Long-Term Hospitals Offer Lackluster Care, Huge Profits
In traditional hospitals, patients have an attending physician or doctors on staff to treat them in the event that their condition worsens. Unfortunately, Medicare loopholes have created an industry of so-called "long-term hospitals" where extended-stay patients are transferred to from traditional hospitals. There are over 400 of these long-term care hospitals across the U.S. One company, Select Medical Corporation, alone has eight locations throughout Florida. These "hospitals" usually do not have an overnight physician on staff. And in the event of an emergency, physicians are called from outside the hospital.
While some long-term hospitals are not-for-profit, most are. The previously mentioned Select Medical Corporation is a for-profit, publically traded company specializing in long-term care hospital management. While Select's profits soar, whistleblowers within the company expose the management's lack of adequate training and quality standards. A recent New York Times investigation reports countless examples of downright gross negligence by Select. It's a widespread problem, with reports showing Select Medical Care has committed four times the national average of Medicare violations on a per-bed basis.
Proponents of long-term care hospitals say while traditional hospitals help patients survive acute illness, they are not equipped for long-term care. Discharging the patients to long-term care hospitals, they say, would be more appropriate. But the reality is, the motive is profit. Under Medicare payment rules, normal hospitals have a financial disincentive to keep patients for long periods of time because Medicare begins paying the hospital less money after 25 days. Meanwhile, long-term facilities have a financial incentive to take these patients, and are subject to less Medicare oversight due to their nature as a "specialized" care facility. The normal hospital frees up a bed for a new patient (which Medicare would pay more for), while Medicare pays the long-term care facility receiving the patient an average of $40,000 for patient care. This amounts to a staggering burden on the Medicare system, projected to be $4.8 billion dollars this year alone.
The long-term care hospital market was founded based on loopholes in the Medicare rules and has been exploited to an alarming level. Medicare reform is long overdue, and absolutely must address the issue of long-term care hospitals. It's vital that the legislature continue to close the loopholes which allow these companies to skirt the rules and severely jeopardize patient lives only to increase profit margins slightly.
If someone you know has been admitted to a long term care facility, research the company as much as you can before placing a loved one. By doing so, you'll probably know more about it than Medicare administrators.
New Study Says Many Orthopedic Surgeon Training Programs Are Inadequate
The procedures and policies in place to train orthopedic surgeons need serious changes to meet growing demand and patient care, this according to an article in the January issue of The Journal of Bone and Joint Surgery. The article was written by researchers at the Hospital of Special Surgery (HSS). January issue of The Journal of Bone and Joint Surgery published a study by researchers at Hospital of Special Surgery (HSS).
Dr. Laura Robbins, the HSS vice president of education and academic affairs, said this about the report: “Before this study, we at Special Surgery thought that we were the only hospital dealing with these complicated challenges. As a result of this study, we have come to realize that as a nation, the prominent training programs around the country are grappling with these same issues.”
One of the chief concerns, according to the report, is the work-hour restrictions set in place by the Institute of Medicine. The rules strictly prohibit resident trainees to work more than 24 hours, have shift breaks, and one day off every seven. While over-working resident trainees is a valid concern, strict rules like these prevent the resident from treating the patient from pre-surgery to post-surgery. This creates discontinuous care, which not only could jeopardize patient care, but also the effectiveness of training.
Additionally, the report points out that gender and generational changes among orthopedic surgeons have created new challenges. Many programs do not provide up-to-date training techniques, such as electronic technology, to help better provide the trainees with the flexibility and effectiveness they desire. In short, orthopedic programs are unable to keep up with the evolving needs of trainees.
Finally, another major concern in the report is antiquated restrictions look to jeopardize patient care and further burden current resident surgeons. The number of trainees that programs can accept has been capped for at the same level for 20 years, even while demand has increased significantly. Dr. Robbins commented on the finding, saying “we know from projections in studies that there won't be enough orthopedic surgeons in the future for the baby boomers who will need joint replacements.”
These are all very valid concerns, and really demonstrate the balancing act caregivers and policymakers must strike in order to ensure patient care. Later this year, when the researchers reconvene to make substantive recommendations, it will likely be a much-needed step forward in the orthopedic surgery field. Until then, the risk of under-trained and overworked orthopedic surgeons is simply too great.
Financial Incentives for ER Doctors Leads to Severe Injury
Fox 13 Tampa Bay recently investigated a suspicious alleged bonus system in place at Brooksville Regional Hospital. According to the allegations, 47 year-old Dave Roberts arrived at the ER after injuring his back and was in obvious pain, was unable to walk, and had lost control of his bladder. The ER doctor chose only to administer two shots (presumably for pain) and ordered an X-ray. Roberts was then sent home. Three days later (the next business day), Mr. Roberts went to a specialist who immediately recognized the severity of the spinal injury and emergency surgery was performed. Unfortunately, Mr. Roberts suffered severe, permanent injury, which according to the lawsuit, was a direct result of Brooksville Regional’s hurry to get Roberts out the door.
It has been uncovered that Brooksville Regional gave a financial incentive to ER physicians for moving patients quickly through the ER. Allegations suggest that ER doctors were offered a quarterly bonus if the average length of stay for a patient in the ER was less than two hours. The hospital is likely using these incentives to decrease the waiting times of patients in the ER (a desire fueled in part because ER wait time is a hot advertising trend) – which by itself is a good intention. Unfortunately some hospitals, such as Brooksville Regional, appear to have decided to rush ER visits instead of adequately staffing their emergency room department.
This bonus system clearly causes a conflict of interest between the doctor’s fiduciary duty of care and the Hospital’s interest in profit and reputation. Bonuses are common in the industry, but a bonus which directly contradicts the ability for a healthcare professional to provide adequate care is unacceptable. And for patients like Dave Roberts, it can ruin lives.