Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

Responses to air ambulance story

There are some interesting letters to the editor of the Wall Street Journal defending the use of air ambulances. (See Air ambulances: costly, dangerous, slow?)

They key points are:

  • ER physicians, scared of liability, are overreacting and sending even minor cases to specialty centers. (This echoes the comment from a Health business blog reader.)
  • When a rural community transports a patient a long distance in a ground ambulance, they put their own community at risk by losing their ambulance for most of the day
  • Once a patient is stabilized, sending them by fixed wing aircraft over a long distance is more comfortable than riding in a bumpy ambulance

However, a physician I know offered another argument against air ambulance use in trauma cases:

Due to noise in the helicopter and the close quarters, helicopter based paramedics are far less able to treat their patients en route than their colleagues in ground ambulances.

Double coverage for the old, none for the young

Senator John Kerry is championing a bill to encourage states to ensure universal healthcare coverage for youths up to age 21, according to the Boston Globe. The bill would amend Medicaid and offer extra funding to states that provide coverage. Republicans are offering strong opposition.

It’s curious that there is such support for universal, non-means tested coverage for older people (Medicare) while even means tested coverage for youth is controversial. Many Medicare recipients already have access to retiree health benefits from their employers, although that’s changing thanks to Medicare’s generosity. I’d rather see Medicare be means tested and Medicaid (for youth) not.

Maybe we should stop calling it “compliance”

As pay for performance plans for physicians become more popular, there is an increasing focus on the gap between what doctors “order” and what patients do. Patients following doctors’ orders are considered to be “compliant,” and those who don’t are “noncompliant.”

Terms like “orders” and “compliance” put too much burden on patients. (It reminds me of how utility monopolies use the term “ratepayers” rather than customers.)

A family physician cited in today’s Wall St. Journal has started to follow up with patients after their visits.

[She] learned to her dismay that many didn’t fill prescriptions or stopped taking medications because of side effects. She now puts all instructions for patients in writing, calls a few days after a visit to make sure they understood and checks with pharmacies to see if prescriptions have been filled.

She’s starting to address the real issues of poor physician/patient communication and follow up, although she’s doing it in a very labor intensive way rather than using a productivity tool such as RelayHealth.

Patients do need to take more responsibility for their own health and engage more effectively with their physicians, but let’s not call it compliance.

Medicare as corporate welfare

Automotive supplier Delphi Corporation has announced that it will no longer offer health care benefits to its salaried Medicare eligible retirees. Look for more companies to cancel retiree health benefits –especially drug benefits—as the Medicare drug benefit kicks in.

Computerized physician order entry systems can introduce new types of medication error

It’s well documented that computerized physician order entry systems (CPOE) reduce medication errors in the hospital. However, the March 9 issue of the Journal of the American Medical Association (JAMA) reports that…

…a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients’ medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often.

Technology is a tool to improve safety, quality, and efficiency, but it’s not a panacea. Good system design and implementation is as critical and difficult in medicine as in any other sector. IT systems usually fail to deliver on their promise at first, and sometimes cause new problems. It takes a while to produce substantial improvements, so hospitals should get started now to gain experience and learn from their mistakes.