health care

Two days after major surgery, the patient seemed to be doing fine medically, and yet, he was cracking up. Anastamosis, a medical student at one of our world-class teaching hospitals, describes why, for want of some simple sleep aids, the patient was nearly lost - despite near constant visits from seemingly endless teams of specialists.

Granted, Charlie Baker runs a private (albeit non-profit) health insurer. Still, he makes the argument that before government begins competing with providers like his, it first needs to deal with the fact that America is getting older and figure out how to be less ridiculously complicated. He cites as just one example a recently enacted subsidy for unemployed workers on COBRA:

... [I]t's really not administered as an individual benefit. Instead, the employer and the health plan are required to figure out who's eligible and for how much over that period of time, to pay out the benefit/subsidy to the eligible individual, and to then claim credit for that payment on subsequent employer payments into Social Security. That's right - the employer and the health plan figure out who's eligible, for how long, and for how much. We then deduct the value of the subsidy from what would be someone's full COBRA payment, we then get reimbursed by the feds through a reduction in our FICA contribution. If this sounds complicated to you, it should - because it is. We spent a lot of money (like hundreds of thousands of dollars) just putting in the technology to keep track of all the moving parts.

And by the way, the form the feds developed for beneficiaries to fill out to claim eligibility is, ah, about 11 pages long and has so many "if /thens," "and/ors," and "must/must nots" associated with it, I wondered when I first read it about how many people would be able to determine if they were eligible or not. I didn't have to wait long to get the answer to that one. To date, we've sent out almost 4,000 letters, answered tons of questions and only enrolled a little over 100 people. Sheesshh. ...

USA Today says Boston has the nation's longest wait times to get an appointment for a specialist. Beth Israel Deaconess CEO Paul Levy discusses the medical center's efforts to cut wait times for its clinics:

Over one year, the average wait time for all of our medicine clinics has dropped from 13 days to 4.4 days.

The hospital is trying to cut that to 3 days. Levy says part of the drop is due to the use of "mystery shoppers," who file detailed reports on their experiences as "patients."

According to a new study, a mobile health clinic run by Harvard Medical School to serve Boston's low-income neighborhoods has substantially improved public health as well as saved the healthcare system millions, the Globe reports.

Channel 5 reports: A Boston woman who defied the medical odds against her to live long enough to see her baby born lost her battle with cancer Saturday.

Tammy Donroe, who normally writes about food, reports she's been diagnosed with breast cancer:

... I've struggled with whether or not to bring this up on the blog. This is a food blog, after all, not a cancer blog. And I don't want this to become a cancer blog (not that there's anything wrong with that). But this blog is about my life through food, and if I censor my life too much, then it doesn't feel honest. Plus, logistically speaking, it was going to be tricky to hide it. Sooner or later you were going to wonder why all of my dinners of late have been composed of 50% potato chips and 50% tequila. The increased unexplained absences might seem suspicious given my previously consistent blogging schedule. And the mood swings. My god, the mood swings. PMS is dreadfully boring by comparison. ...

The Sunday Globe has a well-researched report on the value of tax exemptions and other financial breaks enjoyed by area hospital companies.

The piece gives context, and raises the question of whether hospitals should be paying more to the local government.

In addition to shutting Boston Latin School, the Boston Public Health Commission says it is also closing the Winsor School, a private girls school on Pilgrim Road, for seven days starting tomorrow.

As at Latin, the cause is "unusually high levels of influenza-like illness in recent days." The commission says 34 students - out of 430 - were out sick today.

Boston Public Health Commission statement on Boston Latin and the Winsor School.

Ed. question: Given that the two schools are right in the Longwood Medical Area, are we soon going to hear about a hospital suffering an outbreak?

The Urban Paramedic recounts one of his runs from start in a Blue Line station to finish in an ER staffed by the world's crankiest doctor.

Mass. High Tech reports a Concord start-up has come up with a new way to treat inflamed tonsils: Heat them up.

gRadiant says heating tonsils causes their cells to die, reducing the need to surgery to snip the organs out.

With state revenues continuing to make like a drop of water at Niagara Falls, you're beginning to hear murmurs from political leaders about the costs of health-care reform. David Guarino - former PR person for former Speakah Sal DiMasi - discusses the possibility that this "sacred cow" might have to be led to the slaughterhouse:

... [I]f the trends continue and the choices are to raise taxes a lot more, lay off thousands more firefighters, teachers and cops or cut programs – even the ones that are working well, the sacred cows might just find themselves getting herded up.

The Boston Business Journal reports Bostonians wait an average 50 days for an appointment with a doctor - but up to 70 days to see an OB/GYN. Those world-class numbers compare to a puny 11.2 days to see a doctor in Atlanta.

Paul Levy reports that all the bar-code scanners in the world are still not a substitute for a trained nurse - who thought the bag of medicine she'd just checked out was "slightly heavier than usual" and sure enough, the dosage was higher than it should have been, due to what turned out to be a mistake at the drug wholesaler.

Davis Square statue this morning. Photo by Ringsided.

None of your employees were really worried about swine flu until you all decided this week to send out memos about it. Now they're worried. Please stop taking communications lessons from the Herald, which apparently hasn't gotten the news that while four Massachusetts children died this past winter from boring regular flu, nobody's actually died here from KILLER FLU.

Mike the Mad Biologist compares the hysteria over swine flu with our ho-hum reaction to boring old regular flu, which kills 36,000 people a year:

... That's double HIV/AIDS deaths. But nobody gets paranoid about handwashing (WASH YOUR DAMN HANDS!!). There's no serious awareness of 'coughing' hygiene. It's just shrugged off, even though a successful vaccination strategy would save tens of thousands of lives. Clearly, nobody cares about these deaths: if the public as a whole did care, vaccination would be a sacrament.

But suddenly TEH SWINEY FLOO emerges and suddenly everybody becomes a public health maven. I don't mean to downplay the potential seriousness of this particular influenza, but, so far, it's in roughly the same mortality ballpark as most other influenzas. There needs to be vigilance, but, if this influenza burns out (or even if it doesn't), we'll still have to deal with the seasonal influenza pandemic (which is what it should be called). ...

Apparently, enough people have been calling up the Boston Public Health Commission that the commission felt compelled to issue a statement today:

Dr. Anita Barry, director of the Infectious Disease Bureau at the Boston Public Health Commission, issued the following statement in response to questions from residents about whether it is safe to attend large public events because of the swine flu alert:

"Given that there are no confirmed cases in Boston or Massachusetts, large gatherings in the community need not be cancelled at this time. People who are not ill do not need to restrict their activities; they should continue to follow the advice of state and local public health officials, who will notify the community and work with institutions if and when cases are confirmed and if and when large-scale events need to be cancelled.

It is always a good idea for people who are ill to refrain from going to large public gatherings not only because of swine flu but also other infections. In addition, people with underlying medical conditions who are at high risk for complications of influenza may wish to consider avoiding large gatherings. The Public Health Commission will carefully monitor case finding information and get guidance from the Massachusetts Department of Public Health and the US Centers for Disease Control and Prevention in order to make appropriate changes to this directive as warranted."

Or as Karen Wise tweets:

Good thing about swine flu pandemic: I haven't worried about MRSA all week.

Dr. Anita Barry, director of the Infectious Disease Bureau at the Boston Public Health Commission, talks about, well, you know:

MSNBC vaguely reports.

I know that to some this post will be alarmist, even silly, and -- thankfully at this juncture -- unrelated to Boston, but the flu outbreak in Mexico that shows signs of spreading into the Western and Southwestern states has grabbed my attention.

If you haven't caught the news: boston.com...mexico_struggles_to_contain_swine_flu_outbreak/ Read more

Dr. T, who is an anesthesiologist, says she has a lot of respect for most surgeons, even if they are sometimes more impatient than an anesthesiologist would prefer. But then there's the cutter she refers to as Dr. Myrtha Banshee. It's probably just as well she uses a pseudonym, because Doc Banshee would lose all her patients after they read what she did to one little girl who needed surgery.

Harvard Pilgrim CEO Charlie Baker runs the numbers.

Brigham and Women's Hospital reports a surgical team yesterday performed the nation's second face transplant, on a man who suffered serious injuries in a fall:

The team of seven plastic surgeons and one ear, nose and throat surgeon, nurses, anesthesiologists and residents worked for 17 hours in replacing the mid-face area of the patient including the nose, hard palate, upper lip, facial skin, muscles of facial animation and the nerves that power them and provide sensation.

They used tissue from the body of a man whose family had agreed to donate his organs after his death.

The state Department of Public Health says Beth Israel Deaconess Medical Center failed to adequately deal with outbreaks of antibiotic-resistant staph in its maternity unit.

Medical Center CEO Paul Levy has posted a memo on the state citation and what the hospital is doing about it. He adds all the cases have been treated successfully and none involved babies or parents in the neo-natal intensive care unit.

MassDevice is the "online journal of the medical devices industry in Massachusetts and New England."

Via Tinker Ready.