Hospital stays for heart failure fell a remarkable 30% in Medicare patients over a decade, the first such decline in the United States and forceful evidence that the nation is making headway in reducing the billion-dollar burden of a common condition. But the study of 55 million patients, the largest ever on heart failure trends, found only a slight decline in deaths within a year of leaving the hospital, and progress lagged for black men. "While heart failure hospitalizations have decreased nationally overall, certain populations haven't seen the full benefit of that decrease," said lead author Dr. Jersey Chen of Yale University School of Medicine. Possible explanations for the decline in hospital stays abound, including healthier hearts, better control of risk factors like high blood pressure, and more patients treated in emergency rooms and clinics without being admitted to hospitals, said Dr. Mariell Jessup, medical director of the Penn Heart and Vascular Center in Philadelphia.
Whether or not trauma centers meet national safety standards says little about a patient's risk of dying or getting an infection while there, according to new research. The findings add to evidence that quality measures meant to improve hospital outcomes may not be as effective as hoped. Earlier this month, for instance, another study found that hospitals scoring high for their treatment of children with asthma aren't better at preventing those kids from ending up in the emergency room with asthma attacks (see Reuters Health story of October 4, 2011). The latest results, published in the Archives of Surgery, show that hospital scores on the so-called Leapfrog Safe Practices Survey weren't linked to either death rates or hospital-associated infections. The survey asks hospitals about how they staff their intensive care unit, among other things, and how they try to avoid blood stream infections from catheters.
The U.S. healthcare system is lagging further and further behind other industrialized countries on major measures of quality, efficiency and access to care, according to a new report from the nonprofit Commonwealth Fund, a leading health policy foundation. That is having a profound effect on overall health in the U.S., the report found. Americans die far more frequently than their counterparts in other countries as a result of preventable or treatable conditions, such as bacterial infections, screenable cancers, diabetes and complications from surgery. In 2006-07, the U.S. recorded 96 preventable deaths per 100,000 people. By comparison, France, with the best performing healthcare system, recorded just 55 deaths per 100,000.
New estimates from the U.S. Centers for Disease Control and Prevention show that emergency room visits rose nearly 10% to 136 million in 2009. The preliminary data were released Tuesday at the meeting of the American College of Emergency Physicians in San Francisco. A statement from the organization linked the rise in emergency room visits to physicians' fear of lawsuits, citing two studies also presented Tuesday at the meeting. The first, a survey-based study by researchers at Stony Brook University Medical Center in Stony Brook, N.Y., and at the Mt. Sinai School of Medicine and at Columbia University in New York City, found that in 27% of cases, emergency room physicians who admitted patients with chest pain said that they would not have thought it necessary to stay overnight in the hospital if they had been the patients themselves.
Harris County prosecutors complained to federal Medicare authorities for at least two years that rampant fraud involving private ambulances across the region was costing taxpayers millions of dollars, but say their concerns were ignored. "We have been beating our heads against a wall for two years now," Harris County District Attorney Pat Lykos said Monday, a day after the Houston Chronicle reported that Harris County leads the nation in the number of private ambulance companies, vehicles and Medicare payments. "They're totally unresponsive. This is tens of millions of dollars being wasted. This isn't rocket science." Lykos' office provided the Chronicle Monday with letters and records documenting prosecutors' frustration since 2009. "We need Centers for Medicare and Medicaid Services to address this staggering and out-of-control problem," Lykos wrote last year to Centers for Medicare and Medicaid Services Acting Director Jonathan Blum, calling Houston "the epicenter for a massive Medicare fraud scheme."
Let the post-mortem on the Class Act begin. The health and human services secretary, Kathleen Sebelius, charged with carrying out this first-ever national program of voluntary long-term care insurance, made official on Friday what had been speculated for several weeks: the administration was shutting down Class. After 19 months of research and consultation, "we have not identified a way to make Class work at this time," she said. But was it really unsound? Was it impossible to offer to those who needed help with the activities of daily living a $50-a-day benefit ($18,000 a year) that would help ease the huge financial burden of long-term care? The insurance industry veteran hired to serve as the program's chief actuary, Robert Yee, begs to differ -- or at least, he begs to defer judgment. Mr. Yee, whose dismissal last month first signaled that the program was in trouble, told me on Monday that when it came to setting benefits and premiums, planning for Class remained at a fairly early stage.