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Working inside the system I have to absolutely disagree. I've worked inside two systems in Las Vegas and transported to all of them. I've also done advanced training at, and transported patients to, hospitals in CA and Phoenix.
The CHW facilities in both far exceed any facility here in LV. So do the most of the non CHW facilities I've where I've taken patients. I also did my original training in PA (number three in the Bundle report for quality.) We are WAY behind on quality, training, and cost. Things that are touted as the latest and greatest here were already in place in PA 10 years ago - an example - pre hospital 12 lead EKG interpretation. Paramedics were reading 12 leads and alerting for Heart Attack in the late 1990's. It only hit here two years ago. We were doing TPA for stroke in 2000 in PA. Here it wasn't done till 2007.
I want numbers Tom...not your feelings. I ran large endeavor on the technician side for many years. I always listened to the techs...but I long since discovered that they did not always have it right. They told me what they would like...not what was good for the endeavor.
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As for cost the Quality Care Nevada site I posted previously has a page on pricing. Take a look at the UHS hospitals, Valley average mark up percent is 455%! Summerlin is 464% Quality Care NV pricing and profits (http://s103.advocateoffice.com/index.asp?Type=B_BASIC&SEC=%7B1AB98279-469A-4B0B-9D95-351DE8C7A895%7D - broken link) This far exceeds even Reno let alone any of the higher end states in the Bundle report. CA quality is also better in regards to staff patient ratio. CA has these standards. As noted in The Journal of the American Medical Association The better the nurse to patient ration the better the long term patient outcome. http://198.66.202.157/documents/Hosp...g_Jama2002.pdf
As far as I can tell as both a user and an observer the pricing is an exercise in system gaming. If it was my ball I would make them all set one price and charge it to all comers. But that is not to be...so we see prices that have nothing to do with anything except how to make the insurers think they have a big discount.
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Yet the Nevada Hospital Association has successfully resisted staffing ratios in the past three legislatures. This has a direct effect on the care - or lack of care - Las Vegans receive. I say this as in insider.
That is a labor issue. I am on your side on that one...but then again, I understand that you want to drive up costs...not minimize them...for the benefit of the nurses.
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In my current job I routinely transport patients to Las Vegas, Phoenix, Loma Linda, LA and San Francisco. Seeing the better nursing and ancillary staff ratios in these other communities, the better, far more up to date, and safer equipment (such as IV pumps, defibrillators, ventilators etc.) I am envious. We should have these but UMC is in crisis and the other corporations for or non profit will not spend the money here. St Joseph's Hospital in Phoenix is on the cutting edge of Neurological care and a Level 1 trauma center. It is a CHW hospital. What does CHW do with the three facilities in LV? A 362% price mark up!
Again...how many do they cure versus kill. Let us get past the performance then we can talk about cost. I am skeptical that cost will correllate with performance. I want numbers on outcomes not staffing ratios.
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As a healthcare worker in this system I can tell you by experience we do not meet the standards of anyone else in the Southwest. And the Southwest holds the last three places in the Bundle report. We should be better but we won't until NV voters force Carson City to force the outside money miners to make changes. It's up to us.
And I don't think you know that. I will give you an example. St. Rose Lima on your reference is a 58% on the national ranking. When I check the national ranking it is 98th percentile. So is it in the middle of the pack...or at the top. Apparently your group does not know. Or deliberately misstates...
I spent 25 years married to a Bellevue RN. She eventually got so annoyed with the system she went to doing only private duty on a burn team. So I have some view of the territiory.
UMC is associated with the medical school in Reno and does get residents from there.
The bottom line is our health care is essentially run from people outside the Valley whose main motive is not quality care but maximum profit. The hospital association as fought - won - every effort to establish minimum staffing ratios. The profits aren't spent in NV they go out to these big companies. And the only way it will change is when the politicians are made to answer to the voters. And right now both sides are listening to the outside money miners and not to those of us who use and work in the system.
Today, the medical systems in Las Vegas and the quality of physicians working there are average at best...but things are getting better.
A successful medical care system requires many things, including a pool of dedicated and well-trained physicians.
When I first examined the medical care in Las Vegas during the early 90's, I found more physician-impersonators than Elvis-impersonators.
But in recent years, better trained physicians are going to Las Vegas. (My own excellent physican left California for Las Vegas only two years ago.)
Hopefully, the community will continue to support the efforts of the medical school to expand its presence in Las Vegas. The quality of physicians in a community is a reflection of their training. Without a good source for excellent and dedicated physicians, a city is dependent on outside American physicians (many of whom are very excellent, but others can be less skilled and possibly dangerous retreads from other cities) or foreign trained physicians (which can be a real crap shoot).
The choice is Las Vegas'. I hope the city makes the correct choice. I would like to retire and move to Las Vegas one day.
I want numbers Tom...not your feelings. I ran large endeavor on the technician side for many years. I always listened to the techs...but I long since discovered that they did not always have it right. They told me what they would like...not what was good for the endeavor.
These aren't feelings, they are hardcore at the bedside experiences. The numbers are in the websites I posted. Just because they refute your feelings does not make them wrong. I work in the system now. They are direct observations. I would take your observations on Real Estate as fact, how dare you belittle my actual experience.
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far as I can tell as both a user and an observer the pricing is an exercise in system gaming. If it was my ball I would make them all set one price and charge it to all comers. But that is not to be...so we see prices that have nothing to do with anything except how to make the insurers think they have a big discount.
Nice straw man.The numbers come from research done by the site. The numbers are there. Just because they are different than what you want to hear they are still real. Provide your citations to refute them please.
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That is a labor issue. I am on your side on that one...but then again, I understand that you want to drive up costs...not minimize them...for the benefit of the nurses.
Once again I will point you to the link I posted from JAMA. The numbers and statistics are in the article I linked. Better staffing means better outcomes. Read the article. The numbers are there.
Also here Hospital Nurse Staffing and Quality of Care Read the articles. You will also note the portion that says that more RNS does not affect profit. And the last part of your remark is at best a cheep shot if not a personal attack. I would of thought better of you.
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Again...how many do they cure versus kill. Let us get past the performance then we can talk about cost. I am skeptical that cost will correllate with performance. I want numbers on outcomes not staffing ratios.
Significantly less than Las Vegas. You do recall that Sunrise folded it's kidney transplant program and UMC's permit was revoked becasue of poor outcomes;
All the numbers you want, read the documents. It includes numbers, court cases, prevention guides, autopsy reports, pathology reports, GAO reports, etal.
And I don't think you know that. I will give you an example. St. Rose Lima on your reference is a 58% on the national ranking. When I check the national ranking it is 98th percentile. So is it in the middle of the pack...or at the top. Apparently your group does not know. Or deliberately misstates...
or you are obfuscating to win an argument rather than accept that this system has major problems . I work in the system and have hands on experience so I do know. You saying I don't know is like me saying to you, you don't understand the Las Vegas real estate market. It's a blanket insult.
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I spent 25 years married to a Bellevue RN. She eventually got so annoyed with the system she went to doing only private duty on a burn team. So I have some view of the territiory.
And I am working in the system right now and have direct professional knowledge. This is what I do. Having some view of the territory is like me saying a bought a house so I have as much knowledge as you of real estate. You'd crucify me If I tried that with you. Shoes on the other foot now.
I've provided Quality Care Nevada (numbers), Journal Of the American Medical Association (numbers and statistics), US Department of Health And Human Services / Agency for Healthcare Research and Quality (numbers and statistics), The Bundle Report (numbers and statistics -even if you disagree) The Review Journal (numbers and statistics) and The Las Vegas Sun (numbers and statistics from the State) in addition to my personal experience. Not feelings - experience.
These aren't feelings, they are hardcore at the bedside experiences. The numbers are in the websites I posted. Just because they refute your feelings does not make them wrong. I work in the system now. They are direct observations. I would take your observations on Real Estate as fact, how dare you belittle my actual experience.
I do not belittle your experience. Nor do I accept it as representative. It might be but I need a few thousand others to reach that conclusion.
I just lost two perfectly clean deals to bad bank actions. Should I therefore suggest that all of the problems of the RE Market are being screwed up by bad bank actions?
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Nice straw man.The numbers come from research done by the site. The numbers are there. Just because they are different than what you want to hear they are still real. Provide your citations to refute them please.
Sorry but they in no way differ from what I expected. I can show you reams and reams of data. I am in the midst of fighting a $20,000 bill from Walgreen for intravenous antibiotics. I know perfectly well that it will settle for $3500 and I will pay about $700. or less. I can show you page after page after page of my medicare billing where the Physician or Hospital settled for less than 20% of the amount billed. So which is true?
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Once again I will point you to the link I posted from JAMA. The numbers and statistics are in the article I linked. Better staffing means better outcomes. Read the article. The numbers are there.
Also here Hospital Nurse Staffing and Quality of Care Read the articles. You will also note the portion that says that more RNS does not affect profit. And the last part of your remark is at best a cheep shot if not a personal attack. I would of thought better of you.
I will go look again but I don't think they weigh cost. But I basically agree with you so I don't want to get to crosswise. Cost is not the only determinant.
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Significantly less than Las Vegas. You do recall that Sunrise folded it's kidney transplant program and UMC's permit was revoked becasue of poor outcomes;
Did you not notice that LA closed a major hospital? MLK. For performance. And you hold them up as a standard?
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All the numbers you want, read the documents. It includes numbers, court cases, prevention guides, autopsy reports, pathology reports, GAO reports, etal.
Where are the equivalent cases from Phoenix and LA? You suggesting they don't have the problem?
Yes it is clear there is a problem. But is it Vegas? The SW? The US? What are we fixing?
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or you are obfuscating to win an argument rather than accept that this system has major problems . I work in the system and have hands on experience so I do know. You saying I don't know is like me saying to you, you don't understand the Las Vegas real estate market. It's a blanket insult.
And I am working in the system right now and have direct professional knowledge. This is what I do. Having some view of the territory is like me saying a bought a house so I have as much knowledge as you of real estate. You'd crucify me If I tried that with you. Shoes on the other foot now.
I've provided Quality Care Nevada (numbers), Journal Of the American Medical Association (numbers and statistics), US Department of Health And Human Services / Agency for Healthcare Research and Quality (numbers and statistics), The Bundle Report (numbers and statistics -even if you disagree) The Review Journal (numbers and statistics) and The Las Vegas Sun (numbers and statistics from the State) in addition to my personal experience. Not feelings - experience.
Where are the numbers for LA and Phoenix and SLC and wherever.
Just for illustration the Quality Care Nevada numbers - National Ranking of St Rose LIma...
Quality Care Nevada -- St. Rose Dominican - de Lima Campus (http://s103.advocateoffice.com/index.asp?Type=B_BASIC&SEC={D685444C-7B4B-45C9-92D4-B4E10E295356} - broken link)
Then the first item in Nation Rankings for Health Care in Nevada...
National Performance Rankings :: National Rankings for Hospitals (http://www.healthinsight.org/performance/hosp_rankings/hospitals.html - broken link)
I do not belittle your experience. Nor do I accept it as representative. It might be but I need a few thousand others to reach that conclusion.
And yet when you speak of RE you seem to think we should take all you have to say as representative. You can't have it both ways. You are being disparaging. My opinion of you has greatly lessened.
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Sorry but they in no way differ from what I expected. I can show you reams and reams of data. I am in the midst of fighting a $20,000 bill from Walgreen for intravenous antibiotics. I know perfectly well that it will settle for $3500 and I will pay about $700. or less. I can show you page after page after page of my medicare billing where the Physician or Hospital settled for less than 20% of the amount billed. So which is true?
So the hospitals and physicians groups are over charging. In other words maximizing profits on the backs of Las Vegans. Just what Quality Care NV and the numbers prove. So you agree with me.
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I will go look again but I don't think they weigh cost. But I basically agree with you so I don't want to get to crosswise. Cost is not the only determinant.
But when profit takes precedence over quality care then it is a major determinant.
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Did you not notice that LA closed a major hospital? MLK. For performance. And you hold them up as a standard?
Would you care to compare the UCLA facilities to UMC or Sunrise? Or Loma Linda? UC Davis? For what it's worth these are the facilities that receive patients from here. Not just transplants but the ones that can't be handled here.
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Where are the equivalent cases from Phoenix and LA? You suggesting they don't have the problem?
Yes it is clear there is a problem. But is it Vegas? The SW? The US? What are we fixing? Where are the numbers for LA and Phoenix and SLC and wherever.
The CDC reports are in the links I posted you just have to read them. You'll have to do that yourself.
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Just for illustration the Quality Care Nevada numbers - National Ranking of St Rose LIma...
Quality Care Nevada -- St. Rose Dominican - de Lima Campus (http://s103.advocateoffice.com/index.asp?Type=B_BASIC&SEC=%7BD685444C-7B4B-45C9-92D4-B4E10E295356%7D - broken link)
Then the first item in Nation Rankings for Health Care in Nevada...
National Performance Rankings :: National Rankings for Hospitals (http://www.healthinsight.org/performance/hosp_rankings/hospitals.html - broken link)
Enter NV as the state and see the first item.
And if you go here Medicare Hospital Compare Quality of Care on a link from that same site you see the patient satisfaction scores for St Rose De Lima the best they get is 70%. What that site is a hospitals abilty to fill in Joint Commission and medicare paperwork. It does not fill in data about infection rates, sentinel events, iatrogenic injuries, decubitus ulcers - the things that effect actual hands on quality care. The things used in the Bundle Report.
And NV Ranks number 52 in the Bundle report for Quality care.
You also must not have read the Sun's article on Las Vegas Health Care.
That article can not be ignored. All the stats you want are in those articles. Read the infection rates from the CDC - they are in the Sun's documents link I posted. You'll have to read them yourself.
The bottom line is we are at the bottom. We shouldn't be.
The reason is fairly straightforward. Las Vegas does not have a medical school. Tertiary care, new technologies, and highest caliber physicians are usually associated with a medical school institution. This would be an excellent investment for the economy.
There is Touro University Medical School in Henderson...
Last edited by SportyandMisty; 09-21-2010 at 10:33 AM..
The author offers some simple & inexpensive prescriptions to improve medical care in a meaningful way -- at least from my perspective. What do you think?
The author offers some simple & inexpensive prescriptions to improve medical care in a meaningful way -- at least from my perspective. What do you think?
While I think that the author of the article makes some valid points, the title of the article is intellectually DISHONEST. The system did not kill his father, an infection did.
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