Tag: "emergency room"

Headlines I Wish I Hadn’t Seen

wine-glassRed wine is healthier when it’s non-alcoholic (sorry).

ObamaCare premiums are about to skyrocket; they will double in some parts of the country.

The Obama Administration is will spending $17 million a month advertising for ObamaCare.

Emergency room visits increased after Massachusetts health reform was enacted.

Half of callers to Covered California give up as deadline looms.

Hits and Misses

heartStunning finding: Saturated fat doesn’t cause heart disease.

Laszewski trashes the new Republican health plan.

Johnathan Chait: Is the new Republican plan really a plan or is it just promises, promises?

Are we headed toward a zero marginal cost society?

Should there be special emergency rooms for the elderly?

In five states, an average full-career retiree receives a retirement income higher than his final salary.

Least Surprising Health Research Result Ever: Medicaid Increases ER Use

Medicaid is a welfare program jointly funded by federal and state governments, which claims to provide health insurance to low income people. A few years ago, Oregon expanded Medicaid enrollment by lottery. This created an excellent environment to study the effects of being uninsured versus being enrolled in Medicaid, because it approximated a randomized-controlled trial — the gold standard of medical research, but seldom conducted in the social sciences.

20131231104928-0The latest result of the study, published in Science, reported that Medicaid increased use of emergency rooms by 40 percent (gated abstract here, and reported here).

This result is important for anticipating the consequences of ObamaCare. About half of the 30-plus million people expected to get health insurance under ObamaCare will be enrolled in Medicaid, not private health insurance. Already, the Administration asserts that four million new Medicaid enrollees have signed up via ObamaCare (but this estimate has been questioned).

Medicaid Expansion Means More ER Visits

A number of years ago, Governor Romney told me that under Massachusetts health reform people would go to physicians’ offices for care instead of going to the emergency room. He wasn’t saying that Massachusetts would deliver more care. He was saying that the care would be more appropriate and less expensive.

As it turns out he was wrong. Traffic to the ER in Massachusetts today is higher than it was before the state’s health reform was enacted.

er23The same argument has been used by President Obama and by supporters of the Affordable Care Act. And now it turns out they are wrong too. As The New York Times reports:

The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance.

This is consistent with our own predictions in an NCPA study done soon after the ACA was passed. Ah, if only they had listened.

This is Why We Need More Jeffrey Brenners

file-206642429A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. A 55-year-old Mississippi man with severe hypertension and kidney disease is repeatedly hospitalized for worsening heart and kidney failure; doctors don’t know that his utilities have been disconnected, leaving him without air conditioning or a refrigerator in the sweltering summer heat. A 42-year-old morbidly obese woman with severe cardiovascular problems and bipolar disorder spends more than 300 days in a Michigan hospital and nursing home because she can’t afford a special bed or arrange services that would enable her to live at home. (KHN)

See previous post here.

A Market is Emerging for ER Care

Convenience

Medical entrepreneurs are remaking the emergency room experience. They’re pulling the emergency room out of the hospital and planting it in the strip mall.

It’s called a “free-standing ER,” and some 400 of them opened across the country in the past four years.

Amenities

The waiting room, furnished with brown leather armchairs and a coffee station worthy of a spa, is empty because patients are usually seen right away.

Expense

Free-standing ERs can make a lot of money because they charge ER prices. A visit that might have cost $200 at an urgent-care center can cost four or five times as much at an ER.

Source:Kaiser Health News.

Dealing with the Devil

Liberty Hospital near Kansas City, Mo., has eliminated 120 jobs this year, closed its wound-care clinic, and stopped offering free rides to poor and elderly patients. The Cleveland Clinic is searching for ways to cut $250 million from its $6 billion budget in the next 16 months. It’s already closed expensive maternity wards in half the hospitals it operates. In northern New York, Adirondack Health may shutter its emergency room in Lake Placid and a dialysis center in Tupper Lake. All of these hospitals and scores of others nationwide are squeezing services to make up for unexpected budget shortfalls — the result of a deal they made with the federal government that they’re now having second thoughts about. (Bloomberg)

ER vs. Doctor’s Office, and Other Links

Do low-income patients go to the emergency room rather than a doctor’s office because they prefer the emergency room?

Patients in Medicare Advantage plans got expensive balloons and stenting to clear coronary arteries at a rate 31 percent lower than patients in traditional Medicare, and angiography procedures were 36 percent lower. But geographical variation is still large and we don’t know if this was good for patients.

45% of the nation’s nearly 28 million uninsured workers are employed by large firms, subject to the ObamaCare mandate.

The Market for Pain Relief

Opioids

Overdose deaths

ER Costs

Source: The New York Times.

Maybe This is Why You Have to Wait So Long

The emergency department would seem, at first glance, to be one of the more bustling spaces in medicine. With multiple patients in critical condition, it seems like it would be hard for doctors and other health providers to find a spare minute.

Except it’s apparently not that hard at all: A new study (flagged by Michael Ramlet of The Morning Consult) finds that for every hour emergency department workers use a computer, they spend an average of 12 minutes on Facebook — and that time on the site actually goes up as the department becomes busier.

From Sarah Kliff.