Hospital admissions for elderly US patients with heart failure fell by nearly 30 percent over a decade, an analysis of federal Medicare data shows, a surprising finding that offers fresh evidence of progress in the battle against cardiovascular disease. The report, being published Wednesday in the Journal of the American Medical Association, is the first to document a decline in admissions in the US for the condition, an enormously costly and debilitating problem and the most common reason for hospitalization among Medicare beneficiaries.

The finding is based on data from more than 55 million patients in Medicare’s conventional fee-for-service program who were hospitalized for heart failure between 1999 and 2008. Researchers estimated there were 229,000 fewer admissions for heart failure in 2008 than would have been expected had the rate of admissions remained at 1999 levels.

As a result, the Medicare program saved $4.1 billion in hospital costs related to heart failure. Heart disease overall is still the leading cause of death in the US, and this latest research comes with caveats. For heart-failure patients who were admitted to the hospital, death rates one year after that hospitalization fell only slightly—to 29.6 percent in 2008, the last year of the decade covered by the study, from 31.7 percent in 1999.

Hospitalization rates also varied significantly by state, and the improvement for black men was smaller than that of other groups. But the gains, coming as the population ages and as obesity and diabetes—both risk factors for heart disease—are enormous public-health concerns, were a welcome surprise to some heart experts. Many attributed the improvements to better preventive measures and disease management, as well as a reduction in elderly patients’ rates of heart attack—a common cause of heart failure. About 5.8 million Americans are diagnosed with heart failure, according to the American Heart Association, which estimates that total costs for treating patients, including associated indirect costs, were $39.2 billion in 2010.

Source: Wall Street Journal, health industry

Hospital emergency departments are turning to a number of strategies to reduce wait times, amid growing concern about patients who leave without being seen.  Leaving without treatment can lead to lost revenue for hospitals and health risks for patients.  The national average of those who leave without being seen was about 2.7% in 2007-08, according to the most recent government data available. This is up from 1.7% between 1998 and 2006, according to an analysis by Johns Hopkins University researchers

“People who walk out without being seen are a measure of how we are basically failing as a health system in our ability to deliver important care in emergency departments,” says Renee Hsia, assistant professor of emergency medicine at the University of California San Francisco.

A recent study she led that was published in the Annals of Emergency Medicine shows the left-without-being-seen rate in California ranged as high as 20.3%. Visitors to hospitals serving a high proportion of low-income and poorly insured patients were far more likely to leave without being seen.

Hospitals are tackling a costly side effect of emergency-room overcrowding and long wait times by turning towards “lean” management techniques to speed patients more efficiently through the ER. Following are some effective measures:

1. Posting wait times online or in the waiting rooms at different facilities so patients can chose the shortest option. Akron General Health System in Ohio went one step further last year and began providing live streaming of wait times on highway.
2. Streamlining the traditional methods of triage and reserving beds for only the sickest patients, abandoning the longstanding rule that every patient gets a bed.
3. Staffing the ER with less-costly providers such as nurse practitioners and physician’s assistants, so more expensive ER doctors can focus on care and not on paperwork and discharge plans.
4. Allowing incoming ER patients to be quickly identified and tagged with a bar code linked to a new medical record. Rather than try to create a full medical record, patients were directed to the nearest available emergency room bed immediately after they were triaged as mentioned by Dr. Ted Chan, who works in the ED at the University of California, San Diego, Medical Center, where the average wait times for emergency patients hits two hours during peak demand periods

In addition to aforementioned measures, new protocols such as qTrack designed by department of emergency medicine at New Orleans-based Ochsner Health Systems relies more on providers like physician’s assistants for less-ill patients. Unlike traditional triage, which might take 10 minutes, qTrack has nurses giving a “quick look” evaluation to get basic information in three to five minutes.

A similar program, Door to Doc, which includes a model hospitals can use to match staffing levels to peak-demand periods, was developed by Banner Health, which cut the rate of patients who left before being seen to 0.5% from 8% in 2007.

A new form of E.coli (Escherichia coli-STEC) is causing lot of trouble in Germany, so far 17 people have died and several got infected.   It is causing bloody diarrhea and affecting Kidneys and considered to be “highly infectious and toxic”

As recorded by BBC, Dr Dilys Morgan from the Health Protection Agency says the E. coli outbreak is “alarming, it mainly affects young children and older adults, but what we’ve seen is predominantly young females getting this condition. It’s a very rare organism that’s causing this and it’s thought it has particular properties where the toxin it produces is particularly virulent and therefore is affecting this population more than we would normally expect.”

Professor Hugh Pennington, a microbiologist from the University of Aberdeen, said: “This outbreak is unusual in that it doesn’t seem to be targeting young children, usually children under five have had a very hard time with this kind of bug in the past, they seem to be escaping it, maybe just due to the nature of the food that’s causing the problem.”

According to the Centers for Disease Control and Prevention, to prevent Shiga toxin-producing E. coli (STEC) infection, you should just follow these simple things:

• Wash your hands thoroughly after going to the bathroom or changing diapers
• Wash your hands thoroughly after handling animals, animal bedding, or any material contaminated with animal fecal matter
• Eat only thoroughly cooked ground beef, pork, sheep meat, or sausage.
• Cook ground meat products to an internal temperature of 160ºF
• Avoid drinking unpasteurized milk and juices
• Wash fresh fruits and vegetables thoroughly before eating raw
• Prevent cross contamination in food preparation areas by washing hands, counters, cutting boards, and utensils after they touch raw meat.
• Keep raw meat separate from ready-to-eat foods

As long as you are doing aforementioned, you shouldn’t worry too much.  Ask your physician if you have any more concerns around this.  Just remember prevention is the key to a good health!

Use DocAsap for timely appointments. 

The Government’s vision to create a Health Information Exchange (HIE) has the potential to provide a comprehensive patient history at the point of care. In addition to this data exchange, Internet and “meaningful use” of electronic health records will have a positive and significant impact on the delivery of healthcare and its associated costs. This new arrangement will improve the collaboration among providers and health facilities.  The integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, and University of Pittsburgh Medical Center are extensively utilizing technology to improve access.  These big groups are combining doctors, clinics, hospitals and often some insurance and capturing the financial savings from electronic health records.

However, despite all the benefits, adoption of technology is slow in most of the small practices.  It is surely a change in “status-quo”, and as such small practices do not get financial incentives to use computerized medical records and for some practices it is very time consuming process to convert paper records into electronic records.

“And there are privacy and patient centered concerns as well” said Dr. Donald Tavakoli; a Philadelphia based Psychiatrist. “Obviously for psychiatrists, mental health issues and therapy notes raise a major concern of “discoverability” and differ from the rest of medicine (at least in some people’s minds).  Not to mention, typing with a patient in front of you, which happens a lot with electronic systems, takes away from the doctor patient relationship.  On the other hand, legibility, access to records, and streamlining for billing purposes can increase efficiency and decrease redundancy in testing etc.”

Dr. Tavakoli said “technology being incorporated into practice is a good thing as it increases access (as DocAsap proves), increases efficiency, and decreases risk of errors.  And at the end of the day, it is inevitability.  Increasingly, I’m hearing about things like Ipad’s being considered as notepads for clinicians, which could offer simply touch screen checklist items to mark off during evaluations, this not only reduces medical error but healthcare costs as well.  And it is possible increased technology and Electronic record systems dovetails with increased “checklist” medicine.  The big concern is that in healthcare, sometimes the art of medicine can have immeasurable value, and the doctor patient relationship is crucial (and mental healthcare tops that list, especially with psychotherapy, but it is true in all of medicine).”

Please check Dr. Tavakoli’s profile at DocAsap

Health care professionals’ adoption to social media has been slow. In health care industry, patients are demanding more and more transparency with free information flow and quality care. The patient wants to take control of his health choices, which doctor to see, when to see, etc.

Slow online adoption of health care professionals is resulting in bad reviews, terrible online medical advice on so to speak “content farms”. The online health gap between the consumer/patient search and his/her doctor visit is filled with clutter and misinformation. And it will keep on growing as content farms and other review sites are putting unverified information out there and getting high ranking on the search results.  As it is very well said that if you make your customer unhappy in the physical world, he will tell 6-8 friends but if you make your customer unhappy in the online world he will end up telling to 6000-8000 of his friends.  Therefore, getting health care professionals into the social-media conversation is highly important and efficient.

The doctors may be concerned that participating in social media is a stigma–that if they were quality practitioners, they wouldn’t have time to be messing around on social networks, and that there’s something suspicious about a doctor who advertises his or her services too much. Most doctors think that too much self-promotion is a bad thing; your practice should grow on its own.

However, slowly doctors are realizing the need of interacting on social media because they know that if they are not online their reputation is.  For a simple doctor search, people tend to go online, they go to Google/Yahoo, and they go to review sites and want to check the doctor completely before making an appointment.  And for this simple reason, doctors should be aware of what is being said about them and how legitimate it is.  They have to be involved when it comes to their online patient care evaluation.

Today we are opening blog.docasap.com to anyone who wants to use this forum for driving healthcare improvements. Just send us an email at info@docasap.com and we will publish your cause!

Its been 6 months  since we launched  DocAsap.com. Its amazing how time flies. Looking back, its been a great ride. Undoubtedly, the times that make us most proud today are when we helped patients see a doctor when they really needed. I remember one patient who sent sent us a note telling how she was sick all night, booked an appointment at 3:00am and saw the doctor at 8:00am. In my mind, thats exactly what we stand for and what we will continue to focus on.

While we helped people get timely doctor appointments, we also learned more and more about our health system. We learned how complex the system is and how important it is to look at its problems holistically. We understood the mindsets and behaviors that support or hinder positive change.

The learning drove us to also work and contribute towards other broader issues that our healthcare system is plagued with. Our preventive care campaign and our health awareness creation initiatives are couple worth mentioning. This blog became our mouthpiece and thanks to all of you who have been following it.

Thanks again for all your support. We will continue to keep our heads down and continue working to solve our healthcare system issues.

We live in an age where things move much faster than ever before. This decade showed us downs that at times felt like the tunnel with no light at the end. Be it the two largest economic recessions, terror attacks of unprecedented scale, wars that threatened the stability of our political systems, the earth quakes, tsunamis and the hurricanes or diseases such as bird flu and H1N1 flu that threatened to wipe the human race.

The same decade brought the ups we have never seen before, the communication revolution that brought all economies and countries on a level playing field, the rise of BRIC, the first African-American U.S. President, the landing on Mars and the breakthroughs of the human genome project that professed to cure us of diseases

Decades are long enough to change social political environments, economies and individual lives. This decade was sure that did it all.

DocAsap.com was born in the last few months of this decade and as we grow and keep focus on our mission for increased access to all, we are hoping for a decade of genecology research that cures cancer and AIDS and a decade of reformation and adoption of policies and systems that increase health care access. Your friends at DocAsap.com look at the next decade with hope and wish you a wonderful next decade.

Thought of listing some interesting top tens for the decade. Here are the Top ten medical breakthroughs and the Top ten scientific discoveries for the decade.

As the year comes to an end we though it would be interesting to reflect on the year which could very well be called the year of Health care.  Phenomenal debate! a debate that will change the way we spend more than 3 trillion dollars. A debate that will affect the baby boomers, the gen X and the gen Y alike. A debate that we all need to be part of.

Here are two point of views… you make your own call.

Pros -

Cons -

Last few weeks have been an exciting journey. While we always stayed committed to our core values of increasing access to care, we realized more and more the importance on prevention. We have launched our campaign in Washington DC and Philadelphia, help us spread the word on prevention.

DocAsap your partners in preventive health care!

The debate is on – five congressional committees, town hall meetings, president’s speeches, claims from the left, right and the middle – wow, everyone is thinking of the broken healthcare system. It’s interesting, because while we are talking of costs and changes to the system, we may be losing sight of what we as patients can do.

So, while everyone is talking of reforming our healthcare – we thought of putting some focus on reforming our health.

When I was growing up, I learned that prevention is better than cure. But, “A stitch in time saves nine” is all but a cliché today.

Studies show that the spend on chronic diseases is a huge percentage of our total healthcare spending. On top of it, the billions in productivity loss is not even measured. Chronic disease such as diabetes, heart diseases and obesity –that can all be reduced through healthy lifestyle and timely diagnosis continue to grow at an alarming rate. Prevention being considered more expensive on face of it is delayed.

However there are conclusive studies that spending today on chronic diseases completely dwarfs the money we could spend of the right preventive programs. For that, we at DocAsap are launching a preventive care campaign to promote healthy lifestyle and preventive checkups.

So folks, its time to get your routine workouts, quit junk food and smoking and get that postponed annual health checkup, mammogram, dental checkup and flu shot. Go see your doctor for a preventive checkup.

PS: we at DocAsap continue to be committed to prevention because we believe that a stitch in time can save nine, ten or may be even more.