At Dr. Soong’s hospital, withholding the results of urine cultures, unless doctors actually called the microbiology lab to request them, reduced prescriptions for asymptomatic bacteriuria to 12 percent from 48 percent of non-catheterized patients, with no loss of safety.
“The extra step of having the clinician call eliminated a lot of frivolous testing,” Dr. Soong said.
In patients who have none of the typical symptoms of a urinary tract infection — no painful or frequent urination, no blood in the urine, no fever or lower abdominal tenderness — lab results detecting bacteria in the urine don’t indicate infection and thus shouldn’t trigger treatment.
Older people, and nursing home residents in particular, often have urinary systems colonized by bacteria; they will have a positive urine test almost every time, but they’re not sick.
Most Americans probably aren’t aware of the decline in the number of individuals training to become transplant physicians and how it will affect the future of medicine. Neither are the 2020 presidential hopefuls, all of whom have policies they believe best provide health care coverage for Americans without acknowledging or calling attention to the fact that soon there may not be enough doctors to do the work once more people are insured. We need a plan for that.
During the 25 years I’ve been a transplant doctor, I’ve cared for hundreds of patients who received lung transplants. I’m now worried about the growing number of people who will need this lifesaving procedure in the future but who won’t have enough transplant physicians to do it.
At any given time in the U.S., about 120,000 people are waiting for the call that they’ve been matched with a donor for a new lung, heart, liver, or kidney. That number will continue to rise, but the number of doctors to take the 2 a.m. call that a donor has been found for their patient and perform the transplant is dwindling.
Our 3D deep-learning system performed well in both primary and external validations, suggesting that it could potentially be used for automated detection of glaucomatous optic neuropathy based on SDOCT volumes. Screening with the deep-learning system is much faster than conventional glaucoma screening methods (ie, by experienced specialists), can be done automatically, and does not require a large number of trained personnel on site. Further prospective studies are warranted to estimate the incremental cost-effectiveness of incorporating this artificial intelligence-based model for screening for glaucoma, both in the general population and among at-risk people.
But greater use of biosimilars could create significantly more savings. If biosimilars obtained a 75 percent market share, less than the share of these medicines in many European Union nations, the resulting annual savings for the U.S. healthcare system could be nearly $7 billion, based on Winegarden’s analysis.
Not all drugs are created the same. Take generics and biologics: The former is a chemical-based medicine whose manufacture is easily replicated, while the latter is created using biological processes.
But there’s another key difference between those two classes of drugs, and it pertains to the financial state of the healthcare industry and to U.S. taxpayer dollars. Stated plainly, biosimilars have the opportunity to bring significant savings to state Medicaid programs and consumers with commercial insurance. That gives them a leg up over their chemical-based counterparts.
The irony is most hospitals are “nonprofit,” a status that makes them tax exempt. Many (but not all) do enough charity work to justify tax benefits, yet it’s clear nonprofit hospitals are very profitable. They funnel much of the profits into cushy salaries, shiny equipment, new buildings, and, of course, lobbying. In 2018, hospitals and nursing homes spent over $100 million on lobbying activities. And they spent about $30 million on campaign contributions. Health industries have also been funneling hefty sums into dark money groups. But their political power isn’t just the result of lobbying or electioneering. Hospitals are often the biggest employers in states and cities across America.
A recent study by Yale School of Public Health economist Zack Cooper and colleagues takes a look at hospital politics and helps shed light on why American health care is so insanely expensive.
Cooper and his colleagues have spent years investigating whether this was true, filing Freedom of Information Act requests and crunching data. They’ve uncovered evidence that suggests it was true. They find that legislators who were on the fence and voted “yea” for the legislation were 700% more likely to see a large bump in Medicare payment rates to hospitals in their district. Between 2005 and 2010, Congress shelled out over $2 billion to 88 hospitals through the horse-trading Section 508 provision. It was a clear win for these hospitals, which spent the money on more equipment, buildings, services, and staff.