Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[China]

Steward Health Care looking to sell 4 hospitals, Rep. Lynch says, as patients see surgeries canceled

 

Steward Health Care is looking to sell four of its hospitals immediately, according to Rep. Stephen Lynch, as lawsuits reveal the healthcare company is millions of dollars in debt and patients are seeing surgeries canceled.

 

Lynch said the four hospitals set to be sold are Holy Family Hospital in Methuen, Nashoba Valley Medical Center in Ayer, Norwood Hospital and St. Elizabeth's Medical Center in Brighton.

Late Friday, Mass General Brigham told its doctors to stop performing surgery and other procedures at Holy Family because they may not have the equipment they need. Erin Moylan, who was scheduled to have hip replacement surgery at Good Samaritan Hospital in Brockton, said her surgery was canceled just hours beforehand for the same reason. Good Samaritan is also owned by Steward.

 

"The equipment wasn't there for my doctor to perform the surgery and that all surgeries had been canceled," Moylan said.

 

Gov. Maura Healey said she has yet to see any plans from Steward, including plans to sell facilities.

 

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And in case you weren't already aware (this article is from 2008, but the practice seems to be increasingly problematic) doctors frequently are contractually limited in how much time they have to see patients (and thus aren't always able to adequately review and address patient medical issues):

 

How Strategies for Managing Patient Visit Time Affect Physician Job Satisfaction: A Qualitative Analysis

 

Studies have also shown that managed care limitations on the amount of time physicians are permitted to spend with patients is associated with decreased job satisfaction.26–33 In many cases, physicians are contractually bound by managed care insurers to limit the amount of time with each patient (typically ranging from 10 to 15 minutes) for the purpose of meeting total caseload quotas. Physicians who do not see the number of contractually stipulated patients often earn less and, in some cases, are penalized financially.12 Conversely, physicians who meet or exceed managed care quotas are often given bonuses and other rewards.

 

Criticism of time limits imposed on physician patient visits has been frequent.12,18,28–32 There is agreement that it is crucial to the provision of good medical care to have the professional autonomy to make decisions about how much time a patient needs for an appointment. Time, in this view, is an essential resource physicians have at their disposal for getting to know patients (including relevant psychosocial circumstances), making thorough diagnoses, and developing effective treatment plans. Although some illnesses can be dealt with quickly—for example, a child’s otitis media—other health problems are far more complex and, therefore, require significantly more time to manage. Effectively managing chronic illnesses, which are now more prevalent because of the aging baby boomer population, necessitates significant investments of provider time.12 In addition, it has been argued that limiting the length of encounters with patients runs the risk of interfering with the development of patient trust, productive physician–patient relationships, and, ultimately, desired health outcomes.

 

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[China]

The urban-rural death divide is getting alarmingly wider for working-age Americans

 

In the 1960s and 1970s, people who lived in rural America fared a little better than their urban counterparts. The rate of deaths from all causes was a tad lower outside of metropolitan areas. In the 1980s, though, things evened out, and in the early 1990s, a gap emerged, with rural areas seeing higher death rates—and the gap has been growing ever since. By 1999, the gap was 6 percent. In 2019, just before the pandemic struck, the gap was over 20 percent.

 

While this news might not be surprising to anyone following mortality trends, a recent analysis by the Department of Agriculture’s Economic Research Service drilled down further, finding a yet more alarming chasm in the urban-rural divide. The report focused in on a key indicator of population health: mortality among prime working-age adults (people ages 25 to 54) and only their natural-cause mortality (NCM) rates—deaths among 100,000 residents from chronic and acute diseases—clearing away external causes of death, including suicides, drug overdoses, violence, and accidents. On this metric, rural areas saw dramatically worsening trends compared with urban populations.

 

The federal researchers compared NCM rates of prime working-age adults in two three-year periods: 1999 to 2001, and 2017 to 2019. In 1999, the NCM rate in 25- to 54-year-olds in rural areas was 6 percent higher than the NCM rate of this age group in urban areas. In 2019, the gap had grown to a whopping 43 percent. In fact, prime working-age adults in rural areas was the only age group in the US that saw an increased NCM rate in this time period. In urban areas, working-age adults' NCM rate declined.

 

 

The study, which drew from CDC death certificate and epidemiological data, did not explore the reasons for the increases. But, there are a number of plausible factors, the authors note. Rural areas have higher rates of poverty, which contributes to poor health outcomes and higher probabilities of death from chronic diseases. Rural areas also have differences in health behaviors compared with urban areas, including higher incidences of smoking and obesity. Further, rural areas have less access to health care and fewer health care resources. Both rural hospital closures and physician shortages in rural areas have been of growing concern among health experts, the researchers note. Last, some of the states with higher rural mortality rates, particularly those in the South, have failed to implement Medicaid expansions under the 2010 Affordable Care Act, which could help improve health care access and, thus, mortality rates among rural residents.

 

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