates, hospitals are now spending $40-80k per doctor to purchase EMRs and losing an average of $150k per year per doc they employ largely because of these bad IT purchases. Namely software. In my ‘hospitals gobbling docs’ scenario, software is the bottleneck to profitability. The supposed enabler of the referrals that the above business model is predicated on, is not working to that end. Why would it be? Software is not a web-native connected system. It doesn’t update when the rules change. Software doesn’t even let you send patients from one hospitals to the next (unless one is owned by the other and using the same server – can you imagine? In this day and age?). In fact, outside of vertically integrated systems like Kaiser Permanente and Cleveland Clinic (and they are highly-specialized solutions) and a few others, you’d be hard-pressed to see any cases where software is greasing the referral wheels. In other words software is mucking up the model. As a result, I believe the large capex on health care information technology (here to date largely software) creates a very real risk of balance sheet squeeze which could seriously affect the viability of many hospitals. It is not hard to imagine a sequence of big write-downs coming for obsolete/ineffective software that will trigger loan covenants and lead banks to call loans (more on why they will do so follows). In fact, per the Advisory Board Company, a review of Moody’s data for not-for-profit hospitals shows that IT as a percentage of total capital spending has skyrocketed from 12% in 2008 to 40% in 2009. If that doesn’t scare the bejeesus out of you, I don’t know what will. *Where’s the evidence?* Granted, my evidence to date is largely anecdotal. Over half of our customers are non-profits. We know this is a scenario they’re attuned to – they have told us as much. In fact, many were drifting towards a rocky coast before making IT adjustments to put them on smooth waters and avoid irreparable damage. Consider also that a staggering 35% of our new business wins are coming from hospital systems and physicians who tried a software solution to facilitate electronic medical records that crapped out on them. Where’s the hard evidence of pending system failures? Let alone systemic failure? Well, I’m less good at that. What I think is some enterprising reporters should start knocking on the doors of the financial institutions known for making loans to healthcare. They should ask if they are making more today than in the past; about the terms of the loans; assets used as collateral (software is not an asset people!); use of proceeds as they see it, etc. I’m frankly not smart enough to know what the broad economic impact is of a few health systems going down at the same time, though suspect it would be utterly tragic. It is hard to predict the contagion as systems have (hallelujah!) started working with each other to the benefit of patients. Leave it to health care that cooperation is coming at a time when it could ultimately lead to dangerous consequence. *How does this end?* I quote the great Doug Coughlin, mentor to Tom Cruise’s Flanagan in that classic movie ‘Cocktail’ – “Everything ends badly, otherwise it wouldn’t end.” http://www.imdb.com/title/tt0094889/. This too ends badly. Scenario one: hospitals go under–in large numbers. They are going under in small numbers now but there are few enough of them that for-profit hospital systems with strong balance sheets and decisive management teams can absorb them and make them more efficient organizations – through economies of scale, attention to the bottom-line and Internet (this thing’s going to be big) services that deliver value, rather than suck the viability out of the enterprise. My worry is that the numbers will soon be overwhelming, and the for-profits will not be able or willing to absorb them all. You know the scene from HBO’s great movie chronicling the financial crisis “Too Big To Fail” (adapted from Ross Sorkin’s eponymous book) where a then healthy Bank of America<http://finapps.forbes.com/finapps/jsp/finance/compinfo/CIAtAGlance.jsp?t\ kr=bac & tab=searchtabquotesdark> (or so they thought) exec is simultaneously talking to both Merrill and Lehman about possibly saving their asses (yes asses not assets), and a colleague says “You’ll do both?” and the B of A executive replies something to the end of neither having the wherewithal or appetite for both. Then what? A federal hospital bailout plan? Really? What do you think that does to the debt ceiling? Scenario two: hospitals actually get control of enough doctors that they drive more patients in for more procedures and, with their new vertical monopolies, at higher rates. We have seen this in Massachussets where premiums for commercial health insurance in the first three years (2007-2009) since the global health insurance law passed increased 5-10% annually. In fact, last year state regulators fought off proposed increases in the teens and higher for small businesses and individuals (thanks Mitt). This becomes a bit of a shell game with regard to health care costs. Less cataclysmic by some measures, but also a bad scenario. Under either, one could easily foresee a future of all powerful hospital systems – regularly getting the best of others in the marketplace from insurers (I know, who cares) to most importantly, patients through the exertion of pricing pressure that comes with greater scale and less choice. So while I don’t know when exactly the storm will strike I do know that any loss of access to hospitals that represent the underpinning of our health care systems is a great loss to a patient community that needs more, not less choice. At this point, that’s an unacceptable loss. Is anyone else nervous? Meredith Whitney can you hear me?? *P.S.: Meredith Whitney is the analyst who warned ahead of others in 2007 that Citigroup and other banks were heading into trouble. Forbes had ranked<http://www.forbes.com/lists/2007/25/pf_07topanalaysts_Meredith-Whitney_PV\ YP.html>her as the second-best stock picker that year.* Calling yourself Doctor and what that now means<http://ptmanagerblog.com/calling-yourself-doctor-and-what-that-now-mea> Posted about 17 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=74174392> Calling yourself Doctor and what that now means by Bradley Flansbaum, DO<http://www.kevinmd.com/blog/post-author/bradley-flansbaum>| Embedded media -- click here to see it.<http://ptmanagerblog.com/calling-yourself-doctor-and-what-that-now-mea> In New York State, the issue of scope of practice is at the fore. Mainly, what activities can non-physicians (NP’s) engage in, with or without physician supervision? It is a heated subject here where I reside, but not the one I will address below. The *New York Times<http://www.nytimes.com/2011/10/02/health/policy/02docs.html?_r=1> * discusses a similar matter, although altogether more controversial. Many of you are aware nurses are obtaining doctorate degrees and advancing their training. The divisive issue is how those with newly minted degrees should present themselves to the community, and secondarily, their pay, delay of entry into the workforce and its effect on patient access, and the necessity of this added qualification. “Hi. I’m Dr. Patti McCarver, and I’m your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine. The public may label physicians as biased if we condemn this ascertainment; we are a guild, a monopoly, protective of our turf and salaries. All potentially correct. I am accepting and very tolerant of midlevel collaboration, very much so in fact. Over the years, I am consistently impressed with the level of quality and commitment these folks demonstrate. They deserve accolades and remuneration for their endeavors, and I see a vital future for them. The health system needs them, and I want them beside me. I am a huge booster as those who I work with can attest. Why then does this issue, and articles like this rankle me? I contemplated, and the answer arose quickly. It is in the title *Doctor*, and its application to the nurses employing it. Now psychiatrists, orthopods, and ophthalmologists might disagree, this is sensitive stuff, but I have no compunction in introducing psychologists, optometrists, and podiatrists as “Doctor.” Surveys might prove me wrong, but the environment in which they practice and the scope of their delineated tasks differentiates them in ways I reason the public comprehends, even if it takes a prompt. Here however, there is no discrepancy. Two clinicians–physician and nurse doctor–employed at an examination table; and to a casual observer, a false impression emerges. Is it the money or prestige? No. Is it clinical outcomes performing rudimentary activities? Doubtful. For me, it is communicating to the world the work behind the training—the sacrifices and untold hours of reading and time in the hospital, that in this context is lost. Equal work for equal pay is something I trust in, and there many of my colleagues might not take umbrage. I can live with that. However, if you call yourself doctor in the framework of care delivery in a hospital or office setting—writing prescriptions and referring to subspecialists—ensure patients *get it*. We are not the same. The public service message goes with the title you bear. I am proud of my accomplishments and muddling those efforts are unacceptable, to me at least. Dr. McCarver’s greeting above gets it right. My fear is she is the exception, not the rule. *Bradley Flansbaum is Director, Hospitalist Services at Lenox Hill Hospital in New York City. He blogs at *The Hospitalist Leader<http://blogs.hospitalmedicine.org/SHMPracticeManagementBlog/> *.* via kevinmd.com<http://www.kevinmd.com/blog/2011/10/calling-doctor-means.html> Your Back Pain (And What It's Trying to Tell You: Deepak Chopra<http://ptmanagerblog.com/your-back-pain-and-what-its-trying-to-tell-yo> Posted about 17 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=74176572> Your Back Pain (And What It's Trying to Tell You) <http://www.huffingtonpost.com/deepak-chopra/meaning-behind-back-pain_b_992322.h\ tml> Posted: 10/4/11 08:21 AM ET At one time or another, the misery of lower back pain is felt by everyone, which is no surprise. Our upright spine is as unique to being human as having an opposable thumb. But where anyone can see that using our hands involves every aspect of life, we don't say the same about our backs. But it's just as true. You can read a great deal standing behind someone, reading victory or defeat, success and failure, pride or shame and every degree of self-esteem. More hidden are the stresses that shape the back. On the day that you feel that first twinge of back pain, an entire personal history has already unfolded. Visualization is courtesy of TheVisualMD.com<http://thevisualmd.com/licensing_images> Can we use that history to treat lower back pain? The factors to consider are as varied as each person is, but the most salient include: - Physical stress to the lower back - Sedentary jobs - Lack of exercise - Untended psychological issues - Depression, anxiety - Sudden changes in physical routine - Bad sleep - Coping mechanisms, how you deal with stress - Aging - Old traumas, such as car accidents and sports injuries - Unknown predispositions That's a lot to consider. As you can see, saying " My back went out " or " I must have hurt my back " falls short of an adequate explanation. Everything on the list needs to be considered as a contributing factor. It's important to distinguish between acute pain and chronic pain. *Acute pain * is intense and lasts from a few days to several weeks. Acute back pain is generally due to sprains or strains and usually gets better in a few weeks. *Chronic pain* lasts longer than three months. Chronic back pain is more complicated in terms of its causes and its treatment. We can start with a very general picture. Medicine knows a lot already about this chronic problem. About 1 in 6 Americans suffered from back pain continually for every day of the last month; a quarter of the population reports that they have had back pain in the last three months<http://www.ncbi.nlm.nih.gov/pubmed/17077742>. Back pain is the No. 2 reason people visit their doctor (No. 1 one is colds and flu). And back pain is on the rise. The percentage of people getting care for spine problems increased from 10.8 percent of the U.S. population in 1997 to 13.5 percent in 2006. The health care costs of back pain are up, too -- way up. Expenditures for opioid medications for spinal problems increased an incredible 660 percent during that same period of time, and health expenditures for spine problems rose from about $19 billion to $35 billion, an increase of 82 percent <http://www.medscape.com/viewarticle/710366_3/> . These dramatic increases go hand-in-hand with the rise in back pain surgery. Almost one million spinal surgeries<https://www.thespinefoundation.org/spine_facts/>are performed in the U.S. each year. About one-fourth of them are spinal fusions, costing an average of $60,000 each. *Most* of these surgeries, besides being notoriously unpredictable in their success rate, are unnecessary, and a great many of the unsuccessful ones require re-operation. Surgery often leaves patients in pain, unable to return to work and dependent on opiate medications. We need to realize, on the positive side, that most back pain will respond to conservative treatment that leaves the patient able to return to work and free of the need for opiates. The complex architecture of the human spine makes us susceptible to accidental sprains and strains of the back muscles and ligaments. These passing incidents are by far the most common cause of lower back pain. Sprains occur when ligaments are overstretched or torn from their attachments. Strains happen when muscles are ripped or torn. The injury generally happens when you fall, lift something improperly, carry a heavy object or make a sudden movement. Just having poor posture can cause sprains and strains, too. Other, nonspinal causes of back pain include fibromyalgia and depression (often accompanied by anxiety). Fibromyalgia is thought to be an inflammation of the connective tissue (including the muscles) of the body. Depression and anxiety often manifest with physical symptoms. The good news is that most of the factors<http://www.niams.nih.gov/Health_Info/Back_Pain/back_pain_ff.asp>that put you at risk for back pain can be changed or modified: Look carefully at stress, depression and anxiety, heavy backpacks, poor posture, being overweight, not getting enough exercise, smoking, unhealthy diet, certain medications and job hazards. Risk factors you can't do as much about may include aging, family history of back pain and having had a previous back injury. Still, there are people with healthy backs who have such risk factors but overcome them. In about 85 percent of back pain patients, no clear cause is ever identified. In order to diagnose back pain, a number of imaging technologies are now regularly employed -- X-rays, CT scans and MRI scans are the most common. But it is still very difficult to find out why someone is experiencing chronic back pain. Quite frequently, imaging tests reveal abnormalities of the spine, such as spondylolisthesis and herniated discs, and it's tempting to immediately ascribe back pain to these abnormalities. But bear in mind that these conditions are often found in people who have *no symptoms of back pain* at all. These abnormalities might have absolutely nothing to do with the pain you feel. The majority of back pain heals without any significant medical intervention. Only a very small minority of back conditions require surgery. Worse still, about one-third of spinal surgeries fail to relieve back pain <http://www.ncbi.nlm.nih.gov/pubmed/9647165>, often requiring reoperation. This happens so often there's even an acronym for it: failed back surgery syndrome (FBSS). Fusion surgery is an increasingly popular<http://www.ncbi.nlm.nih.gov/pubmed/17077740?dopt=Abstract>type of back operation in which two or more vertebrae are fused together. Fusion surgery may be useful for slipped vertebrae or some types of fractures, but it is often prescribed for herniated discs, degenerated discs or nerve problems. One large-scale study<http://www.ncbi.nlm.nih.gov/pubmed/20736894>of almost 1,500 people with back pain found that after two years, only one-fourth of people who had fusion surgery had returned to work, while two-thirds of people who *hadn't *had the surgery were back on the job. There was also a 41 percent increase in the use of opiate painkillers by the surgery patients compared with those who hadn't had surgery. Other studies have found that people who have fusion surgery for degenerative disc disease have *worse* outcomes than people with the same condition who choose not to have surgery. In spite of these startling numbers, fusion surgery for degenerated discs is the fastest-growing type of spinal operation. Spinal surgery should be reserved for cases where spinal nerves are compressed and are causing the loss of bladder or bowel control, or creating weakness or numbness in the legs. Only under these conditions, or when someone has chronic, debilitating back pain and has given all conservative, nonsurgical methods a fair trial, is it time to consider back surgery. There are many nonsurgical measures for treating back pain, and they are generally most effective if used in combination with one another. If you have acute back pain, the first line of defense is " fire and ice " -- hot pads and cold packs for easing pain and inflammation. After a few days of rest, you should start to become more physically active and gradually begin to do gentle exercise. Consult with a physical therapist to determine when you're ready for stretching and strengthening exercises. NSAID medications or spinal injections of steroids or anesthetics can provide enough pain relief to allow physical therapy. Massage helps stimulate circulation to the back tissues and aids flexibility. Chronic back pain may be helped by psychological therapy as well. Alternative therapies can be helpful. Many people swear by acupuncture and chiropractic manipulation. Trigger-point therapy treats muscle pain by injecting anesthetics or steroids into painful areas of muscle. If you want to prevent lower back pain, the single most important measure you can take is to stretch and strengthen your core muscles through regular exercise. Yoga and Pilates are ideal for this. Aerobic exercise is helpful because it strengthens your cardiovascular system, increasing circulation to the tissues of your back. Be aware of your posture: Avoid slouching, which places a great deal of strain on your back. Being overweight strains your back as well, so lose weight if you need to. If you smoke, quit -- smoking literally starves your vertebral discs<http://necksolutions.com/pain/back-pain/intervertebral-disc-degeneration-b\ lood-supply/>of oxygen and nutrition. Eat high-nutrition, whole foods to keep your bones and back tissues healthy. Finally, find ways to relax if you're stressed out, because tension alone can create back pain. We have a national disposition to rely on drugs and surgery that is not abating. Our lifestyles are not going to become less sedentary; our lack of exercise and reluctance to treat stress are endemic. So lower back pain waits in the wings to test if each of us can take advantage of the knowledge that exists about this problem, and then to turn it into practice in our only day-to-day habits. *deepakchopra.com<http://deepakchopra.com/2011/09/your-back-pain-and-what-it%E2%\ 80%99s-trying-to-tell-you/> * Health Business Blog » Blog Archive » What does an Explanation of Benefits (EOB) actually explain?<http://ptmanagerblog.com/health-business-blog-blog-archive-what-does-a> Posted about 14 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=74206420> What does an Explanation of Benefits (EOB) actually explain?<http://www.healthbusinessblog.com/2011/10/what-does-an-explanation-of-b\ enefits-eob-actually-explain/> October 5th, 2011 by E. of the Health business blog I recently had some physical therapy for a minor injury. Since the office forgot to charge my co-pay the first time I went in I received a so-called Explanation of Benefits (EOB) from my insurance carrier, BlueCross BlueShield of Massachusetts. (You can check it out here<http://www.healthbusinessblog.com/wp-content/uploads/EOB%20PT.pdf>.) EOBs are a holdover from the mainframe era: arcane, inflexible reports that are hard to interpret. They may have done their job in the day when their only purpose was to let a member know they owed money, but they’re woefully inadequate in the era of consumer driven health care and transparency. The main section of my EOB has 4 lines and each one says the exact same thing: “PHYSICAL THERAPY 08/31/11 – 08/31/11.” That’s not very useful. However, my guess is that it represents a series of specific, billable activities that were undertaken on my visit, such as therapeutic ultrasound, massage, and electrical stimulation. There is also an “amount charged” column, representing the reimbursement level sought by the provider. In my case the first line says $75 and the others are $50 each. This column adds up to $225. Then there is an “amount allowed” column, which is the negotiated rate for each service. The numbers range from $18.63 to $21.74. There is no apparent correlation between the charged amount and the allowed amount. The highest charge ($75) has the lowest allowed amount ($18.63). Other columns include my $25 office visit co-pay –in this case inexplicably distributed between the first two items– a co-insurance column (zero for me) and a benefits column, representing the negotiated rate minus my co-pay. The “your balance” column shows the co-pay, which was uncollected at the time of this visit. Despite the user-unfriendliness of the EOB it still provided me with some useful information. In particular, it’s interesting to see that I would have been charged $225 if I lacked insurance. The BCBS rate is about 2/3 lower. So in fact the real economic benefit to me of the insurance is much more than the $56.31 portrayed in the “benefits” column. For me the economic value is really $200 –the amount charged minus my copay. That’s a number worth appreciating for so-called freeloaders who wait to get insurance until after they have medical expenses. If they do have to pay out-of-pocket for services without the benefit of BlueCross’s negotiating power they are going to get overcharged. I asked BCBS to comment on the EOB and public relations director Tara Murray replied: “We’re required by law to send an explanation of benefits to our members. We send it so that a member can be aware if there is any remaining balance after a claim is processed. However, we understand there is more we need to do to simplify communications for our members. Your inquiry is timely as we’re currently looking at redesigning our explanation of benefits notification.” Those changes will be driven by member needs but also new rules that are part of the Patient Protection and Affordable Care Act. One thing I’d really like to see is the impact to the member and to BCBS of choosing one provider over another. With my current plan it doesn’t really matter where I go as long as it’s in network. But that’s bound to change in the future and we need tools to support that shift. via healthbusinessblog.com<http://www.healthbusinessblog.com/2011/10/what-does-an-ex\ planation-of-benefits-eob-actually-explain/?utm_source=feedburner & utm_medium=fee\ d & utm_campaign=Feed%3A+HealthBusinessBlog+%28Health+business+blog%29> Surprisingly Large Amount Of Surgeries d Out On The Elderly<http://ptmanagerblog.com/surprisingly-large-amount-of-surgeries-carrie> Posted 2 minutes ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=74301146> Surprisingly Large Amount Of Surgeries d Out On The Elderly Embedded media -- click here to see it.<http://ptmanagerblog.com/surprisingly-large-amount-of-surgeries-carrie> Editor's Choice Main Category: Seniors / Aging<http://www.medicalnewstoday.com/sections/seniors/> Also Included In: Public Health<http://www.medicalnewstoday.com/sections/public_health/> Article Date: 05 Oct 2011 - 20:00 PDT Embedded media -- click here to see it.<http://ptmanagerblog.com/surprisingly-large-amount-of-surgeries-carrie> [image: email icon] email to a friend<http://www.medicalnewstoday.com/emailanarticle.php?newsid=235536> [image: printer icon] printer friendly [image: write icon] opinions<http://www.medicalnewstoday.com/articles/235536.php/235536.php#opinions\ > Embedded media -- click here to see it.<http://ptmanagerblog.com/surprisingly-large-amount-of-surgeries-carrie> [image: rate icon] rate article Embedded media -- click here to see it.<http://ptmanagerblog.com/surprisingly-large-amount-of-surgeries-carrie> <http://media.fastclick.net/w/click.here?sid=48070 & m=6 & c=1> *Current Article Ratings: * *Patient / Public:*[image: 4 stars] 4 (8 votes) *Healthcare Prof:*[image: 3 stars] 2.75 (4 votes) Article Opinions: 7 posts<http://www.medicalnewstoday.com/articles/235536.php/235536.php#opinions> Research published today (Wednesday 5th Oct) in the Lancet shows a surprisingly high rate of elderly people undergoing surgery in their final year, month or even week of life. In one of the most detailed studies of people undergoing treatment on Medicare <http://www.medicalnewstoday.com/info/medicare-medicaid/>researchers looked at figures nationally and discovered that close to one in three people had surgery in their final year of life, with one in five in the last month and as many as one in ten in the last week. Those aged 65 had the most amount of procedures in their final year, coming in at 38.4 percent or nearly one in four. At 80 the rate fell to 35.3% and there after dropped dramatically with only 33 percent of those at 90 under going a procedure. Critics of the research say that the data is likely to be somewhat biased because researchers looked only at those who died. It also doesn't take into account the type or reason for the surgery. B. Bach from Memorial Sloan-Kettering Cancer Center weighs in on the issue : " Because the patient died, you can't assume that the treatment and therapies were not of value ..... Although in that individual, things may not have worked out, you have no insight into whether the decision to operate was appropriate. " Another factor that has not been taken into account is how many similar patients who had that same surgery did not die. It would appear that the issue is somewhat more complex than it appears and further investigation of the topic is required. Nonetheless the large percentages of people having surgery in their final year of life was a surprise to researchers, obviously some surgeries were necessary to prolong life or ease pain, however a point was clarified by the team at Harvard School of Public Health who undertook the research, that doctors might operate to more out of sympathy to make repairs where they are able, yet knowing full well that it might not save a dying patient. The Harvard team in all took data from nearly two million Medicare patients aged 65 and over who died in 2008. They also report finding large variations from state to state and city to city, with Honolulu coming in with figures one third of that in , Indiana. Dr. Ashish Jha, an associate professor of health policy at Harvard and the lead author of the study, pointed out the gap in the figures: " Honolulu and , Ind., can't both be doing it right, " Despite the critics, researchers believe they have unearthed a real flaw in the American Medical system: Surgical Intervention which can be painful and debilitating remains tempting for both doctors and patients alike. Dr. Jha concludes: " I will admit to being guilty of this .... Often we say: If you have this intervention, we will be able to fix that problem. You have an intestinal blockage. Surgery will fix it.' But will it let you walk out of the hospital alive? Will it let you return to your old life? " Rupert Shepherd reporting for Medical News Today.com Copyright: Medical News Today via medicalnewstoday.com<http://www.medicalnewstoday.com/articles/235536.php> [image: Posterous] <http://posterous.com> Want your own?<http://posterous.com> Change your email settings<http://posterous.com/email_subscriptions/hash/gspsqucxgqviGogjvCufJwAxB\ xkgmH> Quote Link to comment Share on other sites More sharing options...
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