10 Things Your Hospital Won't Tell You

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10 Things Your Hospital Won't Tell You

By Reshma Kapadia

September 12, 2006

1. " Oops, wrong kidney. "

in recent years errors in treatment have become a serious problem

for hospitals, ranging from operating on the wrong body part to

medication mix-ups. According to a report from the Institute of

Medicine, at least 1.5 million patients are harmed every year from

being given the wrong drugs — that's an average of one person per

U.S. hospital per day. One reason these mistakes persist: Only 10%

of hospitals are fully computerized, with a central database to

track allergies and diagnoses, says Wachter, chief of the

medical service at UC San Francisco Medical Center.

But signs of change are emerging. More than 3,000 U.S. hospitals, or

75% of the country's beds, have signed on for a campaign by the

Institute for Healthcare Improvement implementing new prevention

measures such as multiple checks on drugs. As of June these

hospitals had prevented an estimated 122,300 avoidable deaths over

18 months.

While the system is improving, it still has a long way to go.

Patients should always have a friend, relative or patient advocate

from the hospital staff at their side to take notes and make sure

the right meds are being dispensed.

2. " You may leave sicker than when you came in. "

A week after Leandra Wiese had surgery to remove a benign tumor, the

high school senior felt well enough to host a sleepover. But later

that weekend she was throwing up and running a fever. Thinking it

was the flu, her parents took her to the hospital. Wiese never came

home. It wasn't the flu, but a deadly surgical infection.

About 2 million people a year contract hospital-related infections,

and about 90,000 die, according to the Centers for Disease Control

and Prevention. The recent increase in antibiotic-resistant bugs and

the mounting cost of health care — to which infections add about

$4.5 billion annually — have mobilized the medical community to

implement processes designed to decrease infections. These include

using clippers rather than a razor to shave surgical sites and

administering antibiotics before surgery but stopping them soon

after to prevent drug resistance.

For all of modern medicine's advances, the best way to minimize

infection risk is low-tech: Make sure anyone who touches you washes

his hands. Tubes and catheters are also a source of bugs, and

patients should ask daily if they are necessary.

3. " Good luck finding the person in charge. "

Helen Haskell repeatedly told nurses something didn't seem right

with her son , who was recovering from surgery to repair a

defect in his chest wall. For nearly two days she kept asking for a

veteran — or " attending " — doctor when the first-year resident's

assessment seemed off. But Haskell couldn't convince the right

people that her son was deteriorating. " It was like an alternate

reality, " she says. " I had no idea where to go. " Thirty hours after

her son first complained of intense pain, the South Carolina teen

died of a perforated ulcer.

In a sea of blue scrubs, getting the attention of the right person

can be difficult. Who's in charge? Nurses don't report to doctors,

but rather to a nurse supervisor. And your personal doctor has

little say over radiology or the labs running your tests, which are

managed by the hospital. Some facilities employ " hospitalists " —

doctors who act as a point person to conduct the flow of

information. Haskell urges patients to know the hospital hierarchy,

read name tags, get the attending physician's phone number and, if

all else fails, demand a nurse supervisor — likely the highest-

ranking person who is accessible quickly.

4. " Everything is negotiable, even your hospital bill. "

When it comes to getting paid, hospitals have their work cut out for

them. Medical bills are a major cause of bankruptcy in the U.S., and

when collectors are put on the case, they take up to 25% of what is

reclaimed, according to Mark Friedman, founder of billing consultant

Premium Healthcare Services. That leaves room for some bargaining.

Take Logan . The 26-year-old had started work as a business

analyst near Atlanta but had no insurance when he was rushed to the

ER for an appendectomy. The uninsured can pay three times more for

procedures, says Nora , senior director of Medical Billing

Advocates of America; was billed $21,000. " I was like, holy

cow! " he says. " That's four times my net worth. "

After advice from advocacy group The Access Project, spoke

with hospital administrators, telling them he couldn't pay in full.

Hospitals frequently work with patients, offering payment plans or

discounts. But to get it, you have to knock on the right door: Look

for the office of patient accounts or the financial assistance

office. It paid off for , whose bill was sliced to $4,100 —

20% of the original.

5. " Yes, we take your insurance — but we're not sure about the

anesthesiologist. "

The last thing on your mind before surgery is making sure every

doctor involved is in your network. But since the answer is often no

for anesthesiologists, pathologists and radiologists, what's a

patient to do? Los Angeles-based entertainment lawyer and patient

advocate A. Weiss repeatedly turned away out-of-network pain-

management doctors on a recent visit to the hospital.

We're not suggesting you go as far as Weiss did to save money, but

do ask for someone in your network if you're alert enough. If it's

an emergency and you're stuck with an out-of-network doctor, call

your insurance company to help resolve the issue. If it's elective

surgery, ask a scheduling nurse in the surgeon's office to find

specialists in your plan, says South Bend, Ind.-based billing sleuth

Jane Stull. And if you know your procedure will be out-of-

network, call the hospital billing department to negotiate. It will

likely point you to a patient representative or the director of

billing. Once you've dealt with the hospital, then try the surgeon

or other specialists involved — some hospitals will back you in

those discussions, Friedman says.

6. " Sometimes we bill you twice. "

Crack the code of medical bills and you may find a few surprises:

charges for services you never received, or for routine items such

as gowns and gloves that should not be billed separately. Clerical

errors are often the reason for mistakes; one transposed number in a

billing code can result in a charge for placing a catheter in an

artery versus a vein — a difference of more than $3,900, Stull says.

So how do you figure out if your bill has incorrect codes or

duplicate charges? Start by asking for an itemized bill

with " miscellaneous " items clearly defined. Some telltale mistakes:

charging for three days when you stayed in the hospital overnight, a

circumcision for your newborn girl or drugs you never received. Ask

the hospital's billing office for a key to decipher the charges, or

hire an expert to spot problems and deal with the insurance company

and doctors (you can find one at www.billadvocates.com). Their

expertise typically will cost up to $65 an hour, a percentage of the

savings or some combination of the two. If you want to be your own

billing sleuth, talk to the highest-ranking administrator you can

find in the hospital finance or accounts office to begin untangling

any mistaken codes.

7. " All hospitals are not created equal. "

How do you tell a good hospital from a bad one? For one thing,

nurses. When it comes to their own families, medical workers favor

institutions that attract nurses. But they're harder to find as the

country's nursing shortage intensifies — by 2020, 44 states could be

facing a serious deficit. Low nurse staffing directly affected

patient outcomes, resulting in more problems such as urinary tract

infections, shock and gastrointestinal bleeding, according to a 2001

study by Harvard and Vanderbilt University professors.

Another thing to consider: Your local hospital may have been great

for welcoming your child into the world, but that doesn't mean it's

the best place to undergo open-heart surgery. Find the facility with

the longest track record, best survival rate and highest volume in

the procedure; you don't want to be the team's third hip

replacement, says Collier, vice president of medical

affairs at HealthGrades, which rates hospitals.

The American Nurses Association's Web site lists " magnet " hospitals —

those most attractive to nurses — and a call to a hospital's nurse

supervisor should yield the nurse-to-patient ratio, says Gail Van

Kanegan, an R.N. and author of How to Survive Your Hospital Stay.

She also suggests calling the hospital's quality-control or risk-

management office to get infection statistics and asking your doctor

how frequently the hospital has done a certain procedure. While

reporting these statistics is still voluntary, more hospitals are

doing so on sites like www.hospitalcompare.hhs.gov, which compares

hospitals against national averages in certain areas, including how

well they follow recommended steps to treat common conditions, says

Carmela Coyle, senior vice president for policy at the American

Hospital Association.

8. " Most ERs are in need of some urgent care themselves. "

A new study from the Institute of Medicine found that hospital

emergency departments are overburdened, underfunded and ill prepared

to handle disasters as the number of people turning to ERs for

primary care keeps rising. An ambulance is turned away from an ER

once every minute due to overcrowding, according to the study; the

situation is exacerbated by shortages in many of the " on call "

backup services for cardiologists, orthopedists and neurosurgeons.

And it's getting worse. Currently, 73% of ER directors report

inadequate coverage by on-call specialists, versus 67% in 2004,

according to a survey conducted by the American College of Emergency

Physicians.

If you can, avoid the ER between 3 p.m. and 1 a.m. — the busiest

shift. For the shortest wait, early morning — anywhere from 4 a.m.

to 9 a.m. — is your best bet. If you are having severe symptoms,

such as the worst headache of your life or chest pains, alert the

triage nurse manager, not just the person checking you in, so that

you get seen sooner, says Sherer, an anesthesiologist and

author of Dr. Sherer's Hospital Survival Guide. Triage nurses

are the traffic cops of the ER and your ticket to getting seen as

quickly as possible.

9. " Avoid hospitals in July like the plague. "

If you can, stay out of the hospital during the summer — especially

July. That's the month when medical students become interns, interns

become residents, and residents become fellows and full-fledged

doctors. In other words, a good portion of the staff at any given

teaching hospital are new on the job.

Summer hospital horror stories aren't just medical lore: The

adjusted mortality rate rises 4% in July and August for the average

major teaching hospital, according to the National Bureau of

Economic Research. That means eight to 14 more deaths occur at major

teaching hospitals than would normally without the turnover.

Another scheduling tip: Try to book surgeries first thing in the

morning, and preferably early in the week, when doctors are at their

best and before schedules get backed up, Sherer says.

10. " Sometimes we don't keep our mouths zipped. "

Contrary to what you might think, sharing patient information with a

third party is often perfectly legal. In certain cases, the law

allows your medical records to be disclosed without asking or even

notifying you. For example, hospitals will hand over information

regarding your treatment to other doctors, and it will readily share

those details with insurance companies for payment purposes. That

means roughly 600,000 entities that are loosely involved in the

health care system have access to that information. These parties

may even pass on the data to their business partners, says Deborah

Peel, the founder of Austin, Tex.-based Patient Privacy Rights

Foundation.

If you want to access your medical records, you don't have to steal

them like Elaine did on Seinfeld after she learned a doctor had

marked her as a difficult patient. You are legally entitled to see,

copy and ask for corrections to your medical records.

[Guest guest]

One thing I like about belonging to an HMO is that all physicians involved in my care are paid by the insurance company. Indeed, the physicians are readily on hand so you don't feel like it's only interns and residents who are in charge. And I'm fortunate that the nurses at my hospital are highly responsive to anything reported that's even remotely ununusal. It's really not a good thing to generalize about hospitals and medical care. Lee <jackalope_lepus@...> wrote: 10 things your hospital won't

tell youTreatment errors are common, finding someone in charge can seemimpossible, and patients sometimes wind up sicker than when theyarrived. And here's a tip: Try to avoid hospitals late at night and inJuly. By SmartMoneyIn recent years, errors in treatment have become a serious problem forhospitals, ranging from operations on wrong body parts to medicationmix-ups.At least 1.5 million patients are harmed every year from being giventhe wrong drugs, according to the Institute of Medicine of theNational Academy of Sciences. That's an average of one person per U.S.hospital per day.One reason these mistakes persist: Only 10% of hospitals are fullycomputerized and have a central database to track allergies anddiagnoses, says Wachter, the chief of medical service at UC SanFrancisco Medical Center.But signs of change are emerging. More than 3,000 U.S. hospitals, or75% of the country's

beds, have signed on for a campaign by thenot-for-profit Institute for Healthcare Improvement to implementprevention measures such as multiple checks on drugs.Though the system is improving, it still has a long way to go.Patients should always have a friend, relative or patient advocatefrom the hospital staff at their side to take notes and make sure theright medications are being dispensed.Infections and the chain of command"You may leave sicker than when you came in."A week after Leandra Wiese had surgery to remove a benign tumor, thehigh school senior felt well enough to host a sleepover. But laterthat weekend she was vomiting and running a fever. Thinking it was theflu, her parents took her back to the hospital. Wiese never came home.It wasn't the flu but a deadly surgical infection.About 2 million people a year contract hospital-related infections,and about 90,000 die, according to the national

Centers for DiseaseControl and Prevention. The recent increase in antibiotic-resistantbugs and the mounting cost of health care -- to which infections addabout $4.5 billion annually -- have mobilized the medical community toimplement processes designed to decrease infections. These includeusing clippers rather than a razor to shave surgical sites andadministering antibiotics before surgery but stopping them soon afterto prevent drug resistance.For all of modern medicine's advances, the best way to minimizeinfection risk is low-tech: Make sure any hospital staffers who touchyou have washed their hands. Tubes and catheters are also a source ofbugs, and patients should ask daily if they are necessary."Good luck finding the person in charge."Helen Haskell repeatedly told nurses something didn't seem right withher son , who was recovering from surgery to repair a defect inhis chest wall. For nearly

two days she kept asking for a veteran, or"attending," doctor when the first-year resident's assessment seemedoff. But Haskell couldn't convince the right people that her son wasdeteriorating."It was like an alternate reality," she says. "I had no idea where to go."Thirty hours after her son first complained of intense pain, the SouthCarolina teen died of a perforated ulcer.In a sea of blue scrubs, getting the attention of the right person canbe difficult. Who's in charge? Nurses don't report to doctors butrather to a nurse supervisor. And your personal doctor has little sayover radiology or the labs running your tests, which are managed bythe hospital.Some facilities employ "hospitalists" -- doctors who act as pointpeople to conduct flows of information. Haskell urges patients to knowthe hospital hierarchy, read name tags, get the attending physician'sphone number and, if all else fails, demand a

nurse supervisor, likelythe highest-ranking person who is accessible quickly."Everything is negotiable, even your hospital bill."When it comes to getting paid, hospitals have their work cut out forthem. Medical bills are a major cause of bankruptcy in the U.S., andwhen collectors are put on the case, they take up to 25% of what isreclaimed, according to Mark Friedman, the founder of billingconsultant Premium HealthCare Services. That leaves room for somebargaining.Take Logan . The 26-year-old had started work as a businessanalyst near Atlanta but had no insurance when he was rushed to anemergency room for an appendectomy. The uninsured can pay three timesmore for procedures, says Nora , the senior director of MedicalBilling Advocates of America. was billed $21,000. "I was like, holy cow!" he says. "That'sfour times my net worth."After advice from advocacy group The Access

Project, spokewith hospital administrators, telling them he couldn't pay in full.Hospitals frequently work with patients, offering payment plans ordiscounts. But to get it, you have to knock on the right door: Lookfor the office of patient accounts or the financial-assistance office.It paid off for , whose bill was sliced to $4,100, 20% of theoriginal.Be smart about bills"Yes, we take your insurance, but we're not sure about theanesthesiologist."The last thing on your mind before surgery is making sure every doctorinvolved is in your network. But since the answer is often no foranesthesiologists, pathologists and radiologists, what's a patient to do?Los Angeles entertainment lawyer and patient advocate A. Weissrepeatedly turned away out-of-network pain-management doctors on arecent visit to a hospital.You don't necessarily need to go as far as Weiss did, but do ask

forsomeone in your network if you're alert enough. If it's an emergencyand you're stuck with an out-of-network doctor, call your insurancecompany to help resolve the issue. If it's elective surgery, ask ascheduling nurse in the surgeon's office to find specialists in yourplan, says South Bend, Ind., billing sleuth Jane Stull.If you know your procedure will be out of network, call the hospitalbilling department to negotiate. It will likely point you to a patientrepresentative or the director of billing. Once you've dealt with thehospital, then try the surgeon or other specialists involved -- somehospitals will back you in those discussions, Friedman says. "Sometimes we bill you twice."Crack the code of medical bills and you may find a few surprises:charges for services you never received or charges for routine itemssuch as gowns and gloves that should not have been billed separately.Clerical errors

are often the reason for mistakes. One transposednumber in a billing code can result in a charge for placing a catheterin an artery versus a vein, a difference of more than $3,900, Stull says.So how do you figure out if your bill has incorrect codes or duplicatecharges? Start by asking for an itemized bill with "miscellaneous"items clearly defined. Some telltale mistakes: charging for three dayswhen you stayed in a hospital overnight, a circumcision for yournewborn girl or for drugs you never received.Ask the hospital's billing office for a key to decipher the charges orhire an expert to spot problems and deal with the insurance companyand doctors (you can find one at the Medical Billing Advocates ofAmerica). Their expertise typically will cost up to $65 an hour, apercentage of the savings or some combination of the two.If you want to be your own billing sleuth, talk to the highest-rankingadministrator you

can find in the hospital finance or accounts officeto begin untangling any mistaken codes."All hospitals are not created equal."How do you tell a good hospital from a bad one? For one thing, nurses.When it comes to their own families, medical workers favorinstitutions that attract nurses. But they're harder to find as thecountry's nursing shortage intensifies; by 2020, 44 states could befacing a serious deficit. Low nurse staffing directly affected patientoutcomes, resulting in more problems such as urinary-tract infections,shock and gastrointestinal bleeding, according to a 2001 study byHarvard and Vanderbilt university professors.Another thing to consider: Your local hospital may have been great forwelcoming your child into the world, but that doesn't mean it's thebest place to undergo open-heart surgery. Find the medical center withthe longest track record, best survival rate and highest volume in

theprocedure. You don't want to be the team's third hip replacement, says Collier, the vice president of medical affairs atHealthGrades, which rates hospitals.The American Nurses Association's Web site lists "magnet" hospitals --those most attractive to nurses -- and a call to a hospital's nursesupervisor should yield the nurse-to-patient ratio, says Gail VanKanegan, a registered nurse and a co-author of "How to Survive YourHospital Stay." She also suggests calling the hospital'squality-control or risk-management office to get infection statisticsand asking your doctor how frequently the hospital has done a certainprocedure. Though reporting these statistics is still voluntary, morehospitals are doing so on sites like one of the U.S. Department ofHealth and Human Services, which compares hospitals against nationalaverages in certain areas, including how well they follow recommendedsteps to treat

common conditions, says Carmela Coyle, the senior vicepresident for policy at the American Hospital Association.How to improve your odds"Most ERs are in need of some urgent care themselves."A new study from the Institute of Medicine found that hospitalemergency departments are overburdened, underfunded and ill-preparedto handle disasters as the number of people turning to ERs for primarycare keeps rising.An ambulance is turned away from an ER once every minute due toovercrowding, according to the study; the situation is exacerbated byshortages in many of the "on call" backup services for cardiologists,orthopedists and neurosurgeons. And it's getting worse. Currently, 73%of ER directors report inadequate coverage by on-call specialists,versus 67% in 2004, according to a survey conducted by the AmericanCollege of Emergency Physicians.If you can, avoid the ER between 3 p.m. and 1 a.m., the busiest

shift.For the shortest wait, early morning -- anywhere from 4 a.m. to 9 a.m.-- is your best bet. If you are having severe symptoms, such as theworst headache of your life or chest pains, alert the triage nursemanager, not just the person checking you in, so that you get seensooner, says Sherer, an anesthesiologist and author of "Dr. Sherer's Hospital Survival Guide." Triage nurses are the trafficcops of the ER and your ticket to getting seen as quickly as possible."Avoid hospitals in July like the plague."If you can, stay out of the hospital during the summer, especiallyJuly. That's the month when medical students become interns, internsbecome residents, and residents become fellows and full-fledgeddoctors. In other words, a good portion of the staff at any giventeaching hospital is new on the job.Summer hospital horror stories aren't just medical lore: The adjustedmortality rate rises 4% in

July and August for the average majorteaching hospital, according to the National Bureau of EconomicResearch. That means eight to 14 more deaths occur at major teachinghospitals than would normally without the turnover.Another scheduling tip: Try to book surgeries first thing in themorning and preferably early in the week, when doctors are at theirbest and before schedules get backed up, Sherer says."Sometimes we don't keep our mouths zipped."Contrary to what you might think, sharing patient information with athird party is often perfectly legal. In certain cases, the law allowsyour medical records to be disclosed without asking or even notifyingyou. For example, hospitals will hand over information regarding yourtreatment to other doctors, and it will readily share those detailswith insurance companies for payment purposes.That means roughly 600,000 entities that are loosely involved in thehealth-care

system have access to that information. These parties mayeven pass on the data to their business partners, says Deborah Peel,the founder of the Patient Privacy Rights Foundation in Austin, Texas.If you want to access your medical records, you don't have to stealthem like Elaine did on "Seinfeld" after she learned a doctor hadmarked her as a difficult patient. You are legally entitled to see,copy and ask for corrections to your medical records.This article was reported and written by Reshma Kapadia forSmartMoney. Published Feb. 23, 2007http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/10ThingsYourHospitalWontTellYou.aspx . Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind. -Dr.Seuss . It don't mean a thing if it ain't got that swing. - Duke Ellington . Never place a period where God has placed a comma. - Gracie