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by Raymond Hino
Telemedicine systems, including remote presence technology, have evolved over the years from stationary workstations to mobile carts to the latest "robotic" units that self-propel themselves down our hospital corridors without a driver, according to preprogrammed GPS instructions. This technology has been credited with bringing specialists, including critical care intensivists, to the bedside in hospitals where no such practitioners live or work within hundreds of miles.
Through my experience as a hospital CEO, I have seen our hospitals benefit through coverage in a variety of applications, including intensive care unit and hospitalist coverage and specialty consults in both inpatient and outpatient clinic settings. I have seen ICUs that have reopened after the introduction of telemedicine and remote presence physician coverage of the units. In short, telemedicine has proven itself as a revenue producing service for our hospitals.
Dying in America is big business. It is estimated that most Americans spend almost half of their total lifetime healthcare expenditures in the final year of their lives. Almost half of all Americans die in hospitals and 1 in 5 die in intensive care units despite the futile nature of their conditions and the ambivalence that many family members have of letting a beloved relative go. The numbers are pretty staggering. According to a Congressional Office of Technology report, 2 million Americans are confined to nursing homes, 1.4 million require feeding tubes for survival, and 30,000 are kept alive in comatose or permanently vegetative states. Death also creates a huge financial toll on the living, with up to one third of families losing their lifetime savings in order to pay for end-of-life care (despite having primary insurance coverage).
In 1969, an Illinois attorney Luis Kutner introduced the idea of a "living will" in the Indiana Law Journal based upon existing estate law that permitted an individual to control his/her property after death. In 1991, the Patient Self-Determination Act was passed into law, requiring healthcare providers to inform patients about their right to make advanced directives consistent with the state laws. By 2007, 41 percent of Americans completed living wills that outlined their wishes surrounding potential use of antibiotics, ventilator support, feeding tubes, resuscitative measures and emergent interventions/procedures based upon an individual's medical condition.
by Paul Keckley
Late last month, the Supreme Court ruled 6-3 against the complaint filed by David King and his three Virginia co-plaintiffs. The majority opinion concluded that the intent of section 1321 of the Affordable Care Act's health exchange provision was to provide tax credits for all eligible enrollees whether the exchange is state-run or not. The court's opinion had the immediate impact of sending hospital and health insurer stocks up, while 2016 presidential campaign aspirants either lauded the decision or promised to undo the ACA altogether if elected.
No doubt, other legal challenges to the ACA are forthcoming. The GOP-led House of Representatives has voted 54 times for its repeal. It remains highly divisive: Kaiser Health Foundation tracking polls have consistently shown the nation almost evenly divided for or against the law over at least the past three years. And many elements of the law, including more constraints in the ways insurers do business, remain popular.
For insurance plans, the King v. Burwell decision affirms tax credits will be available for the 6.4 million who might have lost coverage. It also has the immediate effect of temporarily stabilizing premiums and likely participation in the 19,000,000 enrollee individual insurance market. But beyond this, a number of challenges and questions relevant to insurers remain as part of the unfolding of the Affordable Care Act's implementation.
by Lynn McVey
While having a casual conversation with my buddy who is a salesperson, she told me she "doesn't believe there is such a thing as a selfless act." I disagreed, although I didn't argue. It's my personal opinion that my opinion isn't powerful enough to change anyone's thinking.
Unfortunately, my salesperson buddy was scheduled for major surgery thousands of miles away from me and my hospital. Since I couldn't convince her to travel cross country to my facility, I reached out to connect to folks in the facility she was using. I've helped navigate healthcare events for many non-healthcare folks in my career. As an insider, I know how frightening hospitals are. We know the system is too complex and complicated and in dire need of a major repair, so I'm always happy to do my part as an insider.
With the passing of Ken Cohn, M.D., on June 24, the world lost a gentle and caring soul and I lost a friend and colleague. Ken was an unassuming and modest man with great talents who excelled in medicine, in management, in letters, in teaching, in mentoring, in family and in life.
I first met him at Memorial Hospital where he was associate professor of surgery at Dartmouth Hitchcock Medical Center, chief of surgical oncology at the VA Hospital in White River Junction, Vermont, and provided part time surgical coverage for us. He was unusual as a person and even more unusual as a surgeon, as he defied every stereotypical surgical personality trait. He was quiet, modest, self-effacing, intellectual, calm, thoughtful and deeply introspective. I immediately liked him and was drawn (as many have been) to his quiet caring demeanor and thoughtful attitude. His interests were varied and extended from medicine to history to literature to management to classical music to art to the Buffalo Bills, his original hometown heroes.
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