Meatless Monday comes to Riker’s Island

” The NYC Department of Correction has introduced Meatless Mondays for inmates, correctional officers, and jail staff.

On Mondays, everyone at the Department of Correction, which jails around 7,000 inmates in 11 correctional facilities across the five boroughs, will be served a variety of meat-free foods throughout the day. Dishes include veggie chili, fresh fruit, cereals, and veggie burgers.

” The department’s normal everyday menu features a number of plant-based foods, including steamed vegetables and fresh fruit, however, it also features meat-based items, like chicken patties…

” The Department of Correction follows in the footsteps of New York City’s public school system, and its public hospitals. In January 2019, the latter introduced vegan Meatless Monday meals. The president and CEO of Health + Hospitals Dr. Mitchell Katz said the initiative is about empowering patients to live healthy lives after they leave the hospital.

In March, Meatless Mondays arrived at all New York City Schools — the largest public school system in the world…

No doubt you all have access to many sensible science-based studies on the healthful aspects of decisions like this one. While it may be a pitiful comment on American culture — needing administrative instruction to adopt moderate dietary changes even for the incarcerated — hey, every little bit helps.

Google says they’re a nightingale – looking more like a vulture!

❝ Google quietly partnered last year with Ascension — the country’s second-largest health system — and has since gained access to detailed medical records on tens of millions of Americans, according to a November 11 report by The Wall Street Journal.

The endeavor, code-named “Project Nightingale,” has enabled at least 150 Google employees to see patient health information, which includes diagnoses, laboratory test results, hospitalization records, and other data, according to internal documents and the newspaper’s sources. In all, the data amounts to complete medical records, WSJ notes, and contains patient names and birth dates.

❝ The move is the latest by Google to get a grip on the sprawling health industry. At the start of the month, Google announced a deal to buy Fitbit, prompting concerns over what it will do with all the sensitive health data amassed from the popular wearables. Today’s news will likely spur more concern over health privacy issues.

Neither Google nor Ascension has notified patients or doctors about the data sharing. Ascension—a Catholic, non-profit health system—includes 34,000 providers who see patients at more than 2,600 hospitals, doctor offices, and other facilities across 21 states and the District of Columbia.

Most of today’s tech corporations don’t pretend to be anything more than money-gathering machines. Some few – damned few – include the premise of protecting your privacy as the starting point for their endeavor. Even fewer, stick with that plan over time.

I wouldn’t count Google as part of anything other than that first batch of greed-based economic “heroes”.

Hospitals starting to listen — dramatic downturn in hospital-acquired illness

The rate of hospital-acquired conditions has dropped by 17% over a 4-year period…The rate of HACs dropped from 145 per 1,000 discharges in 2010 to 121 per 1,000 discharges in 2014, according to the report, which was issued by the Agency for Healthcare Research and Quality.

Over a 4-year period starting in 2011, “a cumulative total of 2.1 million fewer HACs were experienced by hospital patients … relative to the number of HACs that would have occurred if rates had remained steady at the 2010 level,” the report noted. “Approximately 87,000 fewer patients died in the hospital as a result of the reduction in HACs, and approximately $19.8 billion in health care costs were saved from 2010 to 2014.”

These results represent real people who did not die or suffer infections or harm in the hospital,” said Patrick Conway, MD, chief medical officer at the Centers for Medicare and Medicaid Services, in a conference call with reporters. “The data continue to show … that we are on our way to achieving the results in improving the quality of care in the hospital setting while investing our health dollars more wisely…”

Several factors account for the decreases, AHRQ director Richard Kronick said, “for example, the widespread implementation and improved use of electronic health records at hospitals, the Partnership for Patients effort was launched … and Medicare payment reforms were implemented.”

“Progress was also made possible by investments made…in … producing evidence about how to make care safer, investing in tools and training to catalyze improvement, and investing in data and measures to be able to track change,” he said…

…Overall, the officials were pleased with the results. “As a practicing physician in the hospital setting, this work in improving patient safety is one of, if not the most important, thing we could do for patients,” said Conway. “Patients want to avoid infections and adverse harm events, and we need to have health system that’s as safe as possible for all patients.”

Kronick agreed. “Having been involved in this business for much longer than I care to remember … To see the progress here — 87,000 fewer people dying over the last 4 years than would have died if the 2010 rates remained in place — is very heartwarming for me.”

Say “amen”.

Feel better about your healthcare provider – the number of serial killers is down!


I do not like thee, Doctor Fell,
The reason why – I cannot tell;
But this I know, and know full well,
I do not like thee, Doctor Fell.

The number of serial killings committed by healthcare providers has leveled off in the U.S. in recent decades, although it is rising internationally, Eindra Khin Khin, MD, said here at the annual meeting of the American Academy of Psychiatry and the Law.

According to the literature, the number of cases of healthcare serial killings overall rose from 10 in the 1970s to 21 in the 1980s, 23 in the 1990s, and then to 40 in the years 2000 to 2006, said Khin Khin, who along with her colleagues presented a poster on the topic.

One reason the rates of healthcare serial murders are rising internationally, but not in the U.S., is electronic medical records (EMR), Khin Khin, of George Washington University in Washington, told MedPage Today in a phone interview. She noted that several serial killers, including physician Michael Swango, first got into trouble in the U.S. and then went overseas…

“At least in the [United] States, because of incidents in 1990s and 2000s, we’ve really beefed up on the credentialing system, and institutions have started to communicate with each other better,” she continued. “People are not shedding enough light on the international phenomenon, and the global community has a little bit to catch up on in implementing guidelines and regulatory measures.”

In terms of the site, the vast majority of killings (72%) occurred in a hospital, with the remainder occurring in nursing homes (20%), patients’ homes (6%) and outpatient settings (2%)…

As to the method used, the majority of killings — 52% — were done via lethal injection, followed by unknown methods (25%), suffocation (11%), and water in the lungs (4%). Air embolus and oral medications were each used in another 3%, while equipment tampering and poisoning accounted for 1% each.

Followed by an entertaining segment describing motivation and telltale signs you may have a serial killer onboard.

The researchers recommended several steps for preventing healthcare serial killings, such as educating staff members on the issue, designating a national or international regulation and monitoring body, routine institutional monitoring of high-alert medication use and monthly mortality/cardiac arrest rates, and consensus guidelines for managing suspicious situations.

I imagine that the Feds can data mine the ACA digital record-keeping protocols for serial killers just as they now do for rip-off artists hustling Medicare. Every little bit helps, eh?

Jailed, some mentally ill inmates are in permanent lockdown

Day or night, the lights inside cell 135C of central New Mexico’s Valencia County Detention Center were always on.

Locked inside, alone, for months, Jan Green – a 52-year-old computer technician with schizophrenia and bipolar disorder – rocked on a bench for hours, confiding in an imaginary companion…

Though isolated, Green was, in a sense, far from alone. In jails around the country, inmates with serious mental illnesses are kept isolated in small cells for 23 hours a day or more, often with minimal treatment or human interaction.

Some states have moved to curb long-term “solitary confinement” in prisons, where research shows it can drive those with mental illnesses further over the edge. But there has been little attention to the use of isolation in the country’s 3,300 local jails, the biggest mental health facilities in many communities.

Unlike prisons, jails hold those awaiting trial or serving shorter sentences, limiting time in lockdown. But inmates with serious mental illnesses are more likely to break rules and stay jailed longer, increasing the chances of weeks or months in isolation that risks inflicting additional psychological damage.

A report obtained by The Associated Press found mentally ill inmates in New York City’s jails were disproportionately put in lockdown, some for thousands of days. Inmates who spent time in isolation were far more likely to harm themselves, according to a second report by staff of the city’s health department…

Jails use isolation to punish inmates, but also to separate those with serious mental illnesses because they may be victimized by fellow inmates or are considered dangerous. Many end up in lockdown because of behavior linked to mental illnesses, experts say.

“If they can’t follow the rules outside the facility, how in the world do you expect a mentally ill person to be able to function as an inmate?” says Mitch Lucas, assistant sheriff of Charleston County, South Carolina, and president-elect of the American Jail Association. “So you end up having to deal with whatever tools you have at hand and, in many jails, the tool is restrictive housing and that’s it.”

The number of inmates with mental illnesses has been rising since the 1970s, when states began closing psychiatric hospitals without creating and sustaining comprehensive community treatment programs…

That’s putting it politely. Between Republicans and conservative Democrats, not only state psychiatric hospitals were closed, Reagan tried to end the very existence of the US Public Health Service including their system of Public Health hospitals. Often the sole chance for healthcare for the poor, survival for the mentally ill – Reagan created the avalanche of homeless that swept our nation in following years. Most especially among VietNam era vets who he also ordered blocked from collecting unemployment insurance if they decided against re-enlisting in the US military.

Healthcare transparency can lower costs – if you can make your state require it

When Anthem Blue Cross Blue Shield became embroiled in a contract dispute with Exeter Hospital in New Hampshire in 2010, its negotiators came to the table armed with a new weapon: public data showing the hospital was one of the most expensive in the state for some services.

Local media covering the dispute also spotlighted the hospital’s higher costs, using public data from a state website.

When the dust settled, the insurer had extracted $10 million in concessions from Exeter. The hospital “had to step back and change their behavior,” said health policy researcher Ha Tu, who studied the state’s efforts to make healthcare prices transparent.

New Hampshire is among 14 states that require insurers to report the rates they pay different healthcare providers — and one of just a handful that makes those prices available to consumers. The theory is that if consumers know what different providers charge for medical services, they will become better shoppers and collectively save billions.

In most places, though, it’s difficult if not impossible to find out how much you will be charged for medical care…

In response, some hospitals are putting some prices on their websites — usually list prices, which are much higher than what most people would actually pay. Some insurers also provide enrollees with cost estimates, while free websites, such as Healthcare Bluebook and Fair Health, offer some cost information.

Still, in many cases, the data is limited or is restricted to enrollees in specific health plans. That’s why business groups in almost two dozen additional states have sought laws to require insurers to report what they pay providers…

Right about here the article wanders off into marketplace analysis and pressures. Useful; but, the sort of discussion that doesn’t change policy. Especially if you live in a state with a legislature run by Republicans or Blue Dog Democrats. Still more likely to cop paybacks from state and regional corporations than the national-class robber barons.

Continue reading

Israelis shell Gaza hospitals


In the Al-Aqsa HospitalMohammed Abed/AFP-Getty Images

Israeli tanks have shelled a hospital in the central Gaza Strip, killing at least five people and wounding at least another 50.

Al Jazeera’s Stephanie Dekker, reporting from Gaza, said according to early reports the third floor of the al-Aqsa Hospital in Deir al-Balah had been hit by at least three tank shells on Monday…

Al-Aqsa Hospital is the third to be hit by Israeli tank fire since Israel launched its ground offensive in Gaza four days ago.

Al Jazeera’s Dekker said the scene of the hospital shelling was an area “where a lot of people had been fleeing to”…”There’s extremely heavy shelling going on in that neighbourhood. This is an area you’d think would be relatively safe,” she said…

A distressed doctor at the scene of the attack told Al Jazeera: “We cannot do anything here for our patients, all the patients, all the injured in the emergency department.”

There were no known indications that the hospital was used by armed factions of Hamas…

That is the excuse the Israeli military always uses for killing civilians in any facility normally protected by international protocols.

Continue reading

E.R. ready to open at site that used to offer a full-service hospital


Christopher Gregory/New York Times

Residents of the West Village will soon see something unusual arriving at the shiplike building on Seventh Avenue that used to house part of St. Vincent’s Hospital: ambulances.

Four years after St. Vincent’s closed, the hulking white building, between West 12th and West 13th Streets, is reopening in the coming days, not as a hospital, but as a free-standing emergency room.

“We’ve given back the community the No. 1 thing we think the community needed the most when St. Vincent’s Hospital closed,” said Dr. Warren B. Licht, the medical affairs director for the new emergency room, which will be run by the North Shore-Long Island Jewish Health System.

The new E.R., however, is part of a trend that has as much to do with a hospital’s bottom line as it does with providing acute care.

Free-standing emergency rooms — which are distinct from urgent care centers, which treat non-life-threatening illnesses and injuries at low cost — have sprouted up around the country in recent years, driven by competition to capture lucrative markets, like the neighborhoods around Greenwich Village.

They can bring in significant revenue, since they are allowed to charge the same high fees that hospitals charge while having lower overhead. And, since half of admissions come from the emergency room, free-standing E.R.s can funnel patient business to their parent hospitals…

Arthur Z. Schwartz, a local Democratic district leader who brought an unsuccessful suit to force the state to build a full-service hospital in the neighborhood, said that the HealthPlex “looks like a magnificent facility” but that he worried about its inability to treat the most acute cases.

“All it’s going to be capable of doing is attempting to stabilize someone while they stick them back in an ambulance and ship them off to a hospital,” he said…

Nationally, the first free-standing emergency rooms opened in the 1970s, mostly to serve rural areas that lacked access to emergency care. But the number of such emergency rooms has exploded in recent years, to more than 400.

“It used to be that just for-profit hospitals were starting this trend, but now academic medical centers are realizing that it is quite profitable, too,” said Dr. Renee Hsia, an associate professor of emergency medicine at the University of California, San Francisco.

Profits before people remains the watchword of American medicine, publicly-accessible healthcare.

My experience here in Santa Fe with the one urgent care facility I ever visited puts the lie to the concept of treatment at low-cost. Over $800 billing exceeded my Medicare + Medigap insurance at the time including a set of absolutely irrelevant X-rays for what turned out to be a sinus infection.

Forgive my skepticism; but, knowing a number of dedicated physicians who take their Hippocratic seriously says as little about the healthcare available in the United states as knowing a few ethical lawyers says about the American practice of law.

Born in the USA? Costliest birth in the world!

Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epidural anesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors…

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

RTFA. It’s long, detailed, and scary.

When Dwight Eisenhower left office as president he warned of the political power of the military-industrial complex. Well, they ended up owning enough of Congress that they suck down the lion’s share of our non-insurance federal budget. That leaves what is now being called the medical-industrial complex. And between insurance companies, pharmaceutical manufacturers, healthcare providers and hospitals they seem bound and determined to take the rrest of that budget – and our life savings.

Cracking the Medicare [over]billing codes

Judging by their bills, it would appear that elderly patients treated in the emergency room at Baylor Medical Center in Irving, Texas, are among the sickest in the country — far sicker than patients at most other hospitals.

In 2008, the hospital billed Medicare for the two most expensive levels of care for eight of every 10 patients it treated and released from its emergency room — almost twice the national average, according to a Center for Public Integrity analysis. Among those claims, 64 percent of the total were for the most expensive level of care.

But the charges may have more to do with billing practices than sicker patients. A Baylor representative conceded hospital billing for emergency room care “did not align with industry trends,” but said that the hospital since 2009 has reined in its charges.

The Texas hospital’s billing pattern is far from unique. Between 2001 and 2008, hospitals across the country dramatically increased their Medicare billing for emergency room care, adding more than $1 billion to the cost of the program to taxpayers, a Center investigation has found. The fees are based on a system of billing codes — so-called evaluation and management codes — that makes higher payments for treatments that require more time and resources.

Use of the top two most expensive codes for emergency room care nationwide nearly doubled, from 25 percent to 45 percent of all claims, during the time period examined. In many cases, these claims were not for treating patients with life-threatening injuries. Instead, the claims the Center analyzed included only patients who were sent home from the emergency room without being admitted to the hospital. Often, they were treated for seemingly minor injuries and complaints.

While taxpayers footed most of the bill, the charges also hit elderly patients in the pocketbook, increasing the amount of their 20-percent co-payments for emergency room care.

Asked if the hospital returned Medicare overpayments, Baylor Irving’s president, Cindy Schamp said it has not. “To date, we have not made any payments back to Medicare,” Schamp wrote in response to questions. “However, continuing to work to do the right thing, we feel it is appropriate to review.”

Long, very detailed, worth reading and re-reading.

I post articles here with some frequency about Medicare fraud, healthcare fraud. The articles that reach the surface of the scum sitting atop American healthcare practices generally concern individual physicians, the odd cluster of group practice thieves, scumsuckers who feed off the lives of ailing and dying Americans. Obama’s lead on digitizing medical records and feeding the info into formats useful for data mining are producing a refined understanding of just how much ethical standards have diminished in the United States.

Grayheads especially have to develop a habit of reading those periodic statements that arrive in the mail or online from Medicare. It’s not uncommon in my experience to find a medical procedure double-billed, triple-billed. It isn’t unusual to find a bill that starts out with two minor procedures expanding to three or four by the time each specialist gets a shot at including their added take.

The Office of the Medicare Ombudsman can help you if you have a complaint about your quality of care. That includes overbilling, false billing, questions you have about the facility you deal with raising the care they provided to a classification above the actual service. Call 1-800-MEDICARE and ask for the OMO – the Office of the Medicare Ombudsman or go online for more details.

Not so incidentally, the Feds will give you a $1,000 reward if you spotted something they truly need to put a stop to.