Suck it up, America

From the Pittsburgh Post-Gazette (a Sunday Forum opinion piece by Dr. Thomas Doyle):

Emergency departments are distilleries that boil complex blends of trauma, stress and emotion down to the essence of immediacy: What needs to be done, right now, to fix the problem. Working the past 20 years in such environments has shown me with great clarity what is wrong (and right) with our nation’s medical system.

It’s obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not health-care reform. It’s only health-care insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why.

Health care costs too much in our country because we deliver too much health care. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.

Opinion: How the patient-centered medical home can improve our health care system

A guest post by David Harlow on KevinMD:

The Patient-Centered Medical Home model — described more fully in materials from the Patient-Centered Primary Care Collaborative, and TransforMED, an affiliate of the American Academy of Family Physicians — relies on a shift in physician compensation from a fee-for-service focus to a patient management focus; from an episodic focus to comprehensive, relationship-based care. It’s been implemented in over 100 pilots around the country. Denmark learned about the model here in the U.S. decades ago and has implemented it fully across the country’s health care system, shuttering most of the acute care hospitals in the country in the process. Pilots in the U.S. include Geisinger’s, which Grundy says has been remarkably successful, yielding an ROI of over 250%, including a 12% reduction in ER utilization, a 20% reduction in hospitalization, and a 48% reduction in rehospitalization.

Technology is an important part of these efforts and savings. Even given the potential high cost of technological solutions and Health 2.0 tools, the costs pale in comparison to the $1 million-a-bed cost of hospital construction, let alone hospital staffing and other operating costs.

The key to catching up with places like Denmark and Spain, and systems like Geisinger, Intermountain and the VA, says Grundy, is the recognition and implementation of medical home-compatible payment systems by CMS, since it controls half of the country’s health care spend, and providers march to CMS’s tune. Without that buy-in, it has been difficult to promote the model beyond integrated delivery systems, large group practices, and pilot-project-funded solo and small practices.

Doctor says near-death experiences are in the mind

From CNN:

According to the Near Death Experience Research Foundation, nearly 800 near-death experiences happen every day in the United States.

Dr. Kevin Nelson, a neurologist in Louisville, Kentucky, studies near-death experiences and says they’re not imagined. The explanation, he says, lies in the brain itself.

“These are real experiences. And they’re experiences that happen at a time of medical crisis and danger,” Nelson said.

Humans have a lot of reflexes that help keep us alive, part of the “fight or flight” response that arises when we’re confronted with danger.

Nelson thinks that near-death experiences are part of the dream mechanism and that the person having the experience is in a REM, or “rapid eye movement,” state.

“Part of our ‘fight or flight’ reflexes to keep us alive includes the switch into the REM state of consciousness,” he said.

During REM sleep, there is increased brain activity and visual stimulation. Intense dreaming occurs as a result.

And the bright light so many people claim to see?

“The activation of the visual system caused by REM is causing the bright lights,” Nelson said.

And the tunnel people speak of, he says, is lack of blood flow to the eye. “The eye, the retina of the eye, is one of the most exquisitely sensitive tissues to a loss of blood flow. So when blood flow does not reach the eye, vision fails, and darkness ensues from the periphery to the center. And that is very likely causing the tunnel effect.”

CDC reports delays in H1N1 vaccine production

From Modern Healthcare:

A top official at the Centers for Disease Control and Prevention said there could be 10 million to 12 million fewer doses of the H1N1 flu vaccine available than the Atlanta-based agency had expected by the end of October.

“Some manufacturers have let us know that production might be delayed in future weeks,” Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a news conference. “We wish that we had more vaccine, and there is more coming out every day,” she added. “But it doesn’t look like we’re going to make those production estimates at the end of this month.” Earlier, the CDC said it anticipated that 40 million doses would be available by that time.

AARP, AMA press lawmakers for revamp of doc-pay system

From Modern Healthcare:

The AARP and the American Medical Association have sent a letter to the Senate urging lawmakers to approve a bill that would revamp Medicare’s physician payment system. The legislation is being prepped for consideration on the Senate floor next week.

The bill, sponsored by Sen. Debbie Stabenow (D-Mich.), would essentially wipe out the sustainable growth-rate formula used to calculate physician payments under Medicare, allowing lawmakers and the physician lobby to work on a new payment system

Hospitalist bed management effecting (sic) throughput from the emergency department to the intensive care unit

From Journal of Critical Care:

Rationale

Emergency department (ED) patients in need of an intensive care unit (ICU) admission are very sick. Reducing the length of time to get these patients into ICU beds is associated with improved outcomes.

Objective

To reduce the ED length of stay for patients requiring admission to the medical ICU or coronary care unit through the implementation of the “active bed management” (ABM) intervention.

Methods

A pre-post study design compared data from November 2006 to February 2007 with those from those same months in the prior year at Johns Hopkins Bayview Medical Center in Baltimore. The ABM intervention was carried out by hospitalist physicians and involved: (i) making triage decisions for patients to be admitted and facilitating their transfer from ED to the appropriate care setting and (ii) having proactive management of Department of Medicine resources, which included twice-daily ICU bed management rounds and regular visits to the ED to assess flow.

Measurement

Throughput time for patients presenting to the ED requiring ICU admission was analyzed.

Main Results

The ED census was higher during the intervention period as compared with the control period, 17 573 versus 16 148 patients. Throughput from ED to coronary care unit and medical ICU beds was reduced by 99 (±14) minutes (from 353 minutes in the control period to 254 minutes in the 4 months after the initiation of ABM, P < .0001). Staffing, length of stay, case mix index, ICU transfer rates, and ICU death rates were stable across the 2 periods, all P = not significant.

Conclusion

Conscientious management of hospital beds, in this case by hospitalist physicians providing ABM, can have a positive and substantial impact on the ED throughput of critically ill patients admitted to ICU beds. This efficiency is likely to positively have impacted on patient satisfaction and safety.

EDPMA Action Alert

From the Emergency Department Practice Management Association:

Support Senate SGR Fix

Take Action! Contact Your Senators Now.

The bill, S. 1776, the “Medicare Physicians Fairness Act of 2009,” was introduced on Oct. 13 by Sen. Debbie Stabenow (D-MI). It will serve as the Senate legislative vehicle for eliminating Medicare’s sustainable growth rate (SGR) formula and lay the foundation for a new Medicare physician payment update system. The Senate is scheduled to take action on the bill Monday, Oct. 19, with the first of several procedural motions that will require 60 votes to pass. The emergency medicine community must take immediate action. Contact your two U.S. Senators immediately and urge them to support passage of S.1776. Let them know how important this legislation is to the seniors and physicians in your state. Take action now. Tell your Senators to support S. 1776.

Here’s how: Call 1-800-833-6354 to be automatically connected to your two Senators. Urge them to support all procedural motions and final passage of S.1776. Send an e-mail urging your Senators to support S. 1776.