Medicare Coverage of Routine Screening for Thyroid Dysfunction

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When the Medicare program was established in 1965, it was viewed as a form of financial protection for the elderly against catastrophic medical expenses, primarily those related to hospitalization for unexpected illnesses. The first expansions to the program increased the eligible population from the retired to the disabled and to persons receiving chronic renal dialysis. It was not until 1980 that an expansion of services beyond those required "for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member" was included in Medicare. These services, known as preventive services, are intended either to prevent disease (by vaccination) or to detect disease (by diagnostic test) before the symptoms of illness appear. A Committee was formed "to conduct a study on the addition of coverage of routine thyroid screening using a thyroid stimulating hormone test as a preventive benefit provided to Medicare beneficiaries under Title XVIII of the Social Security Act for some or all Medicare beneficiaries."
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Publisher
National Academies Press
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Published on
Aug 1, 2003
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Pages
135
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ISBN
9780309168106
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Features
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Language
English
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Genres
Medical / Health Care Delivery
Science / Environmental Science
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Content Protection
This content is DRM free.
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In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers.

Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others.

The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.
Sorrel King was a 32-year-old mother of four when her eighteen-month-old daughter, Josie, was horribly burned by water from a faulty water heater in the family’s new Baltimore home. She was taken to Johns Hopkins—renowned as one of the best hospitals in the world—and Sorrel stayed in the hospital with Josie day-in and day-out until she had almost completely recovered. Just before her discharge, however, Sorrel noticed something was wrong—Josie was looking pale, she appeared severely dehydrated, and her eyes were rolling back in her head. Sorrel pleaded with the doctors and nurses (many of whom she had become close to) that something was wrong, and they agreed to stop administering Josie methadone, the narcotic they were using to wean her off morphine. Josie had begun noticeably improving when a new nurse approached her with a syringe of methadone. When Sorrel tried to stop her from administering the drug, the nurse said that the orders had been changed again. Sorrel, against her better judgment, decided that Hopkins must know best, and stepped back. Almost as soon as the drug had been injected into Josie’s system, she went into cardiac arrest. The doctors raced to save her, but by the time they stabilized her, Josie was brain dead, her organs shutting down one by one. She passed away shortly thereafter, her family having made the choice to take her off life support.


In the days and months that followed, Sorrel went through the tumultuous processes of grieving. For a while, she thought she would not survive; suicide and alcohol both seemed like viable escape possibilities, and Sorrel toyed with both. But ultimately it was her rage that kept her alive—rage at the doctors, at Hopkins, and at the medical institution that had allowed this to happen. She wanted the doctors to feel the same pain she had caused them. She wanted to destroy Hopkins “brick by brick.” Dizzy with grief, she came close to ending her marriage, but slowly pulled herself and her life back together, for the sake of her family, and for the memory of Josie.


It was around this time that Sorrel learned a staggering fact—though indeed an error, Josie’s death wasn’t a fluke in the statistical sense of the word. About 98,000 American patients die a year as the result of medical error, making it the fourth most prevalent cause of death in the US. Armed with this fact, the money from her settlement with Hopkins, and a vague awareness that Josie’s death could have been prevented, Sorrel began to penetrate the healthcare industry. An appearance on Good Morning America and a long article in the Baltimore Sun raised the public profiles of her and her mission, while speaking requests began to pour in from hospitals and healthcare groups across the world. For the most part, medical errors had simply not been talked about; most doctors involved in them were paralyzed by remorse and fear of lawsuits, while the patients were dead or badly injured and their families crippled by grief. Sorrel was helping to pull back the curtain on an all-too-common killer, and the world of healthcare knew it. Despite some initial resistance, most in the industry came to welcome her message, and to look to her for answers. With the help of other patient safety advocates—many of them doctors, and some of them the very Hopkins officials who had defended the hospital after Josie’s death—Sorrel and The Josie King Foundation began to develop and implement in hospitals basic programs that emphasize communication, respect of the patient, and attentiveness to their concerns. Rapid Response Teams, for instance, can be called from the beside by patients or their families who feel they are experiencing a serious change in their condition that is not getting sufficient attention from hospital floor staff. A team made up of doctors, nurses and a patient relations coordinator responds quickly to evaluate the patient and develop a plan for care. This is just one example of a program that came out of Sorrel’s efforts, and it’s in place in hospitals across the country, and has saved countless lives.


Sorrel’s account of her unlikely path from grieving parent to nationally renowned advocate is interwoven with descriptions of her and her family’s slow but steady road to recovery, and ends with a deeply affecting description of a ski trip they took recently. The sun is shining, her children are healthy, and they are all profoundly happy—a condition that Sorrel has learned to appreciate all the more for Josie.

The book ends with a resource guide for patients, their families, and healthcare providers; it includes information about how to best manage a hospital stay and how to handle a medical error if one does occur. Two prominent characters from the story, Hopkins’ lawyer Rick Kidwell and Paul Bekman, the personal injury attorney who handled the case for the King family, have come together to contribute advice in a Q & A section, and Sorrel also provides lists of general advice, useful online resources, and essential books on the subject.
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