Patients Rating Hospitals–What a Novel Idea!

According to a story in the British Telegraph “Ministers are trying to improve standards after warnings from watchdogs that too many patients, especially the elderly, experience poor standards of basic care, including insanitary conditions and inadequate nutrition. NHS staff are already asked to take the “friends and family” test, but the Prime Minister will say that extending it to patients will bring benefits to the service.”

The story also points out that, “The Care Quality Commission last year found that one in five hospitals failed to meet basic standards of care for elderly patients.”

Hmm, The Eye on Hospitals wonders how that idea would go over in the U.S. We now have church ministers suing former congregation members about negative Web postings. Too many bad ratings for a hospital and the lawsuits would come out of the woodwork. Besides, if you have spent any time in hospitals in the last few years, particularly if you are elderly, would you want your friends and family to go to the same place? I wonder.

The Hidden, but Pervasive Danger in Hospitals and Other Medical Care Situations

Many hospital dangers are apparent, particularly if you have been reading this blog. Even some hospital staff may recognize these, although many are too busy or uncaring. Perhaps the largest dangerous of all, if you are at all “elderly” is one that seldom is even apparent to health care providers because it is so insidious and built into our culture.

Ageism is as a serious hazard to older adults—not only in hospitals but in general care as well.  A report from Alliance for Aging Research noted in a report as far back as May 19, 2003 how “systematic bias against the elderly hurts older patients in America.” In the book, Top Screwups Doctors Make and How to Avoid Them (2011), the authors write, “In one study of physician knowledge about prescribing to elderly patients, 71 percent scored poorly. Despite their bad showing, 75 percent of those surveyed felt confident prescribing drugs to older people.”

Although not necessarily as harmful physically, the rather common assumption of medical personnel that the elderly must be less able mentally can be psychologically demeaning for a perfectly functioning senior and possibly even lead to a self-fulfilling prophecy. For example, have you ever been asked by a nurse on a doctor visit, “Do you know why you are here?” Would this nurse ask the same question to a 40-year old? It is doubtful. At a medical visit, have you been asked, “Do you know what medications you are taking?” If you are 65 or older, you probably have. Dealing with younger patients, questions like these probably would be put in an open-ended form, such as, “What can we do for you today,” and “What medications are you taking?” rather than casting doubt on the patient’s memory from the start. The elderly may find hospital workers less likely to believe statements from the elderly because of unacknowledged ageism.

 Does your doctor seem to phrase comments and statements in increasingly simplistic ways, as if unsure how much you understand? If language barriers are not involved, you likely are getting up there in years.  Doctors make the same unaware assumptions as other health care staff—this patient may be getting a little less able so I had better dumb things down a bit. Is your doctor more likely to use a cross-examination style of questions with yes/no answers rather than engaging in a two-way conversation? Again, there may be an under-the-surface level of ageism acting in the interchange.

The problem with this hidden danger is that besides short-term problems in dealing with the health conditions of the elderly, longer-term psychological effects may engender a feeling in the patients that they themselves must be less capable than they were when younger, thus leading to a vicious spiral downwards.

According to a report from the Inspector General’s office of Health and Human Services, Adverse Events InHospitals: National Incidence Among Medicare Beneficiaries,” found “an estimated 13.5 percent of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays, and an additional 13.5 percent of Medicare beneficiaries experienced events during their hospital stays that resulted in temporary harm.” “44 percent of adverse events and temporary harm events were clearly or likely preventable.”

It is intuitively reasonable to think that at least a certain portion of these came from ageism.

Another Gift from the Obamacare Approach to Healthcare

Image Source: . Released to public domain by copyright holder Raidurgesh

Research by the American Heart Association (AHA) claims, “differences in regional readmission rates for heart failure are more closely connected with the availability of care and socioeconomics rather than with hospital performance or a patient’s degree of illness.”  This is reported in an article by Kelsey Brimmer in Healthcare Payer News, dated May 17, 2012 and available online (“Readmission rates tied to availability of care, socioeconomics”).  According to Brimmer’s report, the AHA found that in communities with more physicians and hospital beds the populations tended to be poor, black and relatively sicker.  Another group more likely for readmissions was those 65 years and old. The last group would seem obvious.

Now, as another gift from the Obama/Sscialized medicine approach to getting rid of old folks, the Centers for Medicare & Medicaid Services next year plans to “penalize hospitals with higher readmission rates related to heart failure, heart attack and pneumonia. Hospitals with higher-than-average 30-day readmission rates will face reductions in Medicare payments” (Brimmer, 2012). Articles towards the end of 2011 estimated this cut at 1 percent. These cuts are addition to 2012 cuts and the 2 percent cut mandated in the Affordable Care Act (Obamacare) if Congress does not change this.

So, seniors, as the most likely to suffer more cardiac problems, probably will receive short-shrift when it comes to getting necessary care—the basic approach in socialized medicine countries like the U.K. (more on this in another blog)

Hospitals: The Faster Out, the Sooner You Are Back?

According to new studies at the University of Maryland Robert H. Smith School of Business, the faster a hospital kicks you out, the more likely it is you will need to be readmitted within a few days. In a way there is a sort of twisted logic to this–when there are extra beds available, people may try to stay an extra night just to be cautious. When the bed supply is short, the hospital may discharge people who look healthy but really are not ready.

These very large studies covering multiple years and 7,800 patients who had surgery, altogether amounting to 35,500 nights, found that when patients were sent home during the busiest times of hospitals, they were 50 percent more likely to need readmission within three days. Each extra bed in use when the patients were discharged resulted in inceasing the odds of readmission within 72 hours by 0.35 percent.

The report appears in Health Care Management Science, vol. 15, number 1 (2012), 29-36. The title is “The impact of hospital utilization on patient readmission rate,” by David Anderson, Bruce Golden, Wolfgang Jank, and Edward Wasil. It was summarized by Kelsey Brimmer, in Health Care Payer News, May 18, 2012, “Studies show readmission rate higher at busy hospitals.