Mastectomy Legislation

Re: Mr. Miller and friend?

Nope. Just noting that you were the first among your "friends" to say anything of substance. The first response to Randy Miller was knee-jerk condemnation and the second was some guy posing as God.

 

Re: studies

If I can comment on this piece of the picture without choosing sides on the overal issue . . .

Studies done in major teaching hospitals have a strong tendency to be rigorously designed and well executed. All prospective studies are reviewed by Internal Review Boards that are comprised of experts in medical research. Because of this I believe that the default assumption is that this study is a fair and accurate representation. Your implying that the study subjects may have been hand-picked in order to skew the data is without foundation. If you can examine the actual methodology and then offer criticism then your argument may carry some weight. If you can not do this then I believe you need to give the study the benefit of any doubt.
Jack

 

Wow, what division. I guess we can now understand why it is almost impossible to get consensus on prescription drugs for Medicare.

I agree that many studies show healing at home by and large does better. I also agree that few hospitals will challenge a physician if they demand to keep a patient. The problem comes in payment of the service. I don't believe that anyone can hogtie a patient who wants to go home early and keep them there (unless it is a psych hospital but that is another story).

It is not unreasonable to ask an insurance company, that if a physician has made a reasonable choice to keep the patient 48 hours, then they should pay for that. The DRG or per diem payment should cover the amount of time chosen by the physician within reason. The question is can a physician reasonably make a justification to keep a patient 48 hours following a mastectomy?

Any hospital, or physician is free to keep that patient. They then lose money because the insurance will only pay the one day amount. Too many of these kinds of decisions and the hospital closes. Physicians may fight the hospital, but what if they are owners? Chief of staff? On the Med-Exec committee, P&T, Infectios Control, Peer Review, etc?

 

Oh and yes, I believe studies from johns Hopkins should be regarded very highly and make a strong argument.

 

Off topic, but an old chemistry joke: If you are not part of the solution, then you are not dissolved in the solvent.

Regards,

Michael Lloyd
Mill Creek, Washington USA

 

If you're not part of the solution, then you're part of the precipitate.

 

And if you are not part of the precipitate, you are part of the supernatant.

Regards,

Michael Lloyd
Mill Creek, Washington USA

 

studies

I didn't note that Johns Hopkins did all the studies, but even if they were compared to previous inpatient results, there are an incredible number of variables due to the fact that the patients were individuals-each with their own medical history, etc.
Anyway, I recently visited a friend having a lumpectomy at an outpatient hospital, and she was discharged less than six hours after admission. She did fine, and I'm sure it was much more cost effective. I just don't like blanket legislation that treats all patients the same, and I especially don't like insurance agents determining health care. I hope all of you will be part of the solution in honoring Dr. Gina's request.

 

Re: Mr. Miller and friend?

I find it difficult to believe a UCLA grad could make such an ignorant comment. Are you sure you’re not a St. Regis graduate?

If HMOs could reduce costs by requiring an extra day of hospitalization they’d be chaining patients to their beds and supporting this legislation. HMO executives might be greedy bastards but they’re not stupid.

Call your senator or congressperson and oppose this socialist legislation. The future of this country depends on it’s citizens assuming individual responsibility and not depending on Big Brother.

 

Re: Mr. Miller and friend?

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And what if someone does not have the ability to pay for lifesaving procedures or medication? Do you just let them die?

What if it's a child whose parents simply don't have the 2 or 3 thousands dollars required to treat an easily-cured infection?

What if someone is involved in a car accident, and you are unable to determine immediately whether or not they will be able to pay for the hundreds of thousands of dollars worth of care that it would take to save their life?

As long as you are willing to just let these people die, I guess you would have a logically consistent system. And it would be hard to call that stupid. Evil, yes. But not stupid.

 

Hypotheticals are kewl but prove no point. Where are these things happening?

 

They are not, as far as I know. But that is because our current sytem does not always require people to pay out-of-pocket for services rendered. Randy asked if it would be a stupid idea to require this. My response indicated some circumstances that might occur if our system were based on ability to pay.

On the other hand, if you have completely socialized health care demand would soon become unlimited. Then society will be required to make some very tough choices.

 

1. I am not comfortable with the government legislating special benefits for sufferers of particular diseases with politically desirable demographics.

2. I'm not comfortable with legislators taking these kinds of decisions out of the hands of physicians.

3. I'm not comfortable with unfunded mandates.

'Compassion' is not an absolute good if the inevitable social costs of that compassion are not borne by the compassionate ones themselves, but are placed as burdens on others.

'Compassion' isn't an absolute good if it comes in the form of an imposition of authority.

And 'compassion' isn't an absolute good if it is undertaken for selfish motives.

 

As Bill is suggesting, these issues are immensely complicated and real solutions are not found amongst the cliches and platitudes. The whole field of Bio/Medical Ethics has grown up around these issues and there are thousands of people around the world looking for answers. They're not easily found. Wait until they make some more progress in the field of genetic medicine . . . the rich people will be able to afford treatment not available to most people . . . the insurance companies won't be able to afford to provide it for everyone, etc. Then you'll see some fireworks.

Jack

 

Mr. Miller

Obviously, you choose to be close-minded and follow the ravings of extreme right-wing zealots. My comment was not ignorant, but your attitude is.

 

Re: Mr. Miller

OK, Mr. UCLA. But you still ignored the question. Why would an HMO insist on discharging a patient early if it would cost them more money in the long run?

If you answered any of my questions I would have some respect for your posts. For the record, I voted for Clinton twice and have never contributed to a Republican candidate. (Maybe I was undercover in the "vast right-wing conspiracy.)

 

Your comments have nothing to do with the proposed legislation. There is no means test in the proposal. Under the proposal, Bill Gate's wife would get the same extra day whether its deemed to be a medical necessity or not.

Why is it so unreasonable to leave medical decisions to the doctor and patient?

 

"Why is it so unreasonable to leave medical decisions to the doctor and patient?"

"OK, Mr. UCLA. But you still ignored the question. Why would an HMO insist on discharging a patient early if it would cost them more money in the long run?"

Excuse me, its MS. UCLA. Further, your question about HMO's is the same question many have asked. Why would they cover treatment for say, cocaine addiction, but not for smoking cessation? Why are so many preventive measures unfunded, leaving most medical care provisions to be reactive?

Your first question I agree with. I do not believe the insurer knows better than the physician, and I do not believe we should have one legislative mandate to fit all patients, but if they're mandating one day stays when some need two, I'd rather err on the conservative side post-surgery.

 

boy oh boy!

BOY OH BOY! I go away on vacation for a few days, and found all this excitement here about the post that I submitted!


The reasons that I initially submitted this post draw upon my expereinces at my place of work. My primary assignment is on an Inpatient medical/oncology unit ( I am a medical social worker by trade) where I deal with this sort of stuff on a daily basis. Many patients that have undergone a Mastectomy (complete or partial) usually have another diagnosis (eg: Diabetes or Hypertension) that also requires monitoring, let alone the emotional aspects of the procedure. I FREQUENTLY deal with managed care companies, some of which are not so bad to some which are terrible, to obtain aftercare services and supplies for the patient (home care, Visiting Nurse, ect..) Most of the time, the insurance co. is angry in the first place that the patient was either admitted to the hospital and are reluctant to pay for that, even though the physican felt it medically necessary to admit the patient BECAUSE they felt complications may exist due to other factors/conditions. Unless there is a skilled need and the patient is unable to do the dressing/wound care themselves, It is very difficult to obtain approval for any type of homecare service for the patient and the home care agency of the patients choice. Usually, if a patient is appproved for services, it is through one of the HMO's contracted homecare agencies, which are usually not as well run and take a long time to obtain a Visiting Nurse to go to the patients home, therefore delaying the patients D/C even more, whereas the insurance co refuses to pay the hospital and so on. These situations also occur in the outpatient settings as well. For example, I had a 74 year old patient undergo a Right Mastectomy through our ambulatory surgery unit, which required wound care and drainage. The patient, as per physican's assessment, requires a visiting Nurse to assist. Because the patient lived with her husband(who was 79 years old) and had an adult daughter available, the insurance co denied the Visiting Nurse for the patient because there were two adult teachable people available to her, regardless of age and/or employment status (the daughter worked full time) of the family members involved. The patient and family ended up being taught, and the patient had to come back to the medical clinic almost daily for dressing changes until she was admitted to the hospital for an infection due to the "wound care" that she recieved. It took 14 days of antibiotics (IV) to clear the infection, and then the patient required Physical rehabilitation due to deconditioning, which the HMO approved for - at one of their facilities.


So now you see my point in placing this post.