Tag: "ER"

ER: The Gateway to Hospitalization

A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009. During that time, hospital admissions grew only 4% — not even keeping pace with population growth. But ER-related admissions jumped 17%. (ModernPhysician.com)

Why this is important: about half of the newly insured under ObamaCare will get insured by Medicaid, and Medicaid patients use the emergency room twice as often as privately insured patients. Also, hospitals are buying doctors, who will be pressured to admit patients once they get to the emergency room.

May 21, 2013 | 14 comments | by

A Million-Dollar Patient

This is what happens when the government ignores Dr. Jeffrey Brenner:

For more than two decades, Wanda Remo has battled one illness after another. Asthma, chronic lung disease, heart disease, high blood pressure, arthritis, depression, chronic pain, strokes. Specialists treat her lungs, her heart and her joints.

Her litany of ailments brought her to emergency rooms six times last year, between numerous additional visits to a federally subsidized health clinic in South Los Angeles.

“You are one of the million-dollar patients,” her doctor, Derrick Butler, tells the 57-year-old as she leans on her walker during one appointment. (LA Times)

May 09, 2013 | 11 comments | by

Headlines I Wish I Hadn’t Seen

At least 28 former Max Baucus aides are now tax lobbyists.

Obama to health insurance executives: We are now “joined at the hip.”

ObamaCare regulations: photo.

Return emergency room visits after discharge not counted in readmission rates.

Apr 15, 2013 | 6 comments | by

What Did He Expect?

Michael Millenson on the government’s attempt to get everyone to use electronic health records:

Now we come to the behavior that really should inspire the outrage. We as a nation paid out billions in bribes because so many physicians simply refused to believe they could benefit from an EHR that the hospitals dependent on those doctors for admissions refused to buy computerized records no matter what the evidence. The vendors, aiming to ease the transition when hospitals did buy, designed clumsy interfaces based on provider habits and inefficiencies from the paper world. When the market finally changed, all the bad stuff got baked in: difficult interfaces and missing functionality that frustrated physicians; poor customer service from vendors puffed up with profits; absurd flaws ­— a medical record less searchable than a ten-year-old PC ― that were never corrected while piled-on new features created a kluge-job catastrophe.

Then there were the unintended consequences that occur when any innovation is taken to scale. Is it any surprise that academics focusing on efficiency and clinical improvement were blindsided by sharpies who focused, instead, on how EHRs could help game the reimbursement system to make more money? Is it a surprise that a new technology deployed in a hurry can be downright dangerous as well as helpful? Unfortunately, painting a picture of a panacea was useful for public relations purposes, but prompted a widespread backlash when reality set in.

Apr 12, 2013 | 11 comments | by

Hospitals Game the System

One hospital group encouraged its docs to exaggerate the severity of patient conditions and needlessly admit patients from the ER to hospital beds in order to bill more for their treatment. Another hospital group that owns three hospitals and also partially owns an ambulance company was making patient transfers (using their own ambulance company despite slower response times) a top priority — to the extent that a doctor’s transfer rate was a factor in bonuses and performance reviews. An admin email stated that “the performance we are looking for are transfers.”

This is from Roy M. Poses.

Apr 11, 2013 | 14 comments | by

Too Many Emergency Room Visits?

Here is the argument for keeping things just as they are:

Researchers reviewed the records from almost 35,000 patient visits to emergency departments across the country. In 6 percent of cases, the patient was discharged and could have been treated in a doctor’s office.

The researchers then combed through the initial symptoms or complaints of these non-urgent cases and discovered that in nearly 90 percent of the other, more urgent cases, patients came to the emergency room with the same primary presenting symptoms, complaints like abdominal discomfort, chest pain or fever. In addition, more than 10 percent of these urgent patients ended up requiring hospital admission, surgery or intensive care.

I’m skeptical. It looks to me like only 10% of the patients really needed hospital care.

Apr 05, 2013 | 12 comments | by

Headlines I Wish I Hadn’t Seen

An average ER visit costs more than an average month’s rent.

The Queen has entered a private hospital (on Harley Street) rather than an NHS hospital; the same hospital Kate went to. Ah, the joys of socialized medicine.

Sequester will not slow ObamaCare.

Mar 06, 2013 | 13 comments | by

Surprise: Disease Management Programs Don’t Work

OK, you probably aren’t surprised. Jason Shafrin on this study:

Washington, Texas, and Georgia have implemented diabetic disease management programs. The authors use a difference in difference strategy to measure whether costs and number of emergency admissions…decreased relative to states that did not implement diabetic disease management programs…The authors found no effect.

Jan 03, 2013 | 7 comments | by

The Best Thing I’ve Read Recently on Preventive Medicine

More than any other area of medical care, “preventive medicine” attracts by far the highest ratio of uniformed nonsensical rhetoric to actual fact. Al Lewis, at The Health Care Blog, sets the record straight on Asthma:

The average cost of an [asthma] attack requiring an ER visit or inpatient stay is about $2000. The average cost to fill a prescription to prevent or recover from an asthma attack is about $100. It turns out that asthma attacks serious enough to send someone to the ER or hospital are rare indeed. In the commercially insured population, these attacks happen only about 3-4 times a year for every thousand people…a health plan would pay, on average, anywhere from $6000 to $13,300 to prescribe enough incremental drugs to enough incremental people to prevent a $2000 attack…

Assume, very conservatively, that low-risk patients have a risk of attack which is half that of the average patient. This means that putting most low-risk patients on drugs costs $12,000 to $26,600 for every $2000 attack prevented…

It’s not just that this is a wasteful negative return on investment. This is where the catchy title comes in: It’s also that there are known short-term side effects to these drugs.

Entire post is worth reading.

Dec 05, 2012 | 10 comments | by

Hospitals Own More Than A Fourth of Free Standing Urgent Care Clinics

Stephen Wheeler…says he probably would have ended up waiting a long time if he’d gone to the doctor. And even longer at the emergency room.

But they are all about speedy service here at the urgent care center; Wheeler got in and out in 15 minutes. There’s a timer outside of every exam room so the staff knows how long a patient has been waiting. Because Wheeler was already in the MedStar Health system, the clinic was able to pull up his electronic health records and find out if he was allergic to any medications or was due for any other care.

Most of the 9,000 urgent care clinics nationwide are owned by corporations or physicians, but hospital systems are increasingly aiming to get a cut of the booming industry. Hospitals already own about 27 percent of the centers, according to the Urgent Care Association of America.

Source: KHN.

Nov 15, 2012 | 11 comments | by
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