To help combat this crisis, organizations such as the Official Disability Institute (ODG) and The American College of Occupational and Environmental Medicine (ACOEM) have released guidelines for prescribers in the appropriate use of opioids for treating pain specific to workplace injuries.

In a published in a recent edition of the Journal of Occupational and Environmental Medicine, researchers at the ReedGroup and Kaiser Permanente retroactively applied ACOEMā€™s April 2017 guidelines to 7,840 patients who underwent carpal tunnel release (CTR) surgery from 2007 to 2014. Of the 70 percent of cases prescribed an opioid, 29 percent were contrary to the guidelines, which recommend no more than a five-day supply of short-acting opioids for acute postoperative pain for new users. Patients given greater dosages averaged disability durations 1.9 days longer and medical costs $422 higher than their ACOEM-compliant counterparts.

While these cases were not exclusively workersā€™ compensation related, given the volume of injured workers who require CTR surgery annually, itā€™s easy to see how following the guidelines could substantially benefit payers and patients. The study estimates if 29 percent of the 577,000 CTR procedures performed annuallyĀ were prescribed an opioid according to ACOEM’s guidelines, the potential medical cost savings is $71 million per year with a reduction in disability durations by 124,000 days. Incredible.

Clinicians at the Center for Surgery and Public Health at Brigham and Womenā€™s Hospital took guideline research a step further by analyzing more than 200,000 postoperative opioid prescribing patterns to define the ideal prescription length by procedure type. Their , published by JAMA Surgery, determined the optimal length of opiate prescription was four to nine days for general surgery procedures, four to 13 days for womenā€™s health procedures, and six to 15 days for musculoskeletal procedures.

While itā€™s too soon to know the time and monetary impact these guidelines could yield if implemented, itā€™s heartening to see that the risk of prescription opioid misuse is being considered when looking to alleviate temporary acute pain. We must all be mindful of what is in the patientā€™s long-term best interests and limiting opioid prescription duration is a critical step in that process.

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An estimatedā€‹ 440,000 people die each year in the hospital ā€“ and not from the cause that initiated their hospital treatment. Ā That represents the third leading cause of death in this country, behind only cancer and heart disease.

Consider this:

40,000 people die annually in automobile accidents. Ā Mothers Against Drunk Driving (MADD)Ā and other groupsĀ focusĀ on drunk drivers andĀ car safety,Ā saving lives every year. Ā Itā€™s a worthy cause, and to be commendedā€”but does anyone know that approximately 10 times more people dieĀ each year from medical errors in hospitals, than from allĀ auto accidents in the US?

Less than 12,000 people a year are murdered in this country. Ā A horrible statistic, to be sureā€”but 3,688% more are accidentally killed by our own hospital system on an annual basis. Ā Which do we hear about on the news?

It is a terrible situation.

When it comes to hospital treatment, here are a few points to keep in mind:

• Avoid summer treatment. Ā New doctors (residents) start in the summer, and they have very little experience. The more experienced residents are looking for jobs to pay for their massive debt and are not as engaged. Ā A lot more full-time doctors are on vacation. Ā Due to these dynamics, the hospital accident rate is highest during the summer months.
• Ask about every medication being administered. Ā If it does not feel right or necessary, do not take it. Ā You can ask for a case manager or advocate if you do not understand or agree with treatment or medication. Ā Overtreatment and/or overmedicating are primary causes of accidental deaths.
• When possible, avoid procedures in the hospital. Ā If something can be done in an office or outpatient surgical center setting, try to have it performed there. Ā Remember, many physician groups are being purchased by hospital groups, and they are now incentivized to drive care to the hospital setting. Ā The bottom line is, as an individual patient, you need to look out for yourself. You are your own best health advocate.

As a company, this is why discharge management is one of the top goals of our care management programsā€”to get patients out of inpatient treatment as quickly and safely as possible. It is also a main driver and value propositionĀ of our Surgical Care Program (SCP), which moves surgical care out of hospitals and into quality, ambulatory surgical center settings. It just makes good healthcare sense to mitigate these very real risks whenever we can.

The post Third Leading Cause of Death in the US? Hospitals. appeared first on 911³Ō¹Ļ.

ā€œThe study, which looked at 431 colon cancer surgery patients, found that the 13% of patients who had quality-of-life scores below 50 on a 100-point scale were almost 3 times as likely to have serious post-surgery complications as those with scores of 50 or above. In turn, those with complications were hospitalized an average of 3.5 days longer than the others.ā€

Given that each day in a hospital ICU will cost thousands of dollars, the financial impact is dramatic.

Many in the industry include social risk factor scoring in claims risk assessment, but it would be compelling if quality of life score data was incorporated as well.  The quote, “we can now measure quality of life like blood pressure” jumped off the page for me.

So in the context of our industry, this is great information and a great opportunity, but it is just as important to apply this to life. Attitude impacts everything in life, including health.  Work on improving your own happiness and quality of life score.  There is no limit on happiness.

The post Attitudeā€”It Affects Surgery Outcomes appeared first on 911³Ō¹Ļ.

The University of California San Francisco researchers set out to find out how much an appendectomy cost in California. The price varied from $1,529 to $182,955.

The “recovery room” was over $7K for 2 hours. This room charge has always driven me nuts. For an inpatient stay, the patient already has a room they are paying to stay, sleep and “recover” in. That room rate does not get reduced when they are also charged for the “surgical room” to do the surgery, and then they throw in another room or two for “recovery” at massive hourly rates well beyond the cost.

The hospitals cite issues caused by Medicare, Medicaid, and other government programs, stating “…a more straightforward pricing system is only possible when reimbursement from government-sponsored patients covers actual costs.” They are flat out admitting they are cost-shifting to every other person who treats there to cover government plans. From what I’ve seen, many Medicare payments are well above what reasonable costs should be; however, there is likely some validity to this point as I’m sure some payments are unreasonable.

Making pricing transparent (fair to all parties) is critical to the long-term survival of healthcare. 911³Ō¹Ļ’s surgical care program resolves all of these issues, eliminating the variability, moving treatment out of the arbitrary hospital system, and paying providers a fair rate, quickly.

The post Variability in Surgical Costs – Bill Goes Viral appeared first on 911³Ō¹Ļ.

The post The Doctor Shortage & Surgical Care appeared first on 911³Ō¹Ļ.

This is about a study done to compare the skill of doctors performing surgeries.Ā In the study, a group of surgeons watched videos of other surgeons performing gastric bypass surgery, they then rated them on their skill level.

The differences between the most skilled and least skilled surgeons were remarkable. Comparing the top 25% to the bottom 25%, the study found:

• The least-skilled surgeons had nearly triple the rate of complications, 14.5% versus 5.2%.
• The least-skilled surgeons required longer operations, 137 minutes versus 98 minutes.
• Although death is a very rare outcome for gastric bypass surgery, patients had a higher risk of dying if their operation was done by the least-skilled doctors, 0.26% versus 0.05%.

The fact that peers could tell the most skilled providers vs. the least skilled was no surprise. What jumped out to me was the vast difference in speed. The best outcomes came from the people that did the surgery the fastest. They were the most skilled, therefore the most efficient.

This applies to almost everything in life. I want to, and do value, the time and efforts someone puts into work, but the real value is in the outcome. The best can do it faster AND better.

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