Health knowledge made personal
Join this community!
› Share page:
Go
Search posts:

Ten Things Your Hospital Won't Tell You

Posted Nov 05 2009 10:00pm


10 Things Your Hospital Won't Tell You

By Reshma Kapadia of Smart Money
this was shared a few years back via email, from a large Chicago hospital employee - i found it interesting


1. "Oops, wrong kidney."

In recent years errors in treatment have become a serious problem for hospitals, ranging from operating on the wrong body part to medication mix-ups. According to a report from the Institute of Medicine, at least 1.5 million patients are harmed every year from being given the wrong drugs -- that's an average of one person per U.S. hospital per day. One reason these mistakes persist: Only 10% of hospitals are fully computerized, with a central database to track allergies and diagnoses, says Robert Wachter, chief of the medical service at UC San Francisco Medical Center. But signs of change are emerging. More than 3,000 U.S. hospitals, or 75% of the country's beds, have signed on for a campaign by the Institute for Healthcare Improvement implementing new prevention measures such as multiple checks on drugs. As of June these hospitals had prevented an estimated 122,300 avoidable deaths over 18 months. While the system is improving, it still  staff at their side to take notes and make sure the right meds are being dispensed.

2. "You may leave sicker than when you came in."

A week after Leandra Wiese had surgery to remove a benign tumor, the highschool senior felt well enough to host a sleepover. But later that weekendshe was throwing up and running a fever. Thinking it was the flu, herparents took her to the hospital. Wiese never came home. It wasn't the flu,but a deadly surgical infection.About 2 million people a year contract hospital-related infections, andabout 90,000 die, according to the Centers for Disease Control andPrevention. The recent increase in antibiotic-resistant bugs and themounting cost of health care -- to which infections add about $4.5 billionannually -- have mobilized the medical community to implement processesdesigned to decrease infections. These include using clippers rather than arazor to shave surgical sites and administering antibiotics before surgerybut stopping them soon after to prevent drug resistance.For all of modern medicine's advances, the best way to minimize infectionrisk is low-tech: Make sure anyone who touches you washes his hands. Tubesand catheters are also a source of bugs, and patients should ask daily ifthey are necessary.

3. "Good luck finding the person in charge."

Helen Haskell repeatedly told nurses something didn't seem right with herson Lewis, who was recovering from surgery to repair a defect in his chestwall. For nearly two days she kept asking for a veteran -- or "attending"-- doctor when the first-year resident's assessment seemed off. But Haskellcouldn't convince the right people that her son was deteriorating. "It waslike an alternate reality," she says. "I had no idea where to go." Thirtyhours after her son first complained of intense pain, the South Carolinateen died of a perforated ulcer.In a sea of blue scrubs, getting the attention of the right person can bedifficult. Who's in charge? Nurses don't report to doctors, but rather to anurse supervisor. And your personal doctor has little say over radiology orthe labs running your tests, which are managed by the hospital. Somefacilities employ "hospitalists" -- doctors who act as a point person toconduct the flow of information. Haskell urges patients to know thehospital hierarchy, read name tags, get the attending physician's phonenumber and, if all else fails, demand a nurse supervisor -- likely thehighest-ranking person who is accessible quickly.

4. "Everything is negotiable, even your hospital bill."

When it comes to getting paid, hospitals have their work cut out for them.Medical bills are a major cause of bankruptcy in the U.S., and whencollectors are put on the case, they take up to 25% of what is reclaimed,according to Mark Friedman, founder of billing consultant PremiumHealthcare Services. That leaves room for some bargaining. Take Logan Roberts. The 26-year-old had started work as a business analystnear Atlanta but had no insurance when he was rushed to the ER for anappendectomy. The uninsured can pay three times more for procedures, saysNora Johnson, senior director of Medical Billing Advocates of America;Roberts was billed $21,000. "I was like, holy cow!" he says. "That's fourtimes my net worth."After advice from advocacy group The Access Project, Roberts spoke withhospital administrators, telling them he couldn't pay in full. Hospitalsfrequently work with patients, offering payment plans or discounts. But toget it, you have to knock on the right door: Look for the office of patientaccounts or the financial assistance office. It paid off for Roberts, whosebill was sliced to $4,100 -- 20% of the original.

5. "Yes, we take your insurance -- but we're not sure about theanesthesiologist."

The last thing on your mind before surgery is making sure every doctorinvolved is in your network. But since the answer is often no foranesthesiologists, pathologists and radiologists, what's a patient to do?Los Angeles-based entertainment lawyer and patient advocate Michael A.Weiss repeatedly turned away out-of-network pain-management doctors on arecent visit to the hospital.We're not suggesting you go as far as Weiss did to save money, but do askfor someone in your network if you're alert enough. If it's an emergencyand you're stuck with an out-of-network doctor, call your insurance companyto help resolve the issue. If it's elective surgery, ask a scheduling nursein the surgeon's office to find specialists in your plan, says South Bend,Ind.-based billing sleuth Mary Jane Stull. And if you know your procedurewill be out-of-network, call the hospital billing department to negotiate.It will likely point you to a patient representative or the director ofbilling. Once you've dealt with the hospital, then try the surgeon or otherspecialists involved -- some hospitals will back you in those discussions,Friedman says.

6. "Sometimes we bill you twice."

Crack the code of medical bills and you may find a few surprises: chargesfor services you never received, or for routine items such as gowns andgloves that should not be billed separately. Clerical errors are often thereason for mistakes; one transposed number in a billing code can result ina charge for placing a catheter in an artery versus a vein -- a differenceof more than $3,900, Stull says.So how do you figure out if your bill has incorrect codes or duplicatecharges? Start by asking for an itemized bill with "miscellaneous" itemsclearly defined. Some telltale mistakes: charging for three days when youstayed in the hospital overnight, a circumcision for your newborn girl ordrugs you never received. Ask the hospital's billing office for a key todecipher the charges, or hire an expert to spot problems and deal with thensurance company and doctors (you can find one atwww.billadvocates.com).   Their expertise typically will cost up to $65 an hour, a percentage of thesavings or some combination of the two. If you want to be your own billingsleuth, talk to the highest-ranking administrator you can find in thehospital finance or accounts office to begin untangling any mistaken codes.

7. "All hospitals are not created equal."

How do you tell a good hospital from a bad one? For one thing, nurses. Whenit comes to their own families, medical workers favor institutions thatattract nurses. But they're harder to find as the country's nursingshortage intensifies -- by 2020, 44 states could be facing a seriousdeficit. Low nurse staffing directly affected patient outcomes, resultingin more problems such as urinary tract infections, shock andgastrointestinal bleeding, according to a 2001 study by Harvard andVanderbilt University professors.Another thing to consider: Your local hospital may have been great forwelcoming your child into the world, but that doesn't mean it's the bestplace to undergo open-heart surgery. Find the facility with the longesttrack record, best survival rate and highest volume in the procedure; youdon't want to be the team's third hip replacement, says Samantha Collier,vice president of medical affairs at HealthGrades, which rates hospitals.The American Nurses Association's Web site lists "magnet" hospitals --those most attractive to nurses -- and a call to a hospital's nursesupervisor should yield the nurse-to-patient ratio, says Gail Van Kanegan,an R.N. and author of How to Survive Your Hospital Stay. She also suggestscalling the hospital's quality-control or risk-management office to getinfection statistics and asking your doctor how frequently the hospital hasdone a certain procedure. While reporting these statistics is stillvoluntary, more hospitals are doing so on sites likewww.hospitalcompare.hhs.gov, which compares hospitals against nationalaverages in certain areas, including how well they follow recommended stepsto treat common conditions, says Carmela Coyle, senior vice president forpolicy at the American Hospital Association.

8. "Most ERs are in need of some urgent care themselves."

A new study from the Institute of Medicine found that hospital emergencydepartments are overburdened, underfunded and ill prepared to handledisasters as the number of people turning to ERs for primary care keepsrising. An ambulance is turned away from an ER once every minute due toovercrowding, according to the study; the situation is exacerbated byshortages in many of the "on call" backup services for cardiologists,orthopedists and neurosurgeons. And it's getting worse. Currently, 73% ofER directors eport inadequate coverage by on-call specialists, versus 67%in 2004, according to a survey conducted by the American College ofEmergency Physicians.If you can, avoid the ER between 3PM and 1AM -- the busiest shift. For theshortest wait, early morning -- anywhere from 4AM to 9AM -- is your bestbet. If you are having severe symptoms, such as the worst headache of yourlife or chest pains, alert the triage nurse manager, not just the personchecking you in, so that you get seen sooner, says David Sherer, ananesthesiologist and author of Dr. David Sherer's Hospital Survival Guide.Triage nurses are the traffic cops of the ER and your ticket to gettingseen as quickly as possible.While reporting these statistics is still voluntary, more hospitals aredoing so on sites likewww.hospitalcompare.hhs.gov,which compareshospitals against national averages in certain areas, including how wellthey follow recommended steps to treat common conditions, says CarmelaCoyle, senior vice president for policy at the American HospitalAssociation.

9. "Avoid hospitals in July like the plague."

If you can, stay out of the hospital during the summer -- especially July.That's the month when medical students become interns, interns becomeresidents, and residents become fellows and full-fledged doctors. In otherwords, a good portion of the staff at any given teaching hospital are newon the job.Summer hospital horror stories aren't just medical lore: The adjustedmortality rate rises 4% in July and August for the average major teachinghospital, according to the National Bureau of Economic Research. That meanseight to 14 more deaths occur at major teaching hospitals than wouldnormally without the turnover.Another scheduling tip: Try to book surgeries first thing in the morning,and preferably early in the week, when doctors are at their best and beforeschedules get backed up, Sherer says.

10. "Sometimes we don't keep our mouths zipped."

Contrary to what you might think, sharing patient information with a thirdparty is often perfectly legal. In certain cases, the law allows yourmedical records to be disclosed without asking or even notifying you. Forexample, hospitals will hand over information regarding your treatment toother doctors, and it will readily share those details with insurancecompanies for payment purposes. That means roughly 600,000 entities thatare loosely involved in the health care system have access to thatinformation. These parties may even pass on the data to their businesspartners, says Deborah Peel, the founder of Austin, Tex.-based PatientPrivacy Rights Foundation.If you want to access your medical records, you don't have to steal themlike Elaine did on 'Seinfeld' after she learned a doctor had marked her asa difficult patient. You are legally entitled to see, copy and ask forcorrections to your medical records.

Post a comment
Write a comment: