Most reputable companies that provide services tell you what you’ll get for your money. Hospitals are an exception. They haven’t traditionally made public the cost of operations and other procedures. This secrecy has let hospitals set widely different prices for the same procedure. It’s also made it impossible to do any comparison shopping. Yesterday’s release to the public of a once very private database shows just how big the differences can be from hospital to hospital. The database, released by the Centers for Medicare and Medicaid Services, details what 3,300 hospitals charged for the 100 most common treatments and procedures in 2011. It data reinforce the big differences in charges from one part of the U.S. to another. What’s new and surprising are the huge differences sometimes seen between hospitals in the same city, or even the same neighborhood.
Patrick J. Skerrett
Posts by Patrick J. Skerrett
When pain strikes, it’s human nature to avoid doing things that aggravate it. That’s certainly the case for people with arthritis, many of whom tend to avoid exercise when a hip, knee, ankle or other joint hurts. Although that strategy seems to make sense, it may harm more than help. Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body. Yet a new survey from the Centers for Disease Control and Prevention shows that more than half of people with arthritis don’t walk at all for exercise, and only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function.
For many people, medications are a mainstay for preventing and treating disease. Managing multiple conditions and multiple medications can be confusing, especially if you store some of your pills in the medicine cabinet and others in a kitchen cabinet or pill drawer. Every once in a while, it’s a good idea to take inventory of all of your medications. As a reminder to do just that, the American College of Endocrinology has declared April 15th as National Check Your Meds Day. The college recommends checking to make sure the labels on the medications you got from the pharmacy match exactly what your doctor prescribed. It’s also important to check expiration dates.
All-you-can-eat buffets are a boon for hungry, thrift diners and a nightmare for dieters or those trying to maintain a healthy weight. If you are in the latter camp, here are two tips from Brian Wansink, the master of mindful eating: 1) Take a walk around the entire buffet to scope out your options before serving yourself. 2) Put your food on a small plate instead of a big one. Those come from observations of more than 300 men and women dining in two dozen all-you-can-eat Chinese restaurants. Understanding the many factors that influence what and how you eat can help you take more control of your eating habits. Who you eat with, how you are feeling, and activities like parties or shopping can influence when and how much you eat.
Tiny shock absorbers in the knee (each one is called a meniscus) provide a key cushion between the thighbone and the shinbone. They are prone to tearing, and sometimes just wear out. A torn meniscus can cause pain or other symptoms, like a knee that locks. But sometimes they don’t cause any symptoms. In a youngish person, when a knee-wrenching activity like skiing, ultimate Frisbee, or slipping on the ice tears a meniscus, the damage is often repaired surgically. But a torn meniscus is often seen in the 9 million Americans with knee osteoarthritis, and for them the best course of action hasn’t been crystal clear. Results of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial published yesterday in the New England Journal of Medicine indicate that physical therapy may be just as good as surgery. Both therapies led to similar improvements in knee function and pain at six and 12 months.
New guidelines for recognizing and managing sports-related concussions could help protect the brains of millions of athletes at all levels of play, from professional football to youth soccer. The guidelines, released today by the American Academy of Neurology (AAN), replace a now-outdated set published in 1997. The guidelines step away from trying to “grade” concussions or diagnose them on the field or sidelines. Instead, they focus on immediately removing from play athletes who are suspected of having a concussion until they can be evaluated. “When in doubt, sit it out.” The AAN estimates that concussions cause between 1.6 million and 3.8 million mild brain injuries each year. Many athletes don’t get medical attention for these injuries, often because they or their coaches don’t recognize the warning signs or take them seriously. The new guidelines should help better identify athletes who have suffered concussions and improve how concussions are managed and treated.
Americans drive while talking on a cellphone or texting more than their counterparts in seven European countries. A report published yesterday showed that 69% of American drivers surveyed said they had talked on a cellphone while driving at least once in the previous month (31% said they did it “regularly or fairly often”), and 31% said they had read or sent text messages while driving. The least distracted drivers were in the United Kingdom. Not surprisingly, younger drivers were more likely to have reported talking on a cellphone or texting while driving. The statistics on distracted driving are chilling: In 2011 (the last year with complete statistics), 3,331 people were killed in motor vehicle crashes involving a distracted driver, and nearly 400,000 were injured. The National Highway Traffic Safety Administration estimates that distracted driving accounts for about one in five crashes in which someone was injured.
It always takes me a few days to get used to Daylight Saving Time. While I love the extra hour of light at the end of the day, I’m not so wild about the extra hour of darkness in the morning or waking up an hour earlier than I need to. And I sure miss the hour of sleep I lost yesterday. That lost hour seems to be a big deal. A report in this month’s American Journal of Cardiology details the jump in heart attacks seen in a large Michigan hospital the first week after the start of Daylight Saving Time, and the small decline after it ends in the fall. A few years back, researchers showed a similar pattern in Sweden. The number of traffic accidents are similarly affected. In a Canadian study, there were more accidents on the Monday after the start of Daylight Saving Time than there were on the Monday the week before the change. If ever there was a perfect day for a nap, today would be it. A single nap won’t fully reset your body clock or make up for a lost hour of sleep, but it can help. It’s also a good way to stay sharp, especially in the afternoon.
The toll taken by medical mistakes burst into public attention with a 1999 report called To Err Is Human from the U.S. Institute of Medicine. The report estimated that between 44,000 and 98,000 people die each year as a result of preventable medical errors. Such errors can be headline grabbers, like the death of Boston Globe columnist Betsy Lehman from an overdose during chemotherapy. The safety of hospital stays and encounters with health-care providers got a boost today with the publication of 22 evidence-based “patient safety strategies.” Although most focus on care that takes place in hospitals, they extend to almost all interactions between individuals and their doctors, nurses, and other care providers. Very few of the safety practices are expensive, high-tech interventions. Instead, they are almost old-fashioned efforts that aim to improve communication between health-care providers and their patients, and to improve the practice of medicine rather than the art of medicine. The theme of all of these interventions is to create systems that help caregivers follow every step that is known to improve patient care, and to avoid relying on fallible human memory. To err may be human, but it is also often preventable.
A pacemaker-like device that stimulates the brain can help control some of the muscular problems brought on by Parkinson’s disease, the second most common neurodegenerative problem in America. A report in tomorrow’s New England Journal of Medicine may prompt doctors to recommend its use sooner rather than later. For more than a decade, deep-brain stimulation has been used to help control Parkinson’s symptoms. It involves placing a tiny wire called a lead (pronounced leed) in the part of the brain that controls movement and a matchbook-sized stimulator under the skin below the collarbone. The lead and stimulator are connected to each other by a second wire that runs under the skin of the shoulder, neck, and head. The device emits small pulses of electricity that help coordinate movement. Deep-brain stimulation traditionally isn’t used until a person has lived with Parkinson’s for a decade or more. The new report in the NEJM will give doctors more leeway to use this therapy earlier in people with Parkinson’s.