Evidence of Learning #1

Date:​​ ​November 15, 2018

Subject:​​ ​Increasing Infection Rates & Decreasing Treatment options

MLA or APA citation​​:

“Neisseria Gonorrhoeae - Rising Infection Rates, Dwindling Treatment Options |
NEJM.” ​New England Journal of Medicine,​
www.nejm.org/doi/full/10.1056/NEJMp1812269.
Analysis:

In the Emergency Room, people coming in with symptoms of an infection is very

common. Even in today's technologically advanced world, there is a constant increase in

infections like Gonorrhea but a decrease in the treatment options available for patients.

I was curious as to why this was occurring so I wanted to dig deeper into this issue. I

found out that during the Obama Administration, they deemed Clostridium difficile,

Neisseria gonorrhoeae, and other infections as a serious threat to the public health. This

statement led to a boost- in the emergence of antibiotics to treat these infections.

However, with the increasing use of antibiotics, the organism resistance to the drug also

accelerated.

I also learned that Gonorrhoea cases persistently affect young adults and even

though it is ranked third on the list of infectious diseases, the number of cases that come

in has outweighed the other two infections. Since many young adults were infected more

often I wanted to know why and through this article I discovered that it is mainly due to

the fact that they tend to more sexually active. The main downfall for this group of
people is that without a global effort to reduce the organism's resistance to the antibiotic

they are forced to have lengthy stays at hospitals and other required appointments,

which leads to increase in billing. However, this increased cost brought up another

disadvantage to most young adults because they don't have the means to such money

because they are usually in the college with a lot of debt.

Besides that, I was enlightened by the fact that this issue has a direct impact on

the healthcare system as well as the international productivity of societies. However, I

was not that shocked when I found out that an excessive amount of minorities like

African Americans and Hispanics have infections like Gonorrhea more than their

American counterpart. In many minority cases, the infection goes untreated which can

lead to many detrimental health problems. Gonorrhea can be very dangerous if a

pregnant person is infected because it can be transmitted from the mother to the baby

during delivery. This can leave the baby susceptible to other diseases that can be fatal to

its health.

However, there is a way to battle the increasing infection rates or get close to

controlling it. I discovered that the first step in this process is to give easy and affordable

access to screening to patients. If there are routine assessments that can be done at

home it can help people get treated earlier reducing the number of people infected. To

fight this we also need to get laboratories that can do the testing and technology that can

diagnose whether or not an organism will be sustainable to the antibiotics. However,

this will take a combined effort and we all need to do our part.

The article starts on 3 page ends on 4

Neisseria gonorrhoeae — Rising Infection
Rates, Dwindling Treatment Options

Gonorrhea infection is the ​second most commonly reported notifiable condition in the United
States, and case rates have been increasing since 2009. In 2017, a total of 555,608 cases of
gonorrhea were reported nationally, the largest number since 1991 and an 18.6% increase over
2016 (see ​graph​).​1

In 2015, the ​Obama administration deemed ​Clostridium difficile, carbapenem-resistant

Enterobacteriaceae, and ​Neisseria gonorrhoeae the most urgent infectious public health threats
to national security, given the accelerating emergence of antibiotic resistance in these
organisms.​2 Though gonorrhea ranked third on this list, the number of cases of gonorrhea
dwarfs those of the other two infections. Worldwide, gonorrhea cases have persistently affected
young adults. Without a concerted global effort to mitigate antibiotic resistance, infected
persons ​(primarily, sexually active young adults, who tend to be otherwise healthy) ​may require
extended hospital stays and additional follow-up visits for an infection that can currently be
managed on an outpatient basis. Such a shift could impose a serious burden on health care
systems and societal productivity internationally. ​In the United States, this concern is
compounded by the fact that for decades, gonorrhea infections have disproportionately affected
black Americans, American Indians and Alaska Natives, Native Hawaiians and other Pacific
Islanders, and Hispanic Americans.

Untreated gonorrhea infection can have serious health consequences. It is transmitted from an
infected person to a partner during sex or ​from an infected woman to her baby at delivery.
Infections are frequently asymptomatic, but they can lead to serious sequelae such as pelvic
inflammatory disease, ectopic pregnancy, infertility, destructive arthritis, disseminated
infection, and blindness in neonates born through an infected birth canal. In addition, the
mucosal inflammation caused by ​N. gonorrhoeae may facilitate the transmission of HIV
between sex partners.

The Centers for Disease Control and Prevention (CDC) estimates that the annual domestic ​cost
of treating these acute infections and their sequelae is $182.2 million ​(in 2017 dollars). This
estimate ​excludes the cost of gonorrhea-attributable HIV infections and adverse pregnancy
outcomes.​3

Controlling gonorrhea in a population requires many connected activities​. It requires access to

screening, routine assessment of patients’ sexual practices to guide the identification of
anatomical sites requiring specimen collection, laboratory capacity to perform testing,
diagnostic technology that can characterize the organism and its antibiotic susceptibility,
systems for gathering that information to guide treatment recommendations, and above all,
effective and simple antibiotic therapy.

N. gonorrhoeae is prone to the development of antibiotic resistance, and our ability to monitor
antibiotic susceptibility is limited. The advent and increasing adoption of nucleic acid
amplification tests (NAATs) has enabled molecular screening of urine as well as of swabs from
the vagina, rectum, and oropharynx. These tests for diagnosing gonorrhea are more reliable and
convenient than bacterial cultures and have largely supplanted the use of cultures. ​However,
NAAT technology for ​N. gonorrhoeae currently does not provide antibiotic-susceptibility
information. ​Culture is required for that purpose, but since it is impractical to perform for every
patient, many practices have ceased to stock the correct culture medium for such testing.
Evidence of Learning #2

Date:​​ ​November 29, 2018

Subject:​​ ​Outrageous Cost of Healthcare Points Finger at Emergency Rooms

MLA or APA citation​​:

Melnick, Glenn. “Blame Emergency Rooms for the Out-of-Control Cost of Health Care.”
The New York Times,​ The New York Times, 5 Sept. 2018,
www.nytimes.com/2018/09/05/opinion/emergency-rooms-cost-insurance.html.
.
Analysis:

The main problem that many Americans run into when dealing with their health

problems is the shocking costs that come attached with medical care. Many people have

attributed the fact that Americans constantly pay more for their healthcare than other

citizens from other countries to Emergency Rooms. More specifically the blame lands on

the esoteric regulations that are intertwined with Emergency Rooms and Patient Care.

Essentially, I figured out that these set of regulations have led to the development of a

towering monopoly controlling Emergency Room patients and charging than any

ridiculous amount.

I also uncovered that one of the fundamental services that hospitals provide is

maintaining accessible treatment for emergencies. There is also a health care plan that

is put into place to help the patient out in terms of what the insurance covers or closest

facility for emergency situations. This is utilized to help patients navigate the

sometimes confusing world of hospitals while also assisting in a smooth aid to patients
when necessary. Even Though there may be some hiccups along the way the system

works well with its limitations considered.

However, I discovered the main issue that arises with this setup is that it leaves

the hospital with immense power when it comes to pricing. This allows them to

negotiate and potentially win with the insurance companies they work with. Many

people working with insurances companies at Hospital have figured out that when they

demand a higher price and end up getting rejected they can just annul there contract.

This exchange can end up turning into a threat leaving the patient at a financial

advantage. It actually turns out that the doctors will still get paid for treating a patient

that is in an out of network plans. But in addition to that enormous debt, the patient will

also have to pay more because of other factors.

It was also revealed to me that even though this mainly concentrated on to

emergency rooms. However, any people overlook that blatant fact that roughly half of

the patients admitted into the hospitals are received through the emergency

department. This is an extreme disadvantage toward patients because the problem

without a contract is the hospital can bill an unreasonable amount on top of the simple

ER visit. I was shocked to uncover that it can turn a 500 dollars to 5,000.

I was astonished on the fact that many people are unaware of this tension

between the hospital and insurance companies which need to change for the sake of

patients that get caught in this vicious cycle.

Article starts on 3 and ends on 4

Blame Emergency Rooms for the
Out-of-Control Cost of Health Care
By Glenn Melnick

There are many reasons Americans pay more for health care than citizens of any
other country. But one of the most powerful forces driving cost increases is buried in a
little-known set of regulations​ concerning emergency room care.
These regulations have granted hospitals what is essentially a​ monopoly over
emergency room patients,​ allowing them to charge basically whatever they want.
Readily available emergency treatment is among the most fundamental services of our
healthcare system. To ensure it,​ most states require health care plans to tell their
members to go to the nearest hospital in an emergency and that insurance will cover the
visit — even if their plan does not have a contract with that hospital and the emergency
care they receive will be out of network.​ This provision is meant to assure timely access
to needed care and, although some patients have to wait hours to be seen by a doctor,
and some still get hit with additional charges, it generally works pretty well.
The problem is that the​ rules give hospitals tremendous pricing power​ when
they’re negotiating with health insurance companies. Increasingly, hospitals have
learned that if they demand higher prices from health plans and do not get them, the
hospitals can just cancel their contract.​ They will still get paid for treating emergency
patients under those plans — and in fact will be paid more, because those patients will
be out of network. ​(While this applies only to emergency room patients, about half of all
hospital admissions come through emergency rooms.)
 When there is no contract, the hospital issues a highly inflated “billed charge.”
What was a $500 E.R. visit under a contract can become a $5,000 billed charge. This
greatly reduces the health plans’ ability to negotiate lower prices.
Data from California​ illustrate how hospitals have exploited this situation​. From 2002 to
2016, total billed charges by hospitals rose by a staggering $263 billion, to $386 billion,
even though the number of patients admitted did not increase.​ Billed charges to health
plans grew from $6,900 per day to over $19,500 per day. This astronomical run-up in
billed charges gave California hospitals leverage to demand and receive much higher
prices for in-network patients, too. The average price paid by health plans to hospitals
for all care ​grew almost 200 percent​ — to $7,200 per day from $2,500.
In effect, they could threaten: Pay us $7,200 per day to sign a contract or $19,500 per
day for emergency admissions without a contract.
Many patients might not know or care about this fight between hospitals and
insurers. But they should.
Whenever insurance companies have to pay more, patients do too, in premium
increases.​ In some cases, patients have to pay inflated out-of-network E.R. charges
directly to hospitals in the form of “balance billing.” Hospitals are also expanding at a
rapid pace, acquiring medical groups and other outpatient services, and they are using
their E.R. power to gain higher rates for these other services, too.
States urgently need to change their regulations to limit hospital prices for
out-of-network emergency care.
Capping billed charges at 125 percent of contracted prices would keep hospitals
from exploiting their E.R. advantage. Maryland has instituted ​a policy along these lines​.
This change alone would result in immediate price reductions and savings to consumers
exceeding many billions of dollars. And it would begin to restore some competition that
would help keep prices down in the long run.
An American family of four with an employer-sponsored P.P.O. health plan now
pays on average more than $28,000 a year for health care. ​If nothing changes, health
care prices and insurance premiums will continue to grow. This will mean lower
take-home pay for millions of working Americans and increases in the ranks of the
uninsured. Public policy and hospitals are supposed to help us in emergencies, not
create them.