Category Archives: Hospital News

Lawsuit against US Bishops Conference could be thwarted on procedural grounds

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US catholic bishops-Logoby Nina Martin
ProPublica, March 20, 2014

The story of Tamesha Means and her miscarriage three years ago, if it happened the way her lawyers claim it did, is truly awful: Means was 18 weeks pregnant when her water broke and she was rushed to a hospital in Muskegon, Mich. The fetus wasn’t viable, and the pregnancy — Means’ third — was doomed.

But doctors at the hospital, part of the Catholic healthcare network known as Mercy Health Partners, didn’t tell her that, Means’ lawyers say.

Instead of the normal course of treatment — inducing labor and terminating the pregnancy to stave off potentially risky complications — Means was allegedly kept in the dark about her condition, given painkillers, and sent home.  Continue reading

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Seattle hospitals help ER patients sign up for insurance

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swedish

A Swedish staff member helps enroll patients at a December event on First Hill.

By Britt Olsen
Cover King County
Public Health – Seattle & King County

With the blood flow finally stanched by gauze, glue and several hundred dollars’ worth of stitches, you now sit propped up in a stiff but comforting hospital bed.

Your family members survey the damage, and a hospital administrator enters the room, clasping a laptop in her hands.

She is there to sign you up for health insurance. Continue reading

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Washington State Hospital Association files court challenge to new merger and acquisition rule

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H for hospitalFebruary 13, 2014 – The Washington State Hospital Association has gone to court to stop implementation of new rules that would require hospitals and medical groups planning to merge or affiliate to disclose how the proposed agreement will affect access to reproductive services, such as contraception and abortion, and end-of-life care.

Earlier this year, Gov. Jay Inslee directed the Department of Health to assess its rules governing such mergers in response to growing concerns that hospitals merging with hospital systems run by the Roman Catholic Church would no longer provide contraceptive prescriptions, contraceptive services, such as tubal ligation or vasectomy, and abortion or end-of-life care that the church considered to be euthanasia.

In its petition, the hospital association argues the new rules go outside the scope of the law and are excessively burdensome and expensive:

The rule change means that even relatively small business decisions would have to go through an extensive and expensive review—even if they don’t affect patient care or the amount of health services in an area. For example, a hospital’s decision to outsource billing services or share a Human Resources department with another hospital may be subject to Certificate of Need review. Other types of transactions that may be caught in the expanded CON net include bringing in a specialty oncology provider to manage cancer care, or pediatric specialists to manage a Neonatal Intensive Care Unit. Continue reading

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Hospitals serving elderly poor more likely to be penalized for readmissions

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Sign for an emergency room.By Valerie DeBenedette
HBNS Contributing Writer

Hospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties from the Centers for Medicare and Medicaid Services (CMS), finds a new study in Health Services Research.

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Maryland plan will reward hospitals for keeping patients out of the hospital

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Flag_of_MarylandBy Jay Hancock
KHN Staff Writer

January 10, 2014 – Maryland officials have reached what analysts say is an unprecedented deal to limit medical spending and abandon decades of expensively paying hospitals for each extra procedure they perform.

If the plan works, Maryland hospitals will be financially rewarded for keeping people out of the hospital — a once unimaginable arrangement.

“This is without any question the boldest proposal in the United States in the last half century to grab the problem of cost growth by the horns,” said Uwe Reinhardt, a health care economist at Princeton University. Continue reading

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Hospitals must disclose how mergers will affect access to reproductive services, end-of-life care

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H for hospitalHospitals and medical groups in Washington state planning to merge or affiliate must now disclose how the proposed agreement will affect access to reproductive services, such as contraception and abortion, and end-of-life care, according to new rules announced Monday by the Washington State Department of Health.

Earlier this year, Gov. Jay Inslee directed the Department of Health to assess its rules governing such mergers in response to growing concerns that hospitals merging with hospital systems run by the Roman Catholic Church would no longer provide contraceptive prescriptions, contraceptive services, such as tubal ligation or vasectomy, and abortion or end-of-life care that the church considered to be euthanasia.

Under the new rules, before transfer of ownership can take place, the parties involved must submit copies of policies on admission, non-discrimination, end-of-life care, and reproductive health care services to state health officials. This information must then be posted on both the hospital and Department of Health websites for the public to see. The rules go into effect early next year.

“As hospitals look to join together, many people have asked for the opportunity to provide input into these mergers. Requiring the certificate of need process will allow the public to provide comments,” the Washington State Department of Health said in a statement announcing the new rules.

Here is the full text of the announcement:

Hospital mergers/expansion rules amended to give the public a voice

OLYMPIA - Rules filed with the state code reviser today will improve access to information on services hospitals provide and give people a voice on proposed hospital affiliations.

The state Department of Health filed the rule revision after Gov. Jay Inslee directed the agency to assess rules about when a certificate of need review should be required with regard to changes in hospital control. The governor also asked the agency to consider ways to improve how information about medical facilities is made available to the public.

The certificate of need review process supports planned and orderly development of health care services and facilities. Certificate of need work includes developing new hospitals and expanding existing hospitals; the sale, purchase, or lease of all or part of a hospital; adding bed capacity in a nursing home; and more.

The rules filed today require a certificate of need application for any sale, purchase, or lease of a medical facility. That includes when a hospital enters into an arrangement that transfers control of the facility from one entity to another.

Before a transfer of ownership can take place, facilities must submit copies of policies on admission, non-discrimination, end-of-life care, and reproductive health care services to state health officials. All of that information will be posted on both the hospital and Department of Health websites for public access.

As hospitals look to join together, many people have asked for the opportunity to provide input into these mergers. Requiring the certificate of need process will allow the public to provide comments. The rule also makes important information about the facilities available to everyone.

The new rules go into effect Jan. 23, 2014 – 31 days after filing with the code reviser. After that date, all hospitals have an additional 60 days to submit policies to the department.

The updated certificate of need process helps ensure transparency with health care facilities and those who use them, and helps people make informed decisions on where to get medical care.

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App tells how long you’re likely to wait in a hospital’s ER

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Sign for an emergency room.by Lena Groeger
ProPublica

Some medical conditions require and receive immediate care. People who are having heart attacks or who have suffered life-threatening injuries are typically seen by doctors as soon as they arrive at the hospital.

But in less urgent cases, patients arriving at the emergency room can wait for hours before seeing a doctor, receiving pain medication, having tests, or being admitted to the hospital.

And unless you had the foresight to call ahead, there is little way to know how long your visit will take.

Today ProPublica launching an interactive news application called ER Wait Watcher, which gives you a little more information to work with.

The app, which uses nationwide data recently released by the federal government, shows you how long it takes, on average, to see a doctor or other licensed professional at hospitals near you, plus the time it takes to drive there.

In many cases, the hospital closest to you may not be your best bet, because of long waiting times. Traveling farther may get you in front of a doctor sooner.

If you think you’re having a heart attack, or if you’ve suffered a serious injury, you should not use ER Wait Watcher. Please call 911. The ambulance will take you to the closest hospital, and won’t be as affected by traffic because it can speed and run red lights.

The app uses data from the Centers for Medicare and Medicaid Services on measures of “Timely and Effective Care.” These measures are based on a year’s worth of data that CMS updates quarterly (the last update was Dec. 12, 2013).

It includes averages for:

  • How long patients tend to wait before seeing a doctor,
  • how long they spend in the emergency department before being sent home or admitted to the hospital,
  • and how many leave without being seen at all.

All data is reported voluntarily by hospitals, which have a financial incentive to participate.

ER Wait Watcher also estimates in real time how long it would take to drive to nearby hospitals based on current traffic conditions. It fetches this data directly from Google, so travel times will change throughout the day.

While minutes matter when you’re having a medical emergency, longer wait times are not always an indicator of worse care. For example, emergency rooms that see more patients with behavioral health problems like alcohol abuse may have much longer wait times; it may take hours for a patient to sober up enough to be safely discharged.

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Virginia Mason Medical Center had the longest wait times in Seattle, but 81% of patients said they would “Definitely Recommend” Virginia Mason, higher than the state average of 73%.

And time is not the only important factor, of course, so the app also includes patient satisfaction scores and other hospital quality measures to help you make an informed decision about which emergency room to go to.

The federal data includes what researchers say are important quality metrics for the nation’s emergency departments. According to Dr. Jeremiah Schuur, an emergency physician at Brigham and Women’s Hospital in Boston, the most useful measure from a patient’s perspective is waiting time — the time from when a patient walks in the door to when he sees a doctor.

Other emergency room measures, such as total length of stay at the hospital, may vary more depending on condition (a head fracture may take longer than a dislocated elbow) or on other patients (some hospitals treat sicker patients).

But whether or not a patient is seen quickly is a measure that can be compared across hospitals, says Schuur.

CMS’s move to standardize how to measure the quality of emergency care is especially needed now. In the last two decades an increase in ER patients, many of them older and sicker, has led to overcrowding.

Nationwide, ambulances are now turned away once a minute from overcrowded ERs and hospitals have difficulties in finding specialists to take emergency calls.

Some patients leave in frustration without being seen at all, while others can wait many hours for a hospital bed to become available. This confluence of problems led the Institute of Medicine to warn that emergency rooms in the United States are “at a breaking point.”

Overcrowding is not just an annoyance, and doesn’t just affect the people who come in complaining of a headache. A study of almost a million admissions to 187 California hospitals found that patients who were admitted after going through a very crowded emergency room were at 5 percent greater odds of dying than those admitted after passing through a less-crowded emergency room.

To tackle the problem, some experts advocate more measurement. Publicly releasing quality metrics can drive meaningful improvements in emergency care, according to a recent article in Health Affairs, a health policy journal. And the strategy has had some success in the past.

In 2004 hospitals began to publicly report a quality measure called “door-to-balloon time.” It refers to the time between a heart attack patient’s arrival at the emergency room and the moment of surgical intervention (which can sometimes involve inflating a thin balloon inside a heart artery).

CMS used door-to-balloon time to determine a portion of a hospital’s Medicare payment. Since then, emergency departments have focused a great deal of effort and money on identifying patients with heart attacks by screening them at triage. This has led to improvements in care for heart attack patients.

But not all measurements have had the same success. In 2005, England tried implementing another measure — a “four-hour rule” for the length of time a patient could stay in the emergency room before being sent home or admitted to the hospital. The country’s health service mandated that hospitals reach this four-hour time limit for 98 percent of their patients.

While nearly all hospitals met the goal, many also found ways to game the system, for example transferring patients to another doctor right before the clock ran out.

Since 2010, England has relaxed this measure and introduced new ones such as time to triage and percentage of patients who left without being seen.

Some U.S. emergency departments advertise their own quality care metrics, for example by posting waiting times on their websites, on billboards or on smartphone apps.

For people with conditions that are not life-threatening, this information allows them to postpone their trip or avoid a busy hospital altogether.

Theoretically this could help distribute patients more effectively and avoid pockets of crowding, improve patient satisfaction and serve as an incentive for hospitals to speed up their services.

But that information may not be reliable, or useful for comparing hospitals. On their own websites, hospitals are free to advertise any definition of “waiting time” they choose.

While one hospital could choose to count the time from when a patient arrives to when she is evaluated by a doctor, another could decide it’s when a patient is seen by a triage nurse, or receives a welcome from the hospital greeter.

Physician and Nurse Pushing GurneyIn order to solve these discrepancies, CMS established standard definitions and a common metric with which to accurately compare different hospitals.

The agency defines its own “waiting time” measure as the time from when a patient walks in the door to when he is evaluated by a licensed provider (a doctor, physician assistant or nurse practitioner). CMS says its specifications state clearly who qualifies, to avoid confusion.

A caveat: Hospitals may record these times inaccurately. In most cases someone must manually write down the time a patient was seen, so the times are not always precise. To combat this, some emergency rooms outfit doctors and nurses with electronic badges that wirelessly record exact times.

According to CMS, hospitals have 30 days to review their data before submitting it to the government. The agency places most of the responsibility on hospitals for making sure their data is correct before doing so.

Instead of emphasizing timeliness, future measures could look at effectiveness of care or how well emergency departments utilize resources, according to Dr. Schuur. While the newly released data is extremely important to enable individual hospitals to improve their operations, he said, “consumers should be aware that there is much more to the quality of an emergency room than how quickly they see you.”

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Growth of Catholic hospitals — by the numbers

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by Nina Martin
ProPublica

The past few years have been a period of unprecedented turmoil for the hospital industry.Now, a new report confirms that Catholic hospitals are emerging as one of the few clear winners — and the study adds its voice to a growing chorus of warnings about how church doctrine could affect women’s reproductive health care.

The report is by MergerWatch, a New York–based nonprofit that tracks hospital consolidations, and the American Civil Liberties Union. It traces the growth of Catholic hospitals across the U.S. from 2001 to 2011, the most recent year for which complete data is available.

It focuses on full-service, acute-care hospitals with emergency rooms and maternity units —settings in which Catholic religious teachings are most likely to come into conflict with otherwise accepted standards of reproductive care.

The report’s major finding is illustrated in the chart below: At a time when other types of nonprofit hospitals have been disappearing, the number of Catholic-sponsored hospitals has jumped 16 percent.

Over the last decade, only for-profit hospitals have fared better. The gains by Catholic providers are especially striking considering the sharp decline in the number of other religious-owned hospitals during the same period.

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Source: MergerWatch

The numbers reflect the huge wave of hospital consolidations triggered by health care reform. For reasons that the report doesn’t delve into, Catholic hospitals have weathered those market upheavals better than other types of community hospitals—so well that they now make up 10 of the 25 largest health-care networks in the U.S.

Not surprisingly, the number of hospital beds at Catholic providers has also increased faster than at other types of nonprofit hospitals.

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Source: MergerWatch

According to the report, Catholic acute-care hospitals now account for 1 in 9 hospital beds around the country, with much higher concentrations in some states, including Washington (the subject of this ProPublica story), Wisconsin, and Iowa.

(When other types of facilities are included, the Catholic share of hospital beds is closer to 1 in 6, according to this fact sheet.)

Keep in mind that these numbers are from 2011. Since then, according to the report, the largest Catholic health hospital networks, Ascension Health and Catholic Health Initiatives, have grown by another 30 percent or more.

“The trend we’ve identified is continuing and perhaps even accelerating,” Lois Uttley, MergerWatch’s director, said in an interview. “These large Catholic health systems are expanding aggressively, taking over other hospitals and smaller health systems, gobbling up non-Catholic hospitals, and gaining more financial power.”

However, the report’s immediate concern isn’t the hospitals’ economic clout, but rather the impact of Catholic health care policy, as embodied by controversial guidelines known as The Ethical and Religious Directives.

Issued by the U.S. Conference of Catholic Bishops, the ERDs govern medical care at all Catholic hospitals — and influence care at secular hospitals that merge or affiliate with Catholic providers.

The directives ban elective abortion, sterilization, and birth control and restrict fertility treatments, genetic testing, and end-of-life options.

Depending on the hospital and the local bishop, they may also be interpreted to limit crisis care for women suffering miscarriages or ectopic pregnancies, emergency contraception for sexual assault, and even the ability of doctors and nurses to discuss treatment options or make referrals.

A spokesman for the Catholic Health Association of the United States said he had not seen the report and could not comment. But in a statement responding to  a recent New York Times editorial, the association provided a spirited defense of its member hospitals.

“Catholic hospitals in the United States have a stellar history of caring for mothers and infants. Hundreds of thousands of patients have received extraordinary care …There is nothing in the Ethical and Religious Directives that prevents the provision of quality clinical care for mothers and infants in obstetrical emergencies. Their experience in hundreds of Catholic hospitals over centuries is outstanding testimony to that.”

But Louise Melling, the ACLU’s deputy legal director and a coauthor of the new study, sees danger as Catholic hospitals expand their market share and the ERDs extend their reach as well.

She cites the case of a Michigan woman who was allegedly denied proper care for a miscarriage at a Catholic hospital in Muskegon because of its interpretation of the directives banning abortion.

In that case — the centerpiece of a high-profile lawsuit by the ACLU against the Catholic bishops last month — the hospital in question had been secular until 2008, when it was merged with a Catholic health care system.

“Ordinary people are not following hospital mergers and acquisitions,” Uttley said. “They don’t know who runs their hospital, especially if it doesn’t have a Catholic name. Even if it does have a Catholic name, people don’t know what that means.”

Archbishop Joseph Kurtz of Louisville, Ky., the newly elected president of the bishops conference, has called the lawsuit “baseless” and “misguided.” “A robust Catholic presence in health care helps build a society where medical providers show a fierce devotion to the life and health of each patient, including those most marginalized and in need,” he said.

The authors of the new report, titled “Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care,” assert that the risk to patients is especially great in areas where a Catholic hospital is the sole provider for an entire region.

The report also looks at how much money Catholic hospitals take in from Medicare and Medicaid—a total of $115 billion in gross patient revenues in 2011 — and urges the federal government to enforce laws that protect patients under those programs. (Back in 1999, when MergerWatch issued its first report on the role of religion in health care, the total billed by all religious hospitals — not just Catholic-sponsored ones—was $41 billion.)

One of the more surprising findings is the slightly below-average amount of charity care provided by Catholic acute-care facilities. The numbers are based on Medicare Cost Reports, financial and utilization data filed annually by every hospital, the report said.

ProPublica requested comment from the Catholic Health Association, and we’ll post it if it comes.

But the shift, if true, is a big change from the past, when Catholic hospitals were founded by nuns and brothers to minister to the poor, the report says.

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Source: MergerWatch

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Valley Medical Center CEO gets pay cut – but package will still top $1 million

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H for hospitalBy Lewis Kamb, The Seattle Time
This story was produced in partnership with 

Washington’s highest-paid public-hospital executive has won a new two-year employment contract that will pay him more than $1 million a year in salary and bonuses.

But for longtime Valley Medical Center Chief Executive Rich Roodman, the deal amounts to a pay cut.

Roodman’s contract was the focus of a Kaiser Health News story last June, which looked at how incentives for hospital CEOS were driving the kind of hospital profits and expansion that many say are no longer affordable for patients, employers and taxpayers.

The 30-year CEO of the Renton hospital — whose soaring pay has stirred local controversy for years — won unanimous approval for the contract extension Tuesday from the Valley Medical board of trustees.

“We need strong leadership during this period of health-care change,” trustee Bernie Dochnahl said before the vote. Other trustees said the contract represented a good compromise that recognized Roodman’s service but paved the way for new leadership.

Dr. Paul Joos, an outspoken critic of Roodman’s, said the negotiation process revealed possible past errors and “struck a good compromise for the future.”

He noted the search for Roodman’s successor will begin immediately.

Roodman, who attended Tuesday’s board meeting, slipped out without comment after it concluded.

Tuesday’s approval ensures Roodman, 65, will continue working as the top executive of taxpayer-funded Valley Medical Center —- the centerpiece of King County Public Hospital District No. 1 — through at least Jan. 1, 2016. It also signals that his time is coming to an end.

The current contract for Roodman, who earned $1.3 million in total pay last year, expires at month’s end.

Under the new contract, Roodman’s current base salary of about $769,000 will be frozen. He will still get up to $238,341 in annual incentives, but contributions to his supplemental retirement plans stop, as do “retention” bonuses that have recently garnered him more than $235,000 per year.

The contract includes five weeks of annual vacation, standard health benefits provided to hospital executives and physicians, and a car allowance. It also offers Roodman the possibility to work for another year.

Once Roodman retires, he’ll walk away with a $7.5 million retirement package, records show. The amount includes a standard hospital-executive retirement plan valued at $1.6 million, plus supplemental retirement plans worth $3.4 million and two life-insurance policies valued at $2.5 million.

Valley Medical Center, a 303-bed acute-care hospital, serves more than 400,000 South King County residents as part of the state’s largest public hospital district, which encompasses the cities of Kent and Renton and includes parts of Tukwila, Auburn, Black Diamond, Covington, Federal Way, Maple Valley, Newcastle and Seattle.

In 2013, the owner of a typical home in the district assessed at $210,000 paid about $105 in property taxes under the district’s tax rate of 50 cents per $1,000 of assessed value, according to the King County Assessor’s Office.

Seattle Times reporter Christine Clarridge contributed.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Remembering the Sandy Hook tragedy, protecting kids from gun violence – Seattle Children’s

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From Seattle Children’s On the Pulse blog

GunOn Dec. 14 of last year, 20 children and seven adults lost their lives in the senseless tragedy that took place at Sandy Hook Elementary School in Newtown, Conn.

As we approach the anniversary of this horrific event, we remember and mourn the victims and the families who have been affected by this tragedy.

No parent should ever have to suffer through the pain of losing a child to gun violence. And with guns in more than one third of all U.S. households, firearms present a real, everyday danger to children, especially when improper safety techniques are followed.

Frederick Rivara, MD, MPH, division chief of general pediatrics and vice chair of the Department of Pediatrics at Seattle Children’s Hospital, and Dimitri Christakis, MD, MPH, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, offer the following tips and advice for parents looking to keep kids safe from firearms, and to help reduce their exposure to gun violence in the media.

Gun safety in the home

Less than half of U.S. families with children and guns store their guns unloaded and locked away. Each year just in Washington state, about 25 children are hospitalized and four to five die due to unintentional gun injuries.  Most of these shootings occur in or around the home.

The best way to protect children from firearms injury in the home is to remove the firearms entirely. However, if this is not an option, Rivara says there are a number of ways that you can minimize the risk:

Store your guns safely:

  • All weapons should be stored in a securely locked case, well out of the reach of children, and make sure children do not have access to the key or combination.
  • Stored firearms should be unloaded and in the uncocked position.
  • Store ammunition separate from the weapon, also in a securely locked location out of the reach of children.
  • Use trigger locks or chamber locks on weapons. Even a padlock can be used to prevent the cylinder of a weapon from locking into place.
  • Remove guns from your home if a family member is depressed, suicidal or is abusing drugs or alcohol.

With the popularity of shooting video games and toy guns, the lines between these weapons and their very real consequences are often blurred. Parents should talk with their children and make them aware that weapons are not toys and that if they ever do come into contact with a weapon, they are not to touch it under any circumstances. The National Rifle Association (NRA) recommends teaching children four things about what to do when finding a gun: stop, don’t touch, leave the area and tell an adult.

Gun violence in the media

Whether or not you keep a weapon in your home, children will be exposed to gun violence in the media at some point, often very early in life. In fact, a recent study found that the rate of violence in movies is increasing, and that this violence is now more predominant in the PG-13 movies your teens are watching than in R-rated movies. And with the medical consensus being that exposure to violent media can increase aggression in children, and that children often imitate what they see on the screen, parents must be mindful of their children’s exposure to gun violence in the media.

While it’s challenging to prevent your child from encountering this violence, you can help to limit it while you talk to them about its real-world consequences. Here are a few tips to help:

Implement a media diet. Christakis recently conducted a study that found that children reproduce what they see on television or in the movies, both bad and good. He suggests staying aware of what your children are watching by keeping a media diary. He also advises to watch more TV and movies with your children so you’re always aware of the content they’re consuming and can discuss it with your kids.

Be available. When events like the Sandy Hook tragedy occur, these stories of violence are plastered all across the news. Each child responds to this in a different way. Many become fearful and have questions about these events. Some end up angry or grief-stricken, while others feel a sense of betrayal. Be sure to talk with your children about these events to reinforce that they are safe and to assuage their fears. Doing this will also show that you are available to talk with them about anything, no matter how difficult it may be.

Keep an eye out for red flags. Pretend gun play, violent video games and movies and other aggressive influences are a part of our lives, and finding the right balance between limiting children’s exposure to these stimuli and not keeping them entirely in the dark can be difficult. However, it can help to look out for potential red flags, such as a child “accidentally” hurting another, aggressive behavior, or a lack of empathy or remorse for their actions. Please discuss these concerns with your child’s doctor.

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NY database shows hospital charges all over the map

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Dollar WheelBy Fred Mogul, WNYC

New York State has pulled back the curtain on hospital charges with a new databases showing what each hospital charges for 1,400 different procedures.

The differences can be dramatic: At Bellevue Hospital, the median charge for an uncomplicated birth  is $6,330, and at NYU Langone Medical Center next door, the median charge is $12,222.

Lutheran Medical Center in Sunset Park, Brooklyn, typically charges $5,686 and Maimonides Medical Center, a dozen miles away, $14,763.

Patterns can be difficult to discern, and can vary from procedure to procedure. Overall, academic medical centers are more costly because of the additional staff needed for medical training, the greater use of technology, and the severity and complexity of patients.

But those factors do not account for why at Westchester Medical Center, the median charge for a vaginal delivery is $22,143, and at New York Presbyterian Weill Cornell Medical Center, it is $11,900.

The Greater New Hospital Association said the information is “complex and can be confusing,” because “hospital charges do not reflect the far lower payments hospitals actually receive for the services they provide.”

Medicare and Medicaid reimburse much less than what hospitals charge, and insurers and managed care companies also negotiate rates that have little to do with what hospitals ask to be paid.

People without insurance, however, are subject to these sticker prices. In practice, hospitals typically work out some kind of payment plan less than the charged amount and write off losses – but the payments can still be onerous.

Dr. Fred Hyde, from Columbia University’s Mailman School of Public Health, said the relationship between charges and underlying costs is tenuous at best.

“To a large extent in the hospital field, we take our charges in accord with what we think we’re going to be paid, not in any relationship to the cost of goods sold or the combination of wages and materials, or anything else that would go into a genuine cost measurement,” said Hyde, a physician who has been the head of two hospitals and a managed care company.

Experts say patients trying to evaluate potential hospital charges for upcoming treatments should use the state database cautiously, if at all, because the charges listed are likely to be only loosely connected to the prices a patient will see. Instead, patients should try to get information about their out-of-pocket expenses in advance from the hospital and insurance carrier — though in practice that can be difficult, if not impossible.

Making medical costs more transparent is a goal for both consumers and the institutions that pay for most medical treatment, insurance companies and the federal government.

Suzanne Delbanco, from the Catalyst for Payment Reform, said New York and the rest of the country should look to New Hampshire as a model. Its state website allows consumers to plug in their insurance plan, hospital and procedure, and get an accurate projection of real out-of-pocket costs.

Delbanco said New York’s new database “is a good step, but a baby step” toward greater transparency.

In the meantime, she said, people should avoid falling into the trap of assuming places that charge more provide better care.

“Countless studies have looked at the relationship between cost and quality,” Delbanco said. “And the relationship just isn’t there.”

James Tallon, from the United Hospital Fund, said he hopes the newly released data will illuminate the true underlying costs of medical procedures and the wide variations in charges – perhaps eventually making the case for a return to stronger price controls that were in place, before deregulation in the 1980s.

“That’s an open political question – we’re nowhere near that now,” Tallon said, noting that New York “some three decades ago felt it perfectly reasonable public policy to standardize all these rate-setting decisions.”

This story is part of a reporting partnership that includes WNYC, NPR and Kaiser Health News.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Seattle Children’s doctor offers tips to keep kids safe this holiday season

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Photo courtesy of Jay-Simmons

Photo courtesy of Jay Simmons

From Seattle Children’s On the Pulse blog

Tis the season for mistletoe, gingerbread and carefully strung lights. It’s the most wonderful time of the year, but also a potentially dangerous one for children. And although festivities, candles and garland may make the holiday season more cheerful, with them come some serious safety concerns.

Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s Hospital, says the most important thing to remember this holiday season is supervision.

“The holidays are a fun and exciting time, but there are a few more things inserted into the environment, like holiday plants, electrical cables, new toys and festive beverages, which are potentially dangerous,” says Woodward.

Holiday safety tips

To keep kids out of the emergency room this year, Woodward recommends some basic safety tips to ensure an injury-free, but still festive holiday season.

Lights, trees and décor. Sparkly ornaments, shiny holiday decorations and small holiday figurines are potential choking hazards for small children. If an object can fit through a toilet paper tube, it can obstruct the airway of a small child and prevent breathing.

“Think like a child,” says Woodward. “Get down on your hands and knees and look around the house. If something looks shiny and enticing, a child may want to put it in their mouth. Keep decorations high and out of reach.”

Make sure trees and decorations are properly secured, either by a sturdy stand or to the wall. Also, talk to children about holiday decorations and explain that they are not toys. Set limits and supervise children.

Poisoning potential. Holiday plants like mistletoe, holly and poinsettias are commonly used as decorations, but they can be hazardous to children. These plants are considered potentially poisonous and should be kept away from children and out of reach. If a child ingests any part of these plants call a pediatrician or the Poison Help Line immediately at (800) 222-1222. Symptoms from poisoning may include vomiting, diarrhea, nausea or rash.

Medicines and vitamins can also be hazardous for children. Keep an eye out for medicine, vitamins and other personal products found in purses or suitcases that guests visiting for the holidays may bring into the home. Also, be aware when visiting other houses this holiday with your family, especially households without young children because the house may not be child proofed.

Be cautious of raw or undercooked foods during the holidays. Wash hands frequently when handling raw meat or eggs, and don’t leave foods out in reach of children.

Holiday parties. Hosting a holiday gathering this year? Plan for a party’s youngest guests first. Take small children into consideration when planning a party’s food and beverage menu, and before adorning the home with festive décor.

“Decorating the home with garland and strung beads may look great for the holidays, but children can mistake the brightly colored beads and floral arrangements for candy or food, which may cause choking or poisoning,” says Woodward.

Alcohol is another common risk for children around the holidays and during holiday gatherings.

“Kids see adults drinking alcohol and become curious. If glasses are left sitting out in reach of children they may ingest the alcohol, which even in small amounts can be dangerous to kids. Use common sense and always keep an eye on children,” says Dr. Woodward.

Also, stay home from parties or gatherings if children aren’t feeling well. Don’t risk spreading germs to others. Talk to children about proper hand washing and coughing techniques. Germs are easily spread, but these techniques can help prevent the transmission of germs from one person to another.

Fire safety. Keep decorations and trees away from heat sources within the home, which includes fireplaces, radiators, space heaters or electrical outlets. Also, avoid using candles if there are small children in the home.

When buying an artificial tree, make sure it is “fire retardant,” and also make sure a child’s sleepwear is labeled “fire retardant” as well. Be sure to also remove dry trees after the holiday season to reduce fire risk.

Use socket covers to baby-proof electrical outlets and make sure extension cords are well hidden and out of reach. Ensure cords are all the way in the outlets so kids don’t get shocked. Also, do not have water around outlets and wires.

Cooking is the leading cause of home fires in the U.S. Try to keep small children out of the kitchen while cooking or preparing food. Turn pot handles in so they can’t be accidently knocked over and stay in the kitchen while frying, grilling and broiling.

Toy safety. Many toys and holiday decorations require button batteries, which can pose fatal risks for young kids. Be sure batteries cannot be removed easily from toys and gadgets. If a battery is swallowed, it can cause life-threatening injuries. Also, avoid magnets. Toys that contain small magnets are especially dangerous for young kids. If swallowed, magnets can attract to one another in a child’s intestine and cause serious complications and even death.

“Make sure toys are appropriate for the age of a child, but also think about other children,” says Woodward. “Think about the worst case scenario. If a 1-year-old or 2-year-old will be in the home visiting for the holidays, ask if there are toys that could potentially be harmful to them.”

Just like checking a food’s ingredient list, parents should read toy and product labels. Avoid toys and products that contain PVC plastic, xylene, toluene or dibutyl phthalate.

Cold weather. With temperatures dropping, make sure children are properly dressed for the weather with hands, feet and heads covered. Dress children in layers and make sure they come in out of the cold periodically. The nose, ears, feet and hands are at the biggest risk of frostbite if temperatures are below freezing.

Supervise children while they play. Activities like sledding can be dangerous without proper supervision and safety gear. Also, be extremely cautious around water. Never allow children to walk across frozen lakes or ponds.

Lastly, wear sunscreen. It may be cold, but children are still at risk for sunburn.

The holidays are a time for celebration and fun. By following these simple safety tips, families can enjoy the holiday season without injury. Happy Holidays!

Photograph courtesy of Jay Simmons

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