A HealthGrades report indicates that there have been between 400,000-1.2 million error-induced deaths during 1996–2006 in the United States. On top of that, $60 to $80 billion is lost each year in the healthcare system due to fraud, waste, and abuse. How can you protect yourself from these alarming numbers?

As a patient you have many resources at your fingertips. Before you even visit a healthcare facility or provider, perform a due diligence check on both the facility and the provider.

First, confirm your physician’s NPI number – all physicians are required to have a NPI number for Medicare billing. Even if a physician is not billing Medicare, they need to have a NPI number to refer patients to other physicians.

Here is a free site to find your physician’s and facilities’ (where you will be receiving the treatment) NPI number.

Second, authenticate your physician’s and facilities’ information with the NPI registry. Here you will be able to confirm the provider’s legal business name and/or location, contact information, and NPI number. The NPI Registry is a free service located here.

Third, research the background history of your provider to see whether he/she has been disciplined, fined, or has had a suspended license. The State of Illinois License Lookup allows you to confirm all licenses distributed by the State of Illinois including MD, RN, PharmD, DO, etc.

Finally, a simple Internet search on the provider/facility may garner surprising results. Oftentimes, pending lawsuits and court filings appear at the top of Internet searches if the provider/facility is involved.

If you suspect anything, remember to request a copy of your medical records and billing statements. By performing your own mini-investigation you will be able to determine if your provider is supplementing or omitting information from your medical records or billing statements.

Useful sites:

NPI Registry

NPI Number Lookup

State of Illinois License Lookup

According to a recent report titled, “Obesity and its Relation to Mortality and Morbidity Costs” almost 30% of the adult population is overweight, obese, or morbidly obese.

• Overweight – 19.2% (Body Mass Index of 25.0 to 29.9)
• Obese – 7.4% (Body Mass Index of 30.0 to 39.9)
• Extremely Obese – 4.2% (Body Mass Index of 40.0 +)

Some other shocking finds concerning obesity and health from the New York Times:

• Obese Americans spend about 42% more on health care than normal-weight Americans
• Obese Americans spend about $1,429 more on health care each year than the roughly $3,400 spent by normal-weight Americans
• The average American consumes 250 more calories per day than just two decades ago
• Medical spending on obesity-related conditions is estimated to have reached $147 billion a year in 2008. A figure that represents almost 10% of all medical spending

How can health and wellness programs curb this epidemic? First, group programs and working with others on a common goal keep people on track (think Weight Watchers). If employees are accountable for their actions to others, they will more likely stay on task. This also builds comradery and teamwork skills.

Second, you can show your employees that you care for their well-being and want them to be healthy. You can also reduce absenteeism, increase employee loyalty and witness a major decrease in health insurance costs by offering health and wellness services.

What are some services you can offer? Weight management, healthy eating, healthcare financial services, patient advocate services, concierge visits, gym memberships, group fitness programs, counseling, etc. to name a few.

The major thing is to show your employees you care about their well-being and want them to be healthy and feel great. We can curb obesity by re-learning healthy eating/living habits and decrease healthcare spend exponentially.

Health and healthcare are private, yet extremely important issues that affect your life every day. If you aren’t feeling well, that affects your mood. If you have a headache, you’re less likely to be productive. If you’re worried about your health or that of a loved one, that stress can lead to more illness and frustration.

Who are you supposed to turn to when your healthcare situation gets out-of-hand, like you aren’t staying on top or your bills (even afraid to open them) or you haven’t researched adequate treatment options and you’re scared to confront the doctor? Patient advocates are an invaluable resource during troubling health experiences.

When might hiring a patient advocate make sense?

1.       You’re overwhelmed with your bills.

2.       You recently obtained power of attorney of the health of a family member or loved one.

3.       You feel “stuck.” You aren’t receiving answers to questions on care or insurance and are unsure of what to do next.

4.       You have a chronic condition that requires constant monitoring.

5.       You receive advice/an opinion and it doesn’t make sense to you.

6.       You are told that no options exist.

What is a patient advocate?

A patient advocate will help you sort through your bills and develop a personal health record or portfolio of all your important health information. A patient advocate will research treatment options with you and provide multiple physicians/other resources in your area or that best treat your condition. A patient advocate will also contact insurance carries and providers on your behalf to sort through your healthcare finances.

Remember a patient advocate can truly be a life saver. However, all patient advocacy services are not alike. Research the advocacy organization and know the credentials of your advocate.

Good luck and great health!

The Kaiser Family Foundation and the Health Research and Educational Trust (HRET) perform an annual survey regarding the nature of employer-sponsored health benefits at nonfederal private and public companies nationwide. This is the twelfth such survey. The results are grim, for employees at least.

It’s no longer news that healthcare costs are on the rise. Most have begun to brace themselves for cost increases as a result of healthcare reform. In our recent blog post on the NNNN survey we reviewed the plans of large employers to pass the cost increase onto employees in 2011. For the most part, we are prepared to see our healthcare costs rise after the reform takes effect. But we don’t have to wait to feel these increases. Across the board, the average employee has already seen these increases. The survey certainly shows increases- especially in premiums for family and individual plans. The most notable increase may be that seen in the employee contribution.

Historically, employers and employees have shared the burden of rising premium costs. In 2010, however, employers did not increase their dollar-amount contribution. As a result, employee contribution rose 14% from 2009. Employer contribution did not rise.

The survey reports that 27% of employees have deductibles of $1,000 or more for single coverage. This is up from 22% in 2009. The average deductible is considerably less for workers with PPOs or HMOs. Prescription drugs, physicians visits, and preventative care are usually covered (with, of course, a co-pay or coinsurance) before a deductible is met. The out-of pocket maximum varies considerably for workers and plans.

Where are you better off, a large firm or a small firm? For the most part, it’s hard to tell. But, if you’re hoping to pay less of your premium, start sending your resume to small companies. 35% of employees at small firms pay nothing towards single coverage premium and 13% pay nothing towards family coverage. Only 6% at large firms pay nothing for single coverage and 1% towards family coverage.

Employers were not shy about reporting the changes nor the reasons for them.  Increased cost sharing, reduction in the scope of coverage, and increased employee contribution were all responses to the poor economy.

Keep in mind that this survey was conducted from January to May 2010. After our previous post on Large Employers passing rising health costs onto employees, we can only imagine what the survey will show in 2011.

With the holidays right around the corner, many of us will be rushing around, finishing up holiday shopping, attending parties, eating too much… the list goes on.

However, people still get hurt and sick around the holidays and are in the hospital. Hospital staff is lighter around the holidays, giving providers some much needed family time. On the other hand, less providers and tired staff can lead to medical errors.

A recent article by Dr. Bialek of www.covermd.com looks at the top ten most common medical errors in the United States.

1. Technical medical error
Ex: Provider cutting the wrong artery in a heart surgery, leading to complications or death.

2. Failure to use indicated tests
Ex: Patient having chest pains, but doctor failing to perform an EKG and patient has a heart attack.

3. Avoidable delay in treatment
Ex: Patient complains of stomach pains, isn’t seen quickly by ER attendees because of more urgent manners, patient’s appendix erupts causing severe internal bleeding.

4. Failure to take precautions
Ex: Patient is weak and has a history of falling. Nurse takes patient from the bed to the bathroom, unaware of patient’s weakness. Patient falls and fractures hip.

5. Failure to act on test results
Ex: Patient feels dizzy and sick. Doctor orders blood test, believes it’s an infection and sends the patient off with antibiotics. Test results come back, but doctor fails to look at them thinking she just has an infection. Patient ends up in a diabetic comma.

6. Inadequate monitoring after a procedure
Patient has a routine surgery. After surgery, patient is on narcotics. Nurses fail to monitor the patient, although patient’s parents are in the room. They do not realize that the patient has stopped breathing.
Another important list is errors with serious consequences. These occur mostly in intensive care units, operating rooms, and emergency departments.

7. Inadequate patient preparation before a procedure
Patient goes in for surgery. The provider fails to check with the patient to see what medications the patient is taking before surgery is performed. The patient is currently taking a blood thinner. During surgery and bleed occurs and the patient dies.

8. Inadequate follow-up after treatment
Patient has surgery. After surgery the doctor tells the patient to call for any changes in temperature, feeling, etc. Patient feels drowsy and nauseous from anesthesia and blames it on that. When the patient calls the doctor, the doctor tells the patient to wait 24 hours. Patient comes down with a deadly infection.

9. Avoidable delay in diagnosis
Patient comes in after blacking out after being assaulted. Provider waits 12 hours for a CT scan. Patient’s brain is bleeding and never wakes up.

10. Improper medication dose and/or method of use
Ex: A drug mix up causes a patient to take 10 times the normal dose. Patient dies a result.

This past month I was double billed for tickets to a sporting event and charged for services at a health club that I did not receive. My credit card company did not “catch” this activity (nor did they have the information to know that the charges were incorrect – and perhaps fraudulent). I was able to reverse the charges because I understand how to read my credit card statement and can monitor it for inappropriate charges. Imagine if we empowered employees to look at healthcare the same way.

By recognizing how and when employees can add value, organizations can learn useful ways to influence their growth. With the challenge of increasing healthcare costs, employees can also help their organizations reduce their healthcare costs – and even prevent their organizations from being victims of healthcare fraud.

People are good consumers – of automobiles, home appliances, engagement rings and just about any other purchase that deeply affects their own “bottom lines”. Now that payors are shifting more expense to patients through co-payments, out-of-pocket expenses, deductibles, etc. and patients have greater access to healthcare information then ever before, it is the right time to get employees engaged in their healthcare expenditures. Clearly when an employee makes a better financial healthcare decision, their employer also benefits.

Because of the complexity of our healthcare system, it is important to teach employees how to be effective healthcare consumers and arm them with accurate information to make optimal decisions about their care. Patient Advocates help patients navigate our healthcare system – and can train employees to gather, assemble and use information to mange, control and reduce their medical expenses. Critical information that employees need to understand to make informed healthcare decisions include, but are not limited to:

1. Medical records

2. Beneficiary rules

3. Healthcare bills

4. Explanation of Benefits (EOBs)

5. Clinical quality outcome measures

The key is for organizations to explain to employees the incentives of being a conscientious healthcare consumer, including but not limited to:

1. Preventing costly clinically adverse outcomes

2. Preventing inappropriate payments for healthcare services and products

3. Safeguarding personal healthcare information from Medical Identity Theft

People know how to be conscientious consumers – we just need to teach them how to be conscientious healthcare consumers.

Counterfeit drugs are killing or greatly harming patients that are desperate for medical care. Estimates state that nearly 700,000 people are killed each year after ingesting counterfeit malaria and tuberculosis drugs.

The World Health Organization (WHO) estimates that up to 30% of medication on the market in developing countries in Africa are counterfeit and have found that nearly 50% of the drugs sold in Angola, Burundi, and the Congo are of poor quality. Furthermore, nearly two-thirds of anti-malaria drugs in Laos, Myanmar, Cambodia, and Vietnam contain insufficient active ingredients.

A 2003 Interpol survey on the quality of drugs available in Lagos, sub-Saharan Africa’s most populous city concluded that 80% of the drugs available were fakes. In 2008, more than 80 children in Nigeria died after being given medicine that looked, smelled, and tasted like the real thing, but was laced with antifreeze.

Why are the numbers so high? Jacqueline Sawyer, Liaison Officer at WHO’s Prequalification of Medicines Programme, told MediaGlobal “The problem of counterfeit medicines is more prevalent in countries where medicine regulation is ineffective, smuggling of medicines is rampant, secret manufacturing exists, sanctions are absent or very weak, and there is high corruption.”

Do not think counterfeit or tampered drugs only exist in developing countries. An estimated 1% of all medicines dispensed in developed countries are counterfeit. Medicines containing boric acid and other lethal substances have been found recently in certain medications.

To be sure that your drug is safe to use, check the FDA’s website. They announce drugs that might have been tampered with and also have correct packaging and dosage information.
Recent FDA Headlines:
FDA Warns About Fraudulent Tamiflu
Warning: Counterfeit Alli
FDA Issues Warning on Counterfeit Surgical Mesh

Full article here.
FDA here.

In honor of Patient Advocacy Week that took place April 12th – 18th the focus of this commentary will relate to patient safety and self-advocacy.

In a recent RAND report “Is Better Patient Safety Associated with Less Malpractice Activity? Evidence from California” it was found that there is a correlation between the frequency of adverse events and malpractice claims. “On average, a county that shows a decrease of 10 adverse events in a given year would also see a decrease of 3.7 malpractice claims.” What this is telling us is that there is a link between patient safety and malpractice claims. While that might not necessarily be news to some, it does put some light on the “frivolous” lawsuits. If hospitals were to concentrate on patient safety and patient education the malpractice lawsuits will (according to this report) most likely decrease.

Another article by the Wall Street Journal titled “New Focus on Averting Errors: Hospital Culture” highlights the fact that errors made by healthcare professionals cause 44,000 to 98,000 deaths per year. To combat this number hospitals are taking a surprising approach: “Not only are they trying to improve safety and reduce malpractice claims, they’re also coming up with procedures for handling – and even consoling – staffers who make inadvertent mistakes.” Hospitals are taking a proactive approach to patient safety and staffer guidance instead of waiting for a bad event to occur and then reacting.

And now just a little information regarding Personal Health Records (PHRs) and their useful for patient safety. Having a PHR can certainly save you time and help with all the cumbersome paperwork, but having one can also save your life. Patient data is lost/mixed up etc. daily and having your own record of your health will help keep you safe. The state of California has the largest PHR adoption rate. Here is a look at the numbers:
1. 7% of adults had used a Personal Health Record (PHR)
2. California leads the nation in PHR use, at 15%
3. 58% of PHR users with two or more chronic conditions say they know more about their health care as a result, compared to 44% of those with only one or no chronic conditions
4. 48% of caregivers are interested in using a PHR for the person they care for
5. 75% worry about the privacy of PHR information
6. 40% of those who do not have a PHR express interest in using one

Two North Carolina doctors are in hot water after inducing labor and performing a C-section on a woman who wasn’t pregnant.

The doctors and several other interns tried to induce labor because the woman described only as “Patient A” came to the hospital claiming to be pregnant. Only after performing a Cesarean section did the doctors realize that the uterus was empty and the woman was in fact not pregnant.

The doctors later determined that the woman was suffering from pseudocyesis – also known as false pregnancy.

The two doctors in question were issued letters of concern but other doctors commenting on this story thought the punishment should be a little harsher. According to the article, “In this day and age, how can something like this happen? We have sonograms readily available to confirm whether or not someone is pregnant.”

An ultrasound was preformed by a resident (not the doctors in question), however, but it showed no heartbeat and “Patient A” insisted that she needed to be induced for fear of her baby.

The two doctors in question never actually examined the patient before they approved the C-section.

This is where we need to practice intelligent medicine and take the time to examine a patient. Doctors and nurses are extremely busy – especially in a hospital setting, but one simple examination would have shown that the woman was not actually pregnant and a major surgery (C-section) would not have been preformed.

Read full article here.

A new addition is being added to the blog. Our healthcare system is broken and fragmented and patients are usually the ones that receive the brunt of the abuse. Real stories from real patients will highlight the traumatic events that patients have to face in the wake of terminal illness, an accident or any other medical emergency.

Names have been changed to protect the innocent.

A scary night in the ER

“I have been watching my friend for the last 24 hours. First in the ER being monitored by a machine for his heart, oxygen and blood pressure – the alarm is turned off so it doesn’t make any noise – followed by a 6 hour wait for EMERGENCY surgery – hoping that he gets in the cue prior to the onset of internal rupture. I watched patient transport almost pull him out of the room without disconnecting the tubes from the wall – a frustrating reminder that the focus on reform is not about health.

After surgery I was watching him recover and yet again the $200 monitor has the alarm turned off. I thought to myself, ‘I wonder what would happen is there was no one in the room and he couldn’t call out for help?’

My friend received a 2mg narcotic through his IV around 6:00 pm. At 8:00 pm the nurse came back to evaluate for another .5mg of the narcotic. I watched his nurse place the injection on the table, take and enter vital signs into the bedside PC and while I was looking at my notes, the nurse left the room. I asked my friend, “Did the nurse give you anything?” He didn’t know. I looked for injection marks on his right arm – nothing. I walked out and asked the nurse, “Did you give him the injection?” The nurse’s response, “You were in the room the whole time, did you not see me give it to him?”

I took a step back – I am tired and need to turn off my fraud, waste and abuse examiner’s hat. However, I wonder on these points…

1. I believe the nurse stole the narcotic and did not give it to the patient. The next day the floor nurse let me look at the medical record. The patient received the narcotic at 8:00 pm IVP – which means the nurse would have had to ask me to move since I was sitting next to the arm with the IV.

2. The on call surgeon had to wait until the on call surgical staff finished operating on the patient’s rupture appendicitis. He was ready for surgery at 10:00 pm but could not get in until 1:00 am. So what would have happened if the bowel obstruction ruptured any time before 1:00 am? Would he have died in the ER? Been transferred to another hospital?

3. What would have happened on the snowy icy night if an auto accident had been admitted? Would he have been bumped? Did the hospital put their ER in bypass mode?

4. Now what about the ER nurse, did he take the narcotic himself? Was he feeling a little ‘happy’?