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QOTD: What Works

Posted by mdaware on August 01, 2013

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"Most interventions are bad unless someone is acutely dying."
-Doctor Gus

QOTD

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Brussels Sprouts + Math = A Recipe for Confusion

My wife is a dietitian and a very good, healthy cook. Today she was cooking some Brussels sprouts (which I, evidently incorrectly, have been calling "brussel sprouts") and it brought up a great lesson in how hard it is to try to eat healthily in America. Rather, I just finished 26th grade and my wife went to school for this and has literally done this for a living for nearly a decade, and yet we can't figure out what we're eating. We have a 1-pound bag of Brussels sprouts: 1 pound bag = 454 grams According to the label, the serving size is 4 sprouts, or 84g, which contains 40 calories. There are 5 servings per container, which should be 20 sprouts in the bag for a total of 200 calories. The label (photo) is identical to the official USDA label (image above). My wife counted how many sprouts came in the bag, and we have 40, not the 20 the label says we should have (4 sprouts per serving x 5 servings). Which, on the one hand, is great, because, hey, who...

On "unnecessary" ED visits: background reading

Here are a bunch of very informative pieces on why trying to blame excessive costs or busy-ness on low acuity patients in the ED is, at best, a misguided effort: 1) Great overview of many systemic issues which funnel patients to emergency departments, by Annals of Emergency Medicine Editor in Chief Mike Callaham*: The Prudent Layperson’s Complicated and Uncertain Road to Urgent Care 2) We can't discern low acuity diagnoses from chief complaints, by Maria Raven , Robert Lowe, Judith Maselli, and Renee Hsia in JAMA: Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying “ Nonemergency” Emergency Department Visits and accompanying editorial by my (now) chair: some intuitive, oversimplified, yet enduring beliefs about nonurgent patients in the ED should be abandoned. Trying to discern low-acuity conditions and putting up barriers to receiving care or denying payment after receiving care will work no better in future generations than in the past. Attenti...

UHC is Still At It Trying to Deny Low Acuity ER Visits

See The Prudent Layperson Standard OR How I Learned to Keep Worrying About Anthem Breaking the Law and Prudent Layperson, Meet Imprudent Payer and of course On "unnecessary" ED visits: background reading . In August, UHC announced they were going down the " insurers are probably breaking the law trying to dissuade people from going to the ER " path. Here is their recently announced Coverage Determination Guideline . And here is the AHA's response (the hospital group, not the cardiologists). First, the wording is very careful & deliberate, and seems like they are gearing up to put more pressure here and get away within arguably the letter but not spirit of the law. If you're a West Wing or Oliver Platt fan, it reminds me of Babish saying "He did everything right. He did everything you do if your intent is to perpetrate a fraud." They do appropriately define an emergency (or at least close enough to not set off alarm bells when I read this...

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OPINIONS ARE NOT THOSE OF EMPLOYER NOR MEDICAL ADVICE

QOTD: What Works

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