According to the results of a new national survey, less than 2% of American hospitals have completely switched to an electronic medical record-keeping system.

Between 8% and 11% of hospitals have partial electronic systems in place, with at least one department in those hospitals having converted to a digital record-keeping system.

Dr. David Blumenthal, head of the Institute for Health Policy at Massachusetts General Hospital, says that American hospitals are at a “very low stage” of adoption of digital technology as compared to other countries. But with less than 2% of American hospitals completely digital, this seems to be a massive understatement.

American hospitals – and doctor’s offices, for that matter, with just 17% of American physicians using digital record-keeping technology – have a very long way to go.

Health Records, Health Insurance, and Saving Money

Previously, the Bush administration set a goal of 2014, by which time the entire country would (theoretically) have transferred to an electronic medical record-keeping system. This goal got a much-needed boost earlier this year when President Obama signed the economic stimulus package which includes $19 billion for converting physicians and hospitals to an electronic system. (Interestingly enough, the majority of the money is earmarked for incentives to encourage doctors and hospitals to use electronic systems.)

The money is certainly needed. A small hospital to convert to an electronic medical record-keeping system, around $20 million in capital is required. For a large academic hospital, that figure can range up to $200 million. For around 75% of hospitals, lack of funding is the main barrio towards updating their record-keeping systems. Approximately 44% also cited maintenance costs as a significant barrier.

Given the enormous cost, the survey results that show 98% of hospitals, and 83% of doctors are in need of an electronic updage, are somewhat sobering. Will $19 billion be enough to update the country’s antiquated medical record-keeping systems?

Photo credit: David Boyle in DC

Many of us are predisposed towards a mistrust of drug companies. The fact is, they make billions of dollars every year, and it seems like most would do anything for a buck. Recent news that AstraZeneca allegedly suppressed negative information about Seroquel, an anti-psychotic drug, is not helping the tarnished image that the pharmaceutical industry has earned.

A Washington Post article published recently outlines the study, known as “Study 15,” and reported that AstraZeneca had suppressed the study’s negative results, and at the same time promoted more positive results from other studies with less stringent protocols.

Also reported by the Washington Post: The shocking fact that one employee of AstraZeneca praised a colleague’s “smoke and mirrors job” in reference to the suppression of the negative results. Those suppressed results include a possible link between Seroquel and the development of diabetes. In addition, the study showed that Seroquel was no better than other anti-psychotic drugs at preventing psychotic relapses.

Who To Trust With Your Health And Prescription Drugs

Sometimes, it’s hard to know who to trust. And unfortunately, some doctors can’t be trusted when it comes to clinical trials either.

Dr. Scott Reuben, an anesthesiologist currently on leave from Springfield’s Baystate Medical Center in Massachusetts, has been accused of faking data in clinical trials for a staggering twelve years. According to the accusations, Dr. Reuben is responsible for faked data in no less than 21 published medical papers.

• According to news released by the Baystate Medical Center, a routine hospital review carried out in 2008 revealed that some of the doctor’s research had not been approved by the hospital’s review board.
• An investigation into the issue found that Reuben had made up some or all of the data in 21 papers published over the last twelve years.
• The data involves several drugs, including Celebrex, Lyrica, and Effexor, and Reuben attests to their effectiveness as painkillers in the published studies.

On the basis of the studies, Reuben had received numerous research grants from several sources, including drug company Pfizer, which makes and markets Celebrex.

As if the monetary rewards weren’t bad enough, the doctor has become widely respected in the field of anesthesiology on the basis of his fraudulent research, and many doctors have been basing their own use of pain relievers on Reuben’s results.

And even worse for patients, some of the drugs Reuben “studied” have been shown to delay bone healing – but Reuben’s work didn’t show up any of those problems. It’s now likely that many of the clinical trials Reuben published will be redone to ensure that accurate results are achieved.

photo credit: HA! Designs – Artbyheather

President-elect Barack Obama should take note – health reform is about the little things just as much as it is sweeping changes to the system.

Information gathered from a batch of more than 8,500 meetings held around the country in December will be compiled and used to help design the healthcare proposal that has been in the news as of late. Obama’s transition team plans to post some of the material at change.gov.

One particular meeting took place late December 2008, between newly appointed secretary of health and human services, the former Senate Majority Leader Tom Daschle, and more than two dozen seniors During this meeting, seniors told Daschle that they placed more importance on certain things such as waiting times to see their doctor, the increasing cost of prescription drugs, and the narrow range of Medicare coverage for certain medical procedures, equipment, and treatments.

An Example for Health Care Reform: Alzheimer’s

One woman at the meeting cited her family’s history of Alzheimer’s disease for her hope that the new administration will put heavy emphasis on medical research. A man said that helping people live healthier lives should receive more emphasis than it currently does – not only to improve health, but also to reduce medical costs for individuals and the nation as a whole. Another man says he wants medical providers to show more concern for the people they treat than whether or not those people will pay their medical bills.

Daschle says that lawmakers are more likely to get behind a new health care system if voters provide enough incentive pressure. And it seems that the transition team is listening: The Obama administration is encouraging seniors to submit their own stories about health care – and any other issues they think need to be addressed.

The team should also take one final note: The current effort to gather information about the health care system has been compared to the 2005-2006 attempt by the Citizens Health Care Working Group. More than 6,500 people participated in meetings across America, and a further 14,000 participated in online surveys. The Congress-sponsored group eventually recommended guaranteed health coverage for certain doctor’s visits, and some ways to protect people from high health care costs – but none of its recommendations were acted upon.

Let’s hope that this new round of meetings prompts some real change.

photo credit: woodleywonderworks

It’s not just the unemployed facing healthcare insurance problems, according to a new Robert Wood Johnson Foundation report compiling research carried out by the State Health Access Data Assistance Center at the University of Minnesota. Nearly 20% of American workers have no health insurance, up from around 14% in the mid-1990s.

During the mid-1990s, one in seven American workers had no insurance. Just ten years later, that figure has increased to one in five workers uninsured, or around six-million more people over the mid-1990s total.

What’s causing the high rates of uninsured workers?

What has caused the drop in insurance rates? The study notes that it’s likely due to an increase in the cost of insurance – premium costs for employer-sponsored healthcare have increased up to eight times faster than wages, meaning that fewer employers and fewer workers can afford the coverage.

Another fact the study notes is that many workers are newly uninsured, and the percentage of uninsured workers has risen sharply in the last couple of years. Finally, while up to 20% of workers no longer have insurance, around 90% of children are covered, as well as almost all retirees.

Criticism of the health insurance statistics

Some have criticized the statistics and the healthcare system on the basis of the disparity of insurance rates between workers and retirees – saying that workers are paying the bill for coverage for people who are no longer working. But is this really fair?

Today’s retirees – the people who are now on Medicare – are the taxpayers of the last generation. They’ve already paid for the healthcare they’re now receiving. And the current generation of tax-paying workers is paying now for the Medicare they’ll receive when they hit retirement age.

The real problem is that there just aren’t any insurance safety nets for working adults. SCHIP provides coverage for children and young people, while Medicare provides for seniors. For working adults, however, the options tend to be limited to employer-sponsored care, private insurance, or nothing at all.

More significant in terms of the study’s statistics is the fact that the mid-2000s figures were taken from Census 2007 results – and given current trends it’s likely that the number of uninsured workers is actually much higher than one in five.

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The $787 billion economic stimulus package that was signed into law last week includes one or two health-related measures that haven’t been widely publicized, but which are no less important for it.

One of these is the $1.1 billion that has been assigned for a study to compare the effectiveness of a large number of medical treatments, drugs, surgeries, and other current standard medical procedures and devices. A council of fifteen federal employees will be set up to coordinate the research and advise the President and Congress on where the money would best be spent.

The program is a response to growing concerns that doctors have little solid evidence on which to base the value of many of the treatments that are currently considered standard.

Questions to Answer with the Stimulus Package Health Care Money

According to Dr. Elliott S. Fisher of Dartmouth Medical School, the study will help answer questions such as these:

• Should severe neck pain be treated with physical therapy, medication, and exercise, or with surgery?
• What is the best combination of prescription medication and therapy for the treatment of depression?
• Is it more effective to treat arterial blockage in the legs with medication or with surgery?
• Is medication alone an effective treatment for chronic heart failure, or are active health intervention measures also necessary?

Second Concern: Rapidly Increasing Health Care Costs

A second concern is the rapidly increasing cost of health care. Healthcare spending hit a total of $2.2 trillion in 2007. That’s 16% of gross domestic product – and it’s been estimated that figure will hit 25% by 2025. It is hoped that the research will save money by discouraging the use of expensive treatments that are largely ineffective and, at the same time, boosting the use of more effective treatments. During her years as a senator, Hilary Rodham Clinton was a firm proponent of such research and President Obama endorsed the concept during his White House campaign.

Not everyone is supportive of the idea of spending millions of taxpayer dollars on health care comparison studies. Critics say it may allow the federal government to be too intrusive when it comes to personal health care choices, and may jeopardize the doctor-patient relationship by put the government squarely between patients and health care professions. Others worry that insurance companies will use the data gained from the study as an excuse to deny coverage of more costly medical treatments.

photo credit: Emily Taliaferro Prince

Japan’s overcrowded, understaffed hospitals are in danger – and so are the people who rely on those hospitals when they need emergency medical care. An elderly Japanese man who sustained head injuries after being struck by a motorcycle waited ninety minutes in an ambulance – while paramedics phoned fourteen different Tokyo hospitals, trying to find a hospital that would accept the man for treatment. All the hospitals refused to admit the injured man, saying they lacked the equipment and staff needed to treat him. The paramedics arrived at the accident site just a few minutes after the 69-year-old man was injured, but ninety minutes and fourteen hospitals later, the man died just a short time after paramedics finally located a hospital that would accept him for treatment. The man died from the shock caused by the loss of a large amount of blood – a condition which the man might have survived if he had received treatment earlier.

Stretching the Health Care System

This incident is only the latest in a list of recent cases occurring in Japan, where the emergency healthcare system is stretched thin due to staff shortages and the medical needs of an aging population. According to Japanese Health Minister Yoichi Masuzoe, the rapidly increasing number of elderly patients is a large part of the problem, with hospitals so full that there just isn’t room for emergency patients. While this particular incident clearly highlights the problems for Japan’s overburdened healthcare system, it is by no means an isolated occurrence. In 2007, more than fourteen thousand emergency patients were rejected three or more times by overcrowded hospitals before finally receiving treatment. The worst case so far was that of a woman who was rejected 49 times before finally receiving emergency treatment for breathing difficulties. Another high profile case, that of a pregnant woman who died eight days after being refused admission by nineteen different hospitals, finally prompted the government to establish a panel to investigate the issue.

What Tokyo is Doing to Change Things

Following the most recent incident, the city of Tokyo issued a directive that requires paramedics to coordinate with emergency call centers so that emergency patients can be accepted to a hospital within fifteen minutes. However, this doesn’t solve the most pressing problem of hospital overcrowding. Health Minister Yoichi Masuzoe has urged that the government develop a community support system to reduce the burden placed on hospitals. The Japanese government has also announced plans to improve coordination between hospitals and the emergency support system, and to increase doctor numbers in understaffed hospitals.

photo credit: udono

The big healthcare news from the Obama administration over the last few weeks has been that the State Child’s Health Insurance Program will be expanded, but another SCHIP-related change that happened around the same time hasn’t received as much attention.

This change is a reversal of enrollment rules imposed in August 2007 by the Bush administration. Controversial at the time, the new rules made it much more difficult for states to allow certain families to use SCHIP. For families whose income totaled more than 250% of the federal poverty line (that equates to around $50,000 per year for a family of four), it suddenly became all but impossible to use SCHIP. Several states actually sued the federal government over this change, including Maryland, Illinois and Washington.

In May 2008, Bush relented a little by reducing the income restriction to around 200% of the federal poverty line, or about $40,000 per year for a family of four.

Obama Lifts SCHIP Income Requirements

Now, President Obama has sent a memo to Health and Human Services, explicitly lifting those enrolment rules. In the memo, Obama states that since the 2007-2008 eligibility restrictions, “tens of thousands of children have been denied health care coverage.”

A different picture from Bush’s stated intention to prevent SCHIP providing healthcare for children who would otherwise be covered privately. But the 2007-2008 rulings simply didn’t work – with one single eligibility rule covering fifty states with widely different costs of living. Not to mention the fact that for any family with income at 250% of the federal poverty line to even be eligible, the state first had to cover 95% of children at less than 200%.

SCHIP Expansion Funded by Tobacco Revenue

Critics of Obama’s plans to expand SCHIP are mindful of the fact that funds for the scheme are coming from the tobacco industry in the form of a new consumer tax. Other criticism from the public includes that the new administration is needlessly expanding the government’s role in health care, and encouraging families with access to private insurance to rely on the government instead (however, the fact is that SCHIP will only be eligible to families who can’t afford insurance by any other means – families with insurance available through an employer won’t be eligible, for example.)

On the other hand, there are many advantages to expanding SCHIP that aren’t necessarily obvious. One is that covering kids will help provide more preventative health care for families who wouldn’t otherwise have access. Many people living below or near the poverty line simply don’t visit doctors, instead relying on emergency medical treatment. With the country’s emergency health care system already stretched to near breaking point, the possibility of easing the strain is a distinct advantage.

photo credit: Bah Humbug

The close ties between doctors and the drug industry are long-standing, but recently health policy experts have been saying that it’s about time those ties were cut. Over the years, many reports of drug companies providing financial and material perks for doctors has caused an erosion of public trust in medical professionals – and experts say that to repair that particular problem, it’s time for doctors to cut ties with the drug companies that provide the kick-backs.

A series of comments made by health policy experts in the British Medical Journal elaborate on the issue, saying that doctors might have to give up the freebies to win back public trust. From inexpensive prescription pads and pens to seminars at luxurious hotels, there are plenty of rewards for doctors who cultivate good relationships with drug companies.

Benefits of Winning Doctors’ Favor go to the Drug Industry

For the drug industry the benefits are obviously massive, especially so considering recent reports indicate that TV drug advertising is less effective these days than in the past at selling name-brand prescription drugs. That means drug companies are relying more than ever on doctors to prescribe the drugs the companies sell, and offering perks to doctors is the traditional method companies use to get more products sold.

Last year, however, concerns over the relationship between doctors and the drug industry increased after Iowa Senator Charles Grassley accused Harvard University psychiatrist Dr. Joseph Biederman, and other doctors, of failing to disclose payments they had received from certain drug companies.

Solutions to the Drug Industry Payola Problem

According to Dr. Marcia Angell of Harvard Medical School in Boston, the best solution is for doctors to simply cut their ties to the drug industry, once and for all – to stop accepting even the smallest gifts, and to recognize that their prescribing habits might be biased towards the companies they received those gifts from in the past.

Angell believes that instead of attending those cozy drug company-funded seminars, doctors should take personal responsibility for keeping up-to-date with their medical education. And, she says, professional associations shouldn’t allow drug companies to fund publications and meetings.

The meetings might be held in less luxurious surroundings, says Angell, but the results would be preferable, with more emphasis placed on impartial medical education rather than drug companies furthering their own agendas to sell more drugs.

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After being accused of overcharging millions for health care insurance, one of America’s biggest insurers has agreed to a $50 million settlement pay-out.

Hundreds of people made complaints about charges made by Oxford Insurance, and its parent company UnitedHealth Group. The parent company claims that its reimbursement rates are based on “independent research from across the health care industry,” but an investigation by the New York Attorney General’s office revealed that it’s actually Ingenix, a research firm owned and operated by UnitedHealth Group, that supplies the data.

This isn’t just a case of conflict of interest, however – it gets much worse.

According to New York Attorney General Andrew Cuomo, Ingenix has been manipulating the data, allowing UnitedHealth Group’s Oxford Insurance to pay less for reimbursement of its customers.

Surprising Findings in the Health report

Cuomo’s report says that UnitedHealth Group has been under-reimbursing on an enormous scale, “to the tune of at least hundreds of millions of dollars:” in a “huge scam that affected hundreds of millions of Americans.”

In one example, Yonkers, New York, resident Mary Jerome ended up owing a whopping $46,000 for procedures that Oxford Insurance determined were not “usual, customary, or reasonable.”

So what were these unnecessary procedures – cosmetic surgery? No. Those procedures that the company decided did not require reimbursement were chemotherapy and other medications Mary Jerome needed to fight the ovarian cancer she was diagnosed with in 2006.

So far, only UnitedHealth Group and Oxford Insurance have been investigated. However, several other major insurance companies use data supplied by Ingenix. Among them are Aetna, CIGNA, and WellPoint/Empire BlueCross BlueShield.

UnitedHealth Group Response

UnitedHealth Group continues to deny the charges, saying instead that it agreed to the settlement only to solve the conflict, “We respectfully disagree with the New York Attorney General’s findings that we manipulated data … (or that our ownership of Ingenix was a conflict of interest.) We agreed to his settlement because it was an effective way to address any perceived conflict of interest.”

Ivestigations Continue

Cuomo’s investigations aren’t over. In light of the fact that several other large insurers use Ingenix data to determine patient reimbursement rates, the questions continue to pile up.

UnitedHealth Group’s $50 million settlement will be used in the creation of a non-profit, organization that will help determine reimbursement levels in a genuinely independent fashion.

photo credit: rick

Early in January, the California High Court banned emergency room doctors from directly billing insured patients, after their HMOs refused to pay their emergency medical care bills. The High Court has decided that doctors should not be allowed to take up the issue with patients if they believe they’ve been shortchanged by the patient’s HMO.

This new ruling affects around 21 million people, providing them with protection if they are treated by emergency room doctors who are not covered by their HMO plan.

The issue centers around a practice called balance billing. Sometimes, HMOs don’t cover the entirely of an emergency treatment bill, typically because the doctor used by the policy holder isn’t covered by the HMO’s plan. In these cases, the doctor concerned normally directly bills the patient who received the treatment.

High Court Says Don’t Involve Patients in Billing Disputes

In the unanimous seven-person ruling, Justice Ming Chin wrote, “Emergency room doctors must resolve their differences with HMOs and not inject patients into the dispute…We perceive a clear legislative policy not to place patients in the middle of billing disputes between doctors and HMOs.”

In the decision, Chin also wrote of a 1994 law requiring HMOs to pay for emergency visits that were made out of the system, and also made provision for emergency room doctors to sue HMOs if they were not fully paid for their work. Chin concluded that “These provisions strongly suggest that doctors may not bill patients directly when a dispute arises between doctors and the HMOs.”

Good News for Patients, but Doctors aren’t Happy

Unfortunately, many doctors feel that the ruling is going to leave them severely disadvantaged. The California Medical Association has said that the court’s ruling means HMOs will now be in the best position to determine the value of work done by emergency room doctors.

Trauma surgeon Dr. Dev A. GnanaDev, the president of the CMA, claims that the ruling means financially strained emergency rooms will find themselves even more so thanks to this ruling, with emergency doctors forced to go to court if HMOs refuse to pay bills.

So now, the tug-of-war between HMOs and emergency patients has simply changed ends, with the war now between HMOs and emergency room doctors. Doctors complain that HMOs routinely shortchange them on bills, while the HMOS complain that doctors inflate those bills.

It’s hard to say who’s right here, but seventy emergency rooms have closed in California since 1990, and this new ruling is not likely to improve the situation.

photo credit: Todd Ehlers