Stress: the Silent Killer

Stress is a normal reaction that comes from our evolutionary past. The so-called “fight or flight” reaction served our ancestors well, but in our times it is triggered too often by emotions, simple problems, and situations that pose no threat. The grinding pace of modern life streams with repeated “stressors” that build up. Our body reacts to the stress as it distracts our minds and affects our health for the worse. We know when we are “stressed-out,” and it’s a loud and clear message — we’re slowly killing ourselves.

Stress is the body and mind’s reaction to new situations and problems. The body turns up the metabolism with a burst of energy and then braces to react. The mind becomes focused and vigilant. If there is danger it is a good thing; if there is no danger the result is unnecessary wear-and-tear. The damage is both psychological and physical when the body’s reactions don’t match the situation.

During stress the nervous system reacts with chemical releases, hormones prepare the brain for action as it draws more oxygen, muscles tighten, the heart beats harder, and breathing accelerates. The body also suppresses the immune, excretory, and reproductive systems, and it’s all to prepare for action.

A return to a normal state is drawn out when stress becomes routine, for example, with job and family problems. Recurring and overlapping difficult events can easily become chronic stress. Normal function does not return easily and in time health deteriorates.

Constant stress takes its toll with headaches, sleeping problems, and back and stomach pain — if you’re lucky. Over a lifetime, it can cause debilitating and life threatening disease. Existing conditions worsen as the immune system weakens. Mood disorders become more common and daily living suffers.

Anxiety, lack of motivation, anger problems, depression, and anti-social behavior can become problematic. Using drugs, alcohol, and tobacco is a poor way to cope, and they more often add to the stress. The downward spiral begins to destroy personal and work relationships, and as long-term stress progresses it physically manifests as disease. The most common result, as research shows, is high blood pressure that leads to heart disease over time.

When stress seems overwhelming or unmanageable, there are solutions. If stress is dominating your lifestyle, it’s time to reach out.

Nurturing and maintaining social contacts can help you cope. Family relationships give outlet to frustrating life dilemmas, and friends can also be a source of support. Also, church and community organizations can be a path to insight and relief. Paying attention to good health helps the body’s resilience, and maintaining mental hygiene makes stress episodes shorter lived.

Exercise and meditation have proven to be good stress reducers as well. Incorporating more physical activity in daily living can be as simple as taking walks. Regular meditation can settle the mind and help you remain calm in situations that usually cause a lot of stress.

Emotional maturity is about knowing yourself and how you should react to stress. We all have to take on some stress; it’s important to know when to avoid a bad situation. In other words, if you see a train coming, get off the tracks! Take the first step and focus on examining what the sources of your stress are. Sometimes you need to change (or end) bad relationships or situations.

How you internalize and view personal stress has consequences, and your perception of any situation creates positive and negative emotions. Stress can be completely in the mind, but most likely it’s a combination of environment and perception. Knowing what you can change and what stress is appropriate can help keep your life in your hands.

Sources:

Ask Men
Web MD – Stress Management
Web MD – Essential Tremor and Stress Management
Wikipedia – Psychological Stress
National Institute of Health
Mayo Clinic

About the Author:
Iris Stone has worked as a freelance writer since 2011. Her writing has included content on medicine, healthcare, and education, although her interests are wide and varied. Prior to breaking into the freelance biz, Iris worked in sales for a health company and prior to that as an assistant in a chiropractic office. She is currently attending George Mason University and is majoring in Political Science. Check out her Google+ profile.

Swipe Right For Your Health: Reducing Hospital Related Infections With Wearable Tech

Medicine isn’t perfect, and everyone understands that it’s possible for a condition to worsen somewhat over the course of treatment. But imagine instead that you went to the hospital and came down with an unrelated illness that was much more dangerous than the one you already had! Sadly, healthcare associated infections (HAI’s) are commonplace in hospitals and other treatment facilities around the world. In fact, the Center For Disease Control (CDC) reports that nearly one in twenty five patients in the US are affected by HAI’s, which collectively resulted in over 205 deaths a day in 2011.

Of the 722,000 patients who were reported to have HAI’s in 2011, 75,000 of them died from the infection or the complications it introduced in their treatment. Pneumonia, gastrointestinal illness, UTI’s, bloodstream infections, and surgical site infections appear to be the leading culprits when it comes to HAI’s. But there’s a bigger concern here: why are people getting sick in the very place designated for improving their health?

The simple answer is that hospitals consolidate these dangerous bugs in one building, a building filled with people whose immune systems are already compromised from their respective illnesses. But there’s more to it then that. The causes for these pesky infections range from the over prescription of antibiotics to complications from surgery.

One paper found that significant spikes in fatal medication errors correlate with the time of year when medical residencies typically begin (July). Another report, conducted by HealthGrades, found that “a typical patient has a 73% lower risk of dying in a 5‐star rated hospital compared to a 1‐star rated hospital.” While this report was not specific to HAI’s, it nonetheless reveals the dire consequences that can result from negligent or inexperienced doctors, nurses, technicians, and even office administrators.

Hospitals have a number of procedures already in place to prevent the spread of infections among patients and staff. In the case of the most contagious diseases, such as measles or Ebola, hospitals will quarantine the patients and only allow workers to approach them while while wearing protective masks and gloves. But even these extreme measures don’t always work, as evinced by the measles outbreak in a Manhattan hospital last February. If we can’t achieve full compliance with these careful measures, how can we expect to prevent more commonplace infections?

SwipeSense is a young startup that aims to address this exact problem by boosting hand sanitation compliance with wearable tech. Rather than relying on wall-mounted gel dispensers, doctors and nurses wear a small, touchless device on their waists. SwipeSense not only provides convenient hand sanitation, it also records data to measure compliance and reminds staff to sanitize their hands before entering or leaving a patient’s room. SwipeSense has been shown to improve hand hygiene compliance by an average of 64% at some of the nation’s top-rated hospitals.

Most people don’t think about the cost associated with disease, but such figures are constantly at the forefront of hospital administrators’ minds. Every HAI could set a healthcare facility back as much as $15k, while SwipeSense only costs $99/year per practitioner. The numbers don’t lie: this tech gadget is a smart investment both medically and financially. Of course, given its still nascent presence in medical facilities, the jury’s still out on whether or not it will successfully reduce the rate of infections around the world.

Even so, there are two reasons to be optimistic: for one thing, the use of SwipeSense in poorer or lower-rated hospitals will probably have a much more dramatic effect than it has at Northwestern Memorial or Rush Medical Center. What’s more, by eliminating (or nearly eliminating) hand hygiene compliance as a potential cause of HAI’s, researchers can take a significant step forward in pinpointing the exact causes of these widespread infections and seeking more targeted prevention methods.

Sources:
CRAIN’s Chicago Business
New York Times
Mobi Health News
HealthGrades 2011 Report
Mercola
Center for Disease Control

About the Author:
Iris Stone has worked as a freelance writer since 2011. Her writing has included content on medicine, healthcare, and education, although her interests are wide and varied. Prior to breaking into the freelance biz, Iris worked in sales for a health company and prior to that as an assistant in a chiropractic office. She is currently attending George Mason University and is majoring in Political Science. Check out her Google+ Profile.

Pay Versus Pain: How the Affordable Care Act Affects Hospital Funding

After many years of controversy and compromises, the Affordable Care Act (ACA)—also known as “ObamaCare”—is now in full swing, and people are starting to see how the policy changes associated with the bill are affecting both patients and healthcare providers. The media has given plenty of attention to the political and financial sides of the ACA, but many have overlooked some of the less obvious impacts. For example, one of the biggest concerns for healthcare administrators today is not just the amount of funding they receive, but also the ways they must adapt to new measures of quality and performance.

On the surface, linking hospital funding to some evaluation of quality is a no-brainer. There are already groups, including the Joint Commission and the Centers for Medicare and Medicaid Services, which use quantitative metrics to assess compliance with national safety and quality guidelines. But now, instead of mere compliance and ratings, the ACA has begun to associate funding with performance, rewarding “good” hospitals and punishing less successful ones. This feature extends to the provider level; doctors whose patients get better receive better pay.

Misgivings about this policy chiefly concern implementation: what sorts of metrics does the ACA use to evaluate doctors? Does this system actually succeed in improving national health? Is this manner of assessment sustainable? Currently, officials evaluate healthcare facilities and practitioners according to a combination of clinical outcomes and patient satisfaction surveys.

Unfortunately, these measures have already proven problematic. First of all, the implementation of the ACA has launched an influx of formerly uninsured patients into the medical system – much as the bill intended. But many of these patients are receiving care for the first time in years. With so many new, sick patients, it has been difficult for doctors to prove that they are actually improving “clinical outcomes.” This problem is especially prevalent in the poorer areas that need funding the most.

Secondly, relying on “patient satisfaction” as a measure of quality care may encourage hospitals to focus on pleasing patients rather than healing them. In addition, factors like patient compliance and satisfaction are largely outside of doctors’ control; as the saying goes, you can bring a horse to water, but you can’t make him swallow the pill. Yet these factors now play a deciding role in whether a single doctor, nurse, or an entire hospital gets paid at the end of the day.

In order for this new system to work, it will require a fundamental change in the doctor-patient relationship. And maybe that’s a good thing. On the one hand, it may encourage doctors to actually listen to their patients and give them a thorough evaluation, rather than rushing through a 15-minute appointment in an attempt to see as many people as possible. At the same time, it may also encourage healthcare practitioners to be more selective in whom they see. Many doctors have already begun “firing” patients who refuse to vaccinate their children. If a doctor’s pay were strictly linked to the quality of their patients’ health, we might also see them threaten to drop patients who refuse to address other medical issues, from smoking to obesity to addiction. Of course, we can’t be sure that such negative consequences would actually motivate Americans to improve their health in the long term, but it might be worth it to try something new.

Officials have projected that the ACA will begin paying for itself by 2021. What many don’t realize is that this outcome is dependent on much more than flat insurance costs and service charges. Nuanced issues concerning provider pay, hospital funding, and patient motivation could ultimately make the difference in whether this bill sinks in a pool of debt and criticism or floats on a cloud of savings and health.

Sources:
USA Today: ObamaCare Takes Root in Appalachia
USA Today: Hospitals Face Whole New World Under New Healthcare Law
The Heritage Foundation
The Atlantic: The Problem with Satisfied Patients
AL.com: Some Doctors Firing Patients

About the Author:
Iris Stone has worked as a freelance writer since 2011. Her writing has included content on medicine, healthcare, and education, although her interests are wide and varied. Prior to breaking into the freelance biz, Iris worked in sales for a health company and prior to that as an assistant in a chiropractic office. She is currently attending George Mason University and is majoring in Political Science. Check out her Google+ Profile.

A Loophole Could be Obamacare’s Biggest Enemy

The Affordable Care Act: we’ve all heard the name, and we’ve all undoubtedly read numerous articles about this controversial bill. The ACA has been associated with speculation, rumors, and intentionally misleading information since long before the bill was actually enacted. Unfortunately, even after that the policy has been in place for several months, the fog hasn’t exactly cleared. Healthcare providers and administrators face constant frustration as they try to untangle the webs in thousands and thousands of pages of legislation.

And now, we have another concern – loopholes. About a year ago, David King and three other plaintiffs from Virginia brought a case against Obamacare to the Supreme Court that may have substantial consequences not only for the policy itself, but for healthcare on a nationwide scale.

So what’s the problem? The case, labeled King v. Burwell, hinges on a crucial interpretation of an ambiguous passage in the ACA. Essentially, the plaintiffs are trying to defund federal subsidies for dozens of states based on the choice of only a couple words. Whether this wording was carefully or carelessly chosen is up for discussion.

The issue at hand has to do with “marketplaces.” The purpose of these marketplaces is to allow the unemployed, self-employed, and others who don’t receive insurance through their workplace to shop for a policy. Because the federal government can’t force individual states to establish their own marketplaces, they formulated a federally run marketplace to provide coverage for residents of the 34 states that declined to participate.

But interestingly, a literal interpretation of the law suggests that federal subsidies are only legal in states that have established their own marketplaces. As there is no reference to federal marketplaces in the passages that cover subsidies, some (including King) claim that the government can’t use federal funds to support a nationwide marketplace that would compensate for the 34 non-participant states.

The exact portion of the bill reads:

“(2) (a) the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 [1] of the Patient Protection and Affordable Care Act, […]”

The italicized section is the wording under dispute. Taken literally, it maintains that only state-established exchanges can provide the essential subsidies that make ACA policies affordable for lower- and middle-income people who do not get insurance through their employers.

Of course, practically speaking this wouldn’t make any sense, as the entire point of a federal marketplace is to provide service to residents of the states that don’t have their own “shopping” venues. But in legal terms, it’s a different story – one that shines light on why legislation often comes down to just a few strategically worded phrases and can end up bearing more pages than Tolstoy’s War and Peace.

Just recently, the Supreme Court agreed to hear the case. And although the dispute is minor, the consequences of the decision in July are huge. Beyond the stress the government will bear, hospitals and private practice doctors will have to shoulder the burden of the outcome as well. Sources predict that without federal subsidies, millions of people will be unable to afford insurance. Other predictions include a nearly 50% jump in insurance premiums and nearly 10,000 preventable deaths as legislators split hairs over semantics.

For those who work in medicine and simply want to do their jobs, it might not be so easy. Healthcare practitioners may have to adjust their pricing structures, insurance policies, new patient acceptance terms, billing procedures, and more to accommodate the outcome of this case. And that’s just until someone finds another loophole!

Sources:
The Day after King v. Burwell
SCOTUS Blog
King v. Burwell Fallout

About the Author:
Iris Stone has worked as a freelance writer since 2011. Her writing has included content on medicine, healthcare, and education, although her interests are wide and varied. Prior to breaking into the freelance biz, Iris worked in sales for a health company and prior to that as an assistant in a chiropractic office. She is currently attending George Mason University and is majoring in Political Science. Check out her Google+ Profile.

To Pay Or Not To Pay?

Inflated medical expenses are one of the most pernicious problems in modern American healthcare. According to the U.S. Department of Health and Human Services, hospital prices have risen three times faster than inflation since the 1980s, making medical debt one of the leading causes for individual bankruptcy in the nation. What’s more, hospitals are still deplorably underfunded, and doctors and administrators work longer hours for less pay than any decade in U.S. history since WWII.

Of course, these stratospheric prices are merely symptomatic of greater endemic issues in the healthcare industry. From insurance and healthcare reform a la Obamacare to lobbies against pharmaceutical patents, it can be difficult to escape the vicious cycle of rising medical expenses. However, desperate times call for creative measures, and some American patients even go overseas for vacation/treatment/rehabilitation combos that tally a combined cost that is still only a fraction of a domestic bill. But quizzically, public awareness of the unsustainability of U.S. medical treatments hasn’t quelled the surge in prices. At times, it seems as if there is no end in sight.

It should come as no surprise that many are refusing to pay these exorbitant, unjustifiable fees. Jay Hancock articulates the questions that preoccupy patients and employers who are faced with exorbitant fees for inconsequential treatments:

“How can hospitals justifiably charge employers and their workers so much more than they accept from Medicare, the government program for seniors? How can hospitals bill $30 for a gauze pad? How can employee-patients consent to prices they will never see until after they’ve been discharged?”

As outrage increases, some are going corporate with their indignation. Enter the rise of “benefits consulting firms,” companies that make a business out of confronting hospitals head-on. For example ELAP Services, one such firm, received a bill for a 3-day stay that came out to $600,000. After estimating costs for the actual treatment, ELAP paid $28,900 and never heard from the hospital again.

Problem solved? Not necessarily. On one hand, firms like ELAP can compound the problem by leveraging the same heavy-handed legal resources insurance companies use to extort vulnerable patients. It’s useless for patients to partner with a consulting business instead of negotiating with an insurance provider if they are going to feel bullied either way.

Not only that, but hospitals might need to adjust their strategies as well. While it’s no secret that some medical facilities do overcharge for their services – and justify their prices in cryptic ways – hospitals have limitations, too. Administrators have to worry about how to process their own billing, when to abandon cases that are more trouble then their worth, and of course the main concern: paying their staff.

How is it that despite rising medical costs, doctors and nurses are still underpaid? How are so many medical practices understaffed? The money has to come from somewhere, and if administrators aren’t meeting their budgets from patient bills, they may turn their focus on those who do not have the legal firepower to deflect them. Firms like ELAP have the finances to pay the bill – and potentially legal fees if they need to – and so offer significant protection to patients who hire them. Unfortunately, this means patients who can’t afford consulting firms may become targets, and they’re the ones who need the biggest break in the first place.

While it’s always great to have options like ELAP, it’s doubtful that this poses a permanent solution to the nation’s medical problems. As Americans well know, capitalism is all about supply and demand. If patients collectively transform their anger into action by refusing to pay exorbitant bills and taking their business (or in this case, their illness) elsewhere, insurance companies and healthcare providers will ultimately feel the pain that comes from weakening demand. But as with anything of this magnitude, change occurs slowly. So in the mean time: try not to get sick.

Sources:
Kaiser Health News
Agency for Healthcare Research and Quality
ELAP Services
New York Times

About the Author:
Iris Stone has worked as a freelance writer since 2011. Her writing has included content on medicine, healthcare, and education, although her interests are wide and varied. Prior to breaking into the freelance biz, Iris worked in sales for a health company and prior to that as an assistant in a chiropractic office. She is currently attending George Mason University and is majoring in Political Science. Check out her Google+ Profile.

Getting to Know “Orphan Drugs”

If someone were to ask you what the most common drugs are in the country, what would you say? Chances are, this survey would produce a narrow range of results – drugs for cholesterol, erectile dysfunction, birth control, high blood pressure, and maybe a few other common and low-cost prescriptions. And while it’s wonderful that we have treatments for even our most trivial needs, there’s still a huge, mostly unmet need within the pharmaceutical market.

Rare conditions receive very little attention from BigPharma, mostly because the ailments are too rare and too costly to make a drug profitable to produce. And while it sounds abhorrent to rank diseases based on profitability, pharmaceutical companies are a business just like every other industry. If they can’t scrounge up enough money to support the R&D for these often poorly understood afflictions, it doesn’t make sense to bother trying – especially if the number of patients who could benefit from the undoubtedly expensive medicine wouldn’t pay anywhere close to what the business would need to recoup its investment.

Luckily, governments can – and do – play an important role in these matters. In the United States, the 1983 Orphan Drug Act was enacted to stimulate funding for rare diseases and encourage research in areas that would otherwise be a money pit. It also created the FDA Office of Orphan Products Development, which evaluates potential new medications and determines their efficacy in the treatment of low-incidence conditions.

To clarify, a “rare disease” is one that affects fewer than 200,000 people in the United States, or one that affects more than 200,000 people but is so expensive to treat that without external funding, pharmaceutical companies would stay far away. In the last 30 years, the act has enabled medical researchers to develop more than 400 unique drugs, although most of the nearly 7,000 conditions covered under the legislation are still lacking effective treatment options.

Although many people have never heard of the term “orphan drug,” its importance for the healthcare industry is huge. Many of these rare conditions – including Creutzfeldt-Jakob Disease, Duchenne Muscular Dystrophy, Narcolepsy, and Trigeminal Neuralgia – are far more serious than an ailment like high blood pressure, in that they are either fatal or lead to substantially compromised functioning in the afflicted.

Unfortunately, many healthcare providers are unaware of both the conditions and their potential treatments. It can take many years and a highly qualified specialist to recognize a rare condition, and even then, practitioners need to know how to get their hands on these valuable orphan drugs. In some cases, it is not as simple as calling a prescription into CVS or Rite Aid.

Healthcare administrators can do their part by organizing educational seminars on rare conditions, sending doctors and nurses to conferences within their specialty, and educating themselves on the financial costs of treating the unlucky patients. Administrators who work in research should see orphan drugs as an opportunity – tax incentives, marketing rights, clinical research subsidies, and other forms of government assistance are all available to companies that are willing to partake. Lastly, healthcare administrators who work in the insurance industry arguably need to stay informed more than anyone; without knowledge of who needs these expensive medications and just how badly they need them, many insurance agents are quick to deny coverage or push for less expensive (and less effective) alternatives.

For more information, see an overview of the global report for 2015 here.

Sources:
Orphan Drug Act
FDA Office of Orphan Products Development
Global Genes: Rare Diseases List
Orphan Drugs Market

About the Author:
Iris Stone is a freelance writer, editor, and business owner who has written on a range of topics. She has experience covering content on medicine, healthcare, and career training, as well as education. Iris is also interested in science and mathematics and is currently studying to be a physicist. Check out her Google+ Profile.

Caribbean Medical Schools: Second-Chance or Second-Rate?

It’s no surprise that medical school is getting more competitive. As far as aspiring doctors go, undergraduates today must struggle through a completely different experience than their parents and grandparents did. In 1999, a “record” number of students – 1,049 – applied to U.S. medical schools. By 2013, that number had grown to nearly 50,000 a year.

The Association of American Medical Colleges reports that this jump is partially attributable to the increasing number of women and minorities who are seeking positions in healthcare. To their credit, American universities have done their best to keep up with demand; more than a dozen schools have increased their class sizes, and a few new medical colleges have established themselves throughout the country.

Unfortunately, this growth hasn’t done nearly enough to absorb the influx of medical hopefuls. And the “tips and tricks” for applying to school increasingly reads like a set of riddles. For example, a guide on U.S. News suggests that yes, GPA and MCAT scores are still very important, but so are life experiences, diversity, gender orientation, and problem-solving abilities. Students should present themselves as thoughtful and service-oriented. They need to be unique, but should also demonstrate that they will work well in a cohort of other students.

In some ways, the request that medical applicants practically be “all things to all people” ensures that only the very best gain the privilege – and responsibility – of becoming healthcare practitioners. But it also marginalizes many hardworking students who can’t figure out the cryptic magic formula.

More and more often, students who are denied from American medical colleges are turning to alternatives in the Caribbean, where 30-40 schools are ready and willing to take on the American “rejects.” These universities are both painfully expensive and attractively unselective. They admit roughly 1 in 4 applicants, advertising themselves as a “second chance” to curious and passionate students who simply don’t have the chops for American education.

The students who attend these foreign schools offer myriad explanations for their rejections – their age, their major, the fact that they went to a selective undergraduate school, their test scores…the list goes on. But the question remains: are these Caribbean alternatives simply helping determined students get back on their feet, or are they injecting the healthcare system with subpar doctors?

The schools differ wildly in their performance; first-time pass rates on the Medical Licensing Exam Step I range from 19-84%. Plus, most of the universities pay U.S. hospitals to take students for rotations, asking them to ignore the students’ potentially underwhelming abilities. And without an accrediting body or any objective ranking system, it’s nearly impossible to tell if students at Caribbean schools are getting an education that can even compare to the U.S.’s second-rate programs.

Fortunately, there is one clear take-away that may shed light on the issue for administrators involved in the hiring process. These students understand that the most advanced specialties are out of reach for them. Many of them also understand that they won’t make as much as their American-educated counterparts, and their student debt will be much higher. As such, administrators can count on the fact that compared to their colleagues with a glitzy U.S. diploma, these would-be doctors aren’t in it for the money. Add to this the unique education they receive on Caribbean islands – where clinics are shockingly primitive, resources woefully scarce, and patients sickeningly poor – and you have a perfect formula for compassion, service, and patient-centric care.

Hospital administrators who see a résumé adorned with Grenada or Dominica under the “Education” heading might be quick to throw it straight in the trash. If they’re hiring a neurosurgeon, that might be the right call. But administrators who need someone with experience in infectious disease, with the heart to travel to third-world countries (such as through Doctors without Borders), or who can make a respiratory diagnosis without a chest x-ray might due well to put aside the question of whether or not they’re second-rate or second-chance, and take a second look.

Sources:
Association of American Medical Colleges
U.S. News: Medical School Admissions
The New York Times: Second-Chance Med School

About the Author:
Iris Stone is a freelance writer, editor, and business owner who has written on a range of topics. She has experience covering content on medicine, healthcare, and career training, as well as education. Iris is also interested in science and mathematics and is currently studying to be a physicist. Check out her Google+ Profile.

The Pros and Cons, Profits and Costs of Teaching Hospitals

Teaching hospitals are exactly what they sound like – healthcare centers where doctors also act as teachers to medical students and residents. What makes the concept somewhat unique is that it isn’t all about the academics; these hospitals are still businesses, hosting real patients and treating real diseases in a setting that doesn’t allow for homework extensions or “do overs” on tests.

Are teaching hospitals worth it? Administrators have to consider multiple factors before inviting graduate medical students through their doors. First and foremost, there’s the issue of cost. Health insurers and government agencies, particularly Medicare, traditionally cover the cost of medical students through broad subsidies. These payments are designed to cover numerous expenses related to med student education, such as resident salaries, malpractice premiums, and administrative costs. But the bulk of the funding actually goes to indirect healthcare expenses, particularly the higher costs associated with having sicker patients (teaching hospitals are also some of the country’s biggest medical centers, including Mount Sinai Medical Center in New York and Barnes Jewish Hospital in St. Louis).

But of course, this funding is only useful if it covers the total cost of graduate medical education (GME). In 1996, Congress passed the Balanced Budget Amendment, which capped the funding for hospital residencies. And yet, the number of medical students continues to rise, and now hospital administrators have to either turn residents away or dip into their own piggy banks to cover the extra costs. Some hospitals are able to secure outside funding to make up the difference, but otherwise many medical centers are lucky to break even.

Financial officers seem uncertain that medical residents increase profitability at all, despite the increased funding, manpower, and reputation that accompany teaching hospitals. And that raises another question: are teaching hospitals better in the quality of service they provide?

If you’re about to go into surgery, chances are you wouldn’t feel completely comfortable knowing that a resident will be wielding the scalpel. But remember that “resident” doesn’t necessarily mean med school newbie: a surgical resident could gain five or even ten years of experience in the position before earning a spot as an attending physician. And because these hospitals place a premium on learning, they attract top doctors who are at the forefront of research and are highly experienced in treating complex illnesses.

So it seems there might be a reason that even the best financial minds are uncertain of the benefit of teaching hospitals – at least from an administrative point of view. There are too many indirect elements that come into play, from the costs of employing less experienced doctors to the pros of maintaining a larger and more academically minded staff. Hospital administrators might not be able to run a quick cost-benefit analysis, but it’s worthwhile to consider the web of financial factors, as well as how they might change in the future. As the federal budget shrinks under the pressure of ballooning debt and the number of people seeking medical treatment surges, hospitals’ budgets will need to respond in kind.

Sources:
Becker Hospital Review
List of Teaching Hospitals
Fierce Health Finance
U.S. News Health News
Modern Healthcare

About the Author:
Iris Stone is a freelance writer, editor, and business owner who has written on a range of topics. She has experience covering content on medicine, healthcare, and career training, as well as education. Iris is also interested in science and mathematics and is currently studying to be a physicist. Check out her Google+ Profile.

Healthcare Consolidation: a Fight between Giants

There are only five main healthcare insurance providers in operation in the United States: UnitedHealth Group, Humana, Cigna, Anthem, and Aetna. These industry titans are responsible for nearly everything you hear about healthcare – the rising premiums, the confusing restrictions, and of course the loud pushback against the Affordable Care Act.

Although some might argue these companies’ top priority should be patient health, they are businesses that function just as all businesses do – with profit as the primary motive. In order to best protect their bottom lines, many of the insurance industry’s top players are looking to grow even larger through consolidations of epic proportion.

Just recently, UnitedHealth made a run at Aetna, while Anthem has penned a deal to absorb Cigna for an unbelievable $48 billion. Humana quickly put itself up for sale, and both Aetna and Cigna (yes, the two that seem to be up for grabs themselves) have both considered taking over Humana.

As the five major insurance organizations reorganize themselves into just two or three providers, Americans are justified in feeling concerned. This moves the market just a small step away from true monopoly status, and the insurance companies know it. They mostly look to consolidate as a way to gain power in the field and amass financial resources – resources they can then use to hire regulatory experts and lobbyists. The former group helps make sense of the web of regulations thrust upon insurance companies, while the latter group slowly works to dismantle that same web.

Although the mergers themselves are bound to be quite costly, most of these massive organizations cite ambiguous benefits like “synergy” and “impact” as reasons to move forward with the consolidation. In fact, Anthem is already claiming that this synergy will save them $2 billion post-merger. As these vague corporate buzzwords don’t likely have a line for themselves in the accounting books, it may be difficult to verify this claim.

There are other reasons companies like Anthem are looking to merge, as well. For example, hospitals have also started to expand in recent years, for much the same reason the insurers have. Hospitals that band together to form networks buy themselves clout to use in negotiations with insurance companies, securing the best possible deals as medical suppliers and patient providers. If the hospitals insist on growing, insurance companies can’t help but feel pressure to expand just to keep up the pace.

All this leaves patients cowering in fear, painfully aware of their diminutive stature as an explosive battle ramps up between Goliath and, well, Goliath. And while individuals are of little concern to insurance companies right now (the majority of their business comes from employer plans), that may change with some of the new mandates under the Affordable Care Act. Businesses are scrambling to rebrand their employees as “part-time” in order to avoid paying benefits, opening the floodgates for a deluge of new individually-insured customers in the coming years. It remains to be seen how these consolidations will play out. On both sides of the battle, insurance companies and hospitals claim to be fighting for the influence to lower costs while simultaneously clamoring for the right to unchecked pricing power.

As far as hospital administrators are concerned, they’ll need to keep tabs on the insurance companies and consider how this will affect their own patients. Are their hospitals part of a network that can stand up to an insurance Godzilla? How transparent are they being with patients about costs, and can they afford to lower prices if the corporate climate demands it? Are they willing to sever ties with certain insurance companies (or at least threaten to do so) if the situation gets out of hand? These questions are intentionally big, framed to match the grave concerns of individual patients who have no choice but to watch a face-off between healthcare’s biggest heavyweights.

Sources:
Modern Healthcare
Bloomberg View
Forbes

About the Author:
Iris Stone is a freelance writer, editor, and business owner who has written on a range of topics. She has experience covering content on medicine, healthcare, and career training, as well as education. Iris is also interested in science and mathematics and is currently studying to be a physicist. Check out her Google+ Profile.

Surgeon Scorecard Brings Much-Needed Transparency to Healthcare

Conventional wisdom maintains that, just as there are good and bad schools and school districts, there are also good and bad hospitals. Funding from insurance, grants, Medicare, and Medicaid along with patient quality of care reports are the most relied upon—though not necessarily the most reliable—metrics to determine which hospitals are the “best” and which are the “worst.” But just as the RAND Corporation has shown that individual teachers have a larger impact on students’ growth (or lack thereof) than their schools, mounting research in medical complication rates has indicated that individual surgeons and other practitioners can have a commensurably substantial impact on patient outcomes.

ProPublica stands at the forefront of this movement, claiming in a recent article that their “analysis of Medicare data found that, when it comes to elective operations, it is much more important to pick the right surgeon” than the right hospital. ProPublica recently announced that they were “making public the complication rates of nearly 17,000 surgeons nationwide,” with the aim of informing patients of their potential for substantial risk of bodily harm and/or death at the hands of underperforming surgeons.

Researchers have compiled this data into a website called Surgeon Scorecard, which allows patients to search a list doctors and hospitals for past success and complication rates in eight elective procedures. Ranging from hip and knee replacement to lumbar spinal fusion and gallbladder removal, these eight procedures are meant to reflect the greatest actionable statistics for patient decision-making. Since the patients involved in these procedures were typically in good health before the surgery (hence, “elective”), they serve as a control group that most directly reflects the quality of each respective attending surgeon.

Unsurprisingly, Surgeon Scorecard has received a fair amount of criticism, mostly from surgeons and medical spokespeople who are skeptical of patients’ abilities to adequately interpret the data. Dr. Joshua Jacobs of the American Academy of Orthopedic Surgeons remarked to NBC News, “I think you need to have a little more information than just this data to choose a surgeon.” ProPublica has responded to this ambivalence with a comprehensive account of their methodologies and intentions, ranging from how they selected the procedures to how they weight various doctors according to their location, experience, education, and patient profiles.

It remains to be seen whether Surgeon Scorecard will be effective in its aims to empower patients in the increasingly complex and expensive medical arena. Nevertheless, the issue of unnecessary and often deadly surgical complications remains high on the list of problems to tackle for healthcare administration and public policy generally. Between 2009 and 2013, surgical complications led to more than 3,000 deaths during elective surgery alone (where poor patient health and stability play very little role in the outcome of the procedure). Not only that, but problematic surgeries also contributed to 63,000 readmits of Medicare patients over the same time period. The data is open to interpretation, but the fact remains that improving surgeon performance could make a real difference in patient health. Websites like Surgeon Scorecard don’t pass overt judgment on doctors, but they do stand for transparency, and opening the data up to public scrutiny may be the motivation hospitals need to address this long-standing issue.

Sources:
Surgeon ScoreCard
ProPublica – Surgery Risks
NBC News
RAND

About the Author:
Iris Stone is a freelance writer, editor, and business owner who has written on a range of topics. She has experience covering content on medicine, healthcare, and career training, as well as education. Iris is also interested in science and mathematics and is currently studying to be a physicist. Check out her Google+ Profile.