symtym - Latest Comments

Re: » Never Events the New Class Actions? symtym

symtym — Thu, 14 Aug 2008 20:40:23 -0000

I think "never event" was chosen because it will not be reimbursed (negative compensation). But, with the law of unintended consequences, I suspect it will be used to seek tort compensation.

Re: » Never Events the New Class Actions? symtym

DrCris — Thu, 14 Aug 2008 20:29:37 -0000

The "Never Event" is unfortunately named. In Australia a list of similar events are called Critical Indicators. I accept that they are preventable, but it is hard to say never in medicine and these things happen. By calling it a "Never" event, it suggests compensation. That may be reasonable, but it is impressive for the political system to stack things that way.

Re: Your Business

raja, MD, MS — Mon, 17 Dec 2007 17:24:09 -0000

I wonder about the full disclosure issues. While I believe in them, I think that we are unnecessarily limiting the scope of disclosure practices to physicians. I believe that lawyers, politicians, and officers of corporations should also be obliged to fully disclose their business practices and associations.

Re: Concierge Medicine

Chuck McKay — Thu, 29 Nov 2007 20:49:07 -0000

We don't already have a two-tiered medical system? One for the well-off, and one for everyone else?

Re: MRSA: Medicare’s Superbug

Darwin Corby — Tue, 27 Nov 2007 17:09:30 -0000

This is important information, especially for an elderly person on the Medicare part d plan. They don't need any more nasty surprises like being declined for care

Re: King Dies

symtym — Sun, 12 Aug 2007 16:36:41 -0000

I certainly understand what you are saying; however, this was not a reprimand. King failed to meet its contractual duties under the CMS/Medicare contract. These failures were noted on several visits over several years. CMS, consistent with the contract, removed funding. With the lack of funding, Los Angeles County can not run King. There was no reprimand, but a repeated failure to fulfill contractual duties to receive Medicare funding.

A reprimand implies some form of a discipline for a transgression, this was much more formal and serious.

Re: King Dies

parameddan — Sun, 12 Aug 2007 09:37:16 -0000

I have a hard time understanding how closing a facility that is obviously needed is the correct reprimand.

Re: Unintended Path

Mike — Mon, 06 Aug 2007 02:22:33 -0000

It is having said that until today 2007 many of healthcare organizations are unaware of what exactly the HIPAA rules and regulations are and/or they don’t want to invest their money to get HIPAA compliant. With the growing incidence of privacy breaches the compliance authorities should need to put more efforts bringing awareness about the HIPAA compliance and should try to make it easy and cost effective for organization to get HIPAA compliant. Very recently I came across one tool which I really find more helpful. This tool will help many organizations for multitask compliance achievement. A crosswalk between different regulations poster from Symantec is a very useful tool. This poster is crosswalk between: Sarbanes Oxley, HIPAA, Payment Card Industry (PCI), GLBA, NERC standards CIP and PIPEDA (Canada) http://www.compliancehome.com/symantec/

Re: Toast

Sun, 05 Aug 2007 21:14:24 -0000

But now you're golden toast-- way to go!

Re: Toast

JR — Sun, 05 Aug 2007 16:37:10 -0000

Congratulations on getting through those 3 days!! Will the eldest son be following in his father's footsteps?! We're proud of you!!

Re: Disruption Found

Eric B — Wed, 27 Jun 2007 09:49:02 -0000

Judging by today’s selloff, I think potential customers are starting to realize how expensive the iPhone will be. If you sign the mid-range $99.99/mo service plan after purchasing the 8GB iPhone model, that alone will set you back $3000 during the two-year contract (without any accessories)!

Here’s a few other potential hurdles that could prevent the iPhone from exceeding its already lofty expectations:

* You must be an AT&T customer to use the iPhone. With a market share of 20%, that means 80% of wireless customers must cancel their current contracts to sign with AT&T. Being a Sprint customer, I would have to pay a $175 cancellation on top of the $3000 price tag for the iPhone. AT&T’s exclusive contract runs through 2009.
* Only 4 & 8GB of hard drive space? My tiny video iPod holds 30 GB for less than $200.
* Recent surveys have shown that the majority of IT departments will not even consider the iPhone due to its PC incompatibilities & exclusive AT&T contract. That will dampen business spending & all but eliminate demand for the higher-tier contracts.

This is the ultimate “sell the news” scenario. On Jan 9th 2007, Steve Jobs announced the iPhone at the Macworld Conference & Expo. The stock has since been on fire rising 50% to $125, adding $30 billion to the company's market capitalization. Will the iPhone really hold that much value for Apple? This huge runup comes after a fantastic finish to 2006 after Apple’s stock bottomed out at $50 in October. Thus, nearly everyone holding Apple is sitting on huge gains.

Expect an Apple selloff on Friday when the iPhone is finally released. 3 similar mini-selloffs have occurred during this recent runup:

* June 26th: Apple announces 6 AT&T service plans for the iPhone. The stock drops 3% on investor concerns over the high prices.
* June 11th: Steve Jobs shows off the iPhone at Apple’s World Wide Developer's Conference. The stock falls 5% after investors saw no “surprises”.
* March 20th: Apple beats 4th quarter analyst earnings & revenue estimates. The stock falls on profit taking.

Apple’s recent success has created impossible expectations. With all the mega-hype already priced into the stock, just meeting expectations will create a selloff. I plan to sell tomorrow and buy back in a couple months. Longer-term investors need not worry because the future looks bright with Macs gaining market share & the iPods continuing their dominant foothold on the music industry.

Re: 219 Hello 250

GruntDoc — Wed, 20 Jun 2007 11:50:01 -0000

Nah, you've just been under-rated all these years!

Re: Inexcusable Indifference

Susan Doerfler — Wed, 13 Jun 2007 13:10:00 -0000

We have heard this story many times before. It seems all dispatchers police, fire and emergency medical technicians feel they have heard it all and they are able to make vital decisions over the phone, this is not true and their arrogance and indifference to someones situation (if not textbook related )then they feel their power to disagree, argue, and even deny someone emergency care.
Probably they have heard many stories and have thought they heard it all, but it is obvious this is untrue. May God Bless all that risk their lives everyday for the well being of all of us....but may they not forget, they too are a part of the human race and they are not God and they should not be ego driven to make these decisons because they didn't believe the callers...

God bless the callers of loved ones when they don't get the help they deserve...god bless the dispatchers who made bad decisions and people have died. May this never happen to your family and loved ones!

Come down to earth and be the helper of humanity you wanted to be when you chose your professions.

Re: Boarding

N1 — Wed, 13 Jun 2007 10:39:07 -0000

The Institute for Healthcare Improvement has done some good work around this. I discovered that most of the boarders have chronic diseases and fall in the medical service - lower reimbursement rates, while elective admissions skate right in around them. As soon as hospitals are forced to hold elective admissions until all ED boarders are placed in beds, ED boarding will stop as hospitals "magically" find beds and staff. One way to fight this is to count all admitted, but boarded patients on the inpatient census and attach them to the inpatient units they belong to. THe hospital can be held accountable by JCAHO in the Leadership Standard -for counting these inpatient boarders on the inpatient census and for providing safe nurse staffing to care for them..Personally, I believe that moving patients to inpatient hallways is a disaster - for fire safety, privacy and the potential to make mistakes in terms of patient ID, continuity of care and nurse workload.

Thanks for picking up on this. It's important, and the data supports clear discrimination in wait times based on medical diagnosis, assigned service and reimbursement rates.

Re: Flea at Post

symtym — Mon, 11 Jun 2007 05:53:07 -0000

Agree, but the risk is that you might contradict something you put in one forum (e.g., a blog) and later put in another forum (e.g., court). Consistency is what set Flea up for failure—we as physicians know exactly what he meant. The problem is how it is portrayed for the jury. If Flea did not settle the case, he would have had his character impeached with an inconsistent statement. Lethal? We will never know.

Re: Flea at Post

GruntDoc — Sun, 10 Jun 2007 01:20:10 -0000

I don't think an endorsement indicates that I accept uncritically the entire opus. I like lots of things, but that doesn't mean I like or agree with all of them.

Re: Flea at Post

symtym — Wed, 06 Jun 2007 00:42:48 -0000

"[I]t was like watching an accident as it was happening." That was my very first impression—along with, this will end very badly.

Re: Flea at Post

Hans Poppe — Tue, 05 Jun 2007 22:02:43 -0000

I agree, as an attorney, I can tell you the Flea's case was fascinating. You are correct that the Flea has taken us to a new place in the law. He pushed the envelope. It was absolutely the wrong thing to do as a doctor defendant. As a spectator, it was like watching an accident as it was happening. The only thing more enticing might by an anonymous blog by a juror during a case. One can only hope. Here are more of my observations on the Flea and how the case was likely settled because of its facts as opposed to Flea's blog. http://www.poppelawfirm.com/blog/index.cfm?id=721

Re: End of an Era

Steve — Sat, 05 May 2007 02:46:03 -0000

Memories for sure. Stopped into Valley MC in September 1974 and met Bob Daily thinking I might train there, but it was 116 or so and I didn't think it was the place for me. Stayed east and trained in my home town. That hospital--MCP--closed a few years ago. One never forgets those training times and the place, but it's really the people that made it then. Some of us got together a week ago. I made the 110 mile trip just for the event. Worth every bit of it. Call those old friends--docs and nurses alike--and get together. Time is passing and sadly not just buildings--people too. /S

Re: Death for Profit

symtym — Sat, 21 Apr 2007 04:33:00 -0000

Charles

I think you are missing the point, it is the physicians and their investors that are acting just like the ones you are indicting, "the legal profession, the insurance cartels, the pharmaceutical companies...." Profit has motivated the creation of specialized hospitals that lack basic safety features.

Your statement, "[t]he issue is not what those with, can afford, but what those without, can not afford[,]" has no logical relevance to the article. Specialty hospitals *only* cater to those with the ability to pay.

This article is, plain and simple, another example of cream-skimming the healthcare dollar, and doing so in a manner that may potentially harm or kill the very clients they seek. Trading a savings for a potential threat is not a wise investment.

As more cases of harm and death mount, Congressional angst will rise and specialty hospitals will become the subject of ever increasing regulatory burden and their profitability may very well vanish. They may die, not because they are not successful, but because they are not safe.

The other side of the coin, which I have touched upon before, is what is the cost of cream-skimming to acute care hospitals and the overall cost to healthcare in the communities served by specialty hospitals. A search in this blog on "specialty hospital" will show several related articles.

Re: Death for Profit

Charles — Fri, 20 Apr 2007 21:49:00 -0000

Seems to me Grassley, Baucus, Stark and the rest of congress would better spend their time in and out of committee addressing the unscrupulous politicos working for or in public office who, for their own enrichment, pander to the legal profession, the insurance cartels, the pharmaceutical companies and the various business and special interests that make specialized hospitals something more noteworthy than other specialized business catering to elite in search of basic needs like food and shelter i.e. classy restaurants, and five star resorts. Such establishments also turn away those who can not pay the price. The issue is not what those with, can afford, but what those without, can not afford. What you have really highlighted is that national health care initiatives have progressed no further than our basic right to call 911, which in an emergency, is the implied responsibility of the health care facility that, knowing you must eat, sends you to McDonalds or knowing you must sleep, sends you to Motel 6.

Re: Incremental Death

Tue, 27 Mar 2007 18:01:00 -0000

It's digusting that fat insurance companies profit off the needy by deceit and thievery. They need to be held to the contracts agreed to and paid for, and given huge penalties for stonewalling.

Re: Fire Engine Red

symtym — Wed, 14 Feb 2007 14:02:00 -0000

> Welcome back!

Thanks

> Is the bar exam done?

Not yet, see the "CBX Countdown" upper left sidebar. The exam is Feb 27, 28 and Mar 1.

Re: Fire Engine Red

cardioNP — Wed, 14 Feb 2007 13:58:00 -0000

Welcome back! Is the bar exam done?

Re: Expectations Trumps Exam

universalhealth — Fri, 08 Dec 2006 03:14:00 -0000

Yes to all of the above reasons and to add to them: employers' expectations that workers come to work when ill (presenteeism), parents' inability to take time away from work to bring children in for office visits, delay in getting office/clinic appointments, decreased availability of school nurses to see children with acute symptoms, attempts for primary providers to see as many patients as can be crammed into the clinic/office schedule, little risk of acute harm for extant practice.

Does anyone still use the self-assessment diagnostic tool to distinguish viral from bacterial caused URIs?