OIG Fraud Crackdown: Critical Access Hospitals

From Fierce Healthcare:

It’s no secret that federal officials have been on the warpath as of late, cracking down on healthcare fraud, abuses, and waste, hoping for (and recently achieving) millions in recovered Medicare and Medicaid dollars. The Office of Inspector General (OIG) yesterday detailed next fiscal year’s work plan for the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General, calling for continued attention to fighting healthcare fraud.

Among the work plan changes for hospitals regarding Medicare Parts A and B are the following:

Critical access hospitals: Inspectors will examine how many and what kind of patients critical access hospitals treat to determine the appropriateness of a CAH designation.

Bath Salts Treatment

From JEMS:

The first thing that must be done is restrain them, but physically restraining such people — who are severely agitated and in a state of excited delirium — can be harmful and even life-threatening because they usually have increased heart rates and high blood pressure, the conference attendees were told.

Restraining patients “increases their release of adrenalin and puts them at risk,” Busko said. “They can go into cardiac arrest.”

The Bangor area has experienced “probably two or three deaths from excited delirium,” the emergency room doctor said. “We’re probably seeing a patient every two or three days with those symptoms.”

The best restraint is to use chemicals to counteract the ones ingested, the conference presenters said. For most patients, benzodiazepines are used to sedate the patient and then an anti-psychotic is added, and a third drug, a paralysing agent, also can be injected if needed, the doctors said.

“Once they’re down and sedated, that’s a wonderful thing,” Busko said.

The temperatures of suspected bath salts users are taken first to see if they are hyperthermic, and when they get to the hospital an EKG is used to look at the heart, he said. Kidney function also is examined. The patients are tested for other illegal or diverted drugs and a check is done for creatine kinaseare, an enzyme that can indicate a heart attack, Busko said.

All that information is used to shape treatment.

Mayo clinic robot comes to Heartland ER

From the News-Press:

The new stroke specialist in Heartland Health’s emergency room stands about 6 feet tall, brings Mayo Clinic expertise to the patient’s bedside and needs to be wheeled into a patient’s room.

Heartland Health’s telestroke robot allows stroke neurologists at the Mayo Clinic in Phoenix, Ariz., to consult on cases that present to the ER in St. Joseph. Heartland’s telestroke robot marks the first non-Mayo Clinic facility to take part in the program, which has shown a 96 percent accuracy in emergency stroke diagnosis, according to Mayo Clinic data.

When a complex stroke case presents, Heartland staff will page telestroke neurologists in Phoenix for a consult, and set up the robot. The on-call doctor will then query the patient from a screen the size of a desktop monitor.

Shift Work May Increase Risk of Heart Disease

From MedPage Today:

Younger shift workers have elevated levels of stress-related cortisol that may place them at increased cardiovascular risk, according to Dutch researchers.

In a group of shift workers who were less than 40 years of age, hair cortisol levels were significantly higher at 48.53 pg/mg hair (95% CI 36.56-64.29) compared with 26.42 pg/mg hair in day workers (95% CI 22.91-30.55; P<0.001), according to Laura Manenschijn, MD, from Erasmus Medical Center in Rotterdam, and colleagues.

One cop’s response to the ER doctor survey

From PoliceOne:

A published survey reporting that emergency physicians believe that law enforcement officers use excessive force keeps showing up in the literature. The research was published in 2009 in the Emergency Medicine Journal.¹ The surveys were sent to 393 emergency room physicians with 315 responding. Of the responding physicians, 99.8 percent believed excessive force actually occurs and 97.8 percent replied that they had managed patients with suspected excessive use of force. The fact that the respondents believe it “actually occurs” does not necessary imply that they believe it occurs with great frequency.

The survey goes on to report that these incidents were not reported by 71.2 percent of respondents. A full 96.5 percent had no departmental policies (for an emergency room physician to report a belief of excessive force) and 93.7 percent had not received training in the management of these cases. The survey was quickly questioned by several prominent experts including Dr. Bill Lewinski. Indeed, Dr. Lewinski plainly states that the survey’s methods appear to conform to academic standards but the results are “meaningless.”² This comment put into context wraps up the study and its worth very accurately. Several other law enforcement professionals added their opinions as to the report’s value. Not surprisingly, these opinions closely mirrored those expressed by Dr. Lewinski.³

Take the survey for what is it, and for what it is worth. It is a report based on the subjective feelings and uninformed opinions of a group of people that have little or no training in the evaluation of a use of force incident. So what is its worth? Although it is certainly interesting reading, it holds no worth either in a legal sense related to determining the reasonableness of a use of force in any particular investigation, or in exposing any trends regarding excessive force used by law enforcement.

Kids’ ER concussion visits up 60 percent over decade

From the Sacramento Bee:

The number of athletic children going to hospitals with concussions is up 60 percent in the past decade, a finding that is likely due to parents and coaches being more careful about getting head injuries treated, according to a new federal study.

“It’s a good increase, if that makes any sense,” said Steven Marshall, interim director of the University of North Carolina’s Injury Prevention and Research Center.

“These injuries were always there. It’s not that there are more injuries now. It’s just that now people are getting treatment that they weren’t getting before,” said Marshall, who was not involved in the new research.

Study Finds 69 Million Travel Far to Reach Trauma Centers

From JEMS (AP article):

One hour can spell the difference between life and death for victims of severe injury, but about a quarter of Americans now have to travel farther to reach the nearest hospital trauma center, a study published Wednesday concludes.

The reason: Hundreds of trauma centers have closed over the past two decades.

Sixty-nine million people had to travel farther to reach a trauma center in 2007 than in 2001, according a study in the journal Health Affairs.