Rural hospitals blast ‘arcane’ policies

From Modern Healthcare:

The 96-hour rule and a possible direct-supervision policy are a danger to critical-access hospitals, rural health leaders said at a congressional hearing Tuesday.

They also told members of the House Ways and Means Committee’s Health Subcommittee that graduate medical education slots need to be more fairly allocated to help rural areas recruit providers.

‘Jaw-dropping': Medicare deaths, hospitalizations AND costs reduced

From US Today:

The U.S. health care system has scored a medical hat trick, reducing deaths, hospitalizations andcosts, a new study shows.

Mortality rates among Medicare patients fell 16% from 1999 to 2013. That’s equal to more than 300,000 fewer deaths a year in 2013 than in 1999, said cardiologist Harlan Krumholz, lead author of a new study in the Journal of the American Medical Association (JAMA) and a professor at the Yale School of Medicine.

“It’s a jaw-dropping finding,” Krumholz said. “We didn’t expect to see such a remarkable improvement over time.”

Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

From JAMA:

Importance  In a period of dynamic change in health care technology, delivery, and behaviors, tracking trends in health and health care can provide a perspective on what is being achieved.

Objective  To comprehensively describe national trends in mortality, hospitalizations, and expenditures in the Medicare fee-for-service population between 1999 and 2013.

Design, Setting, and Participants  Serial cross-sectional analysis of Medicare beneficiaries aged 65 years or older between 1999 and 2013 using Medicare denominator and inpatient files.

Main Outcomes and Measures  For all Medicare beneficiaries, trends in all-cause mortality; for fee-for-service beneficiaries, trends in all-cause hospitalization and hospitalization-associated outcomes and expenditures. Geographic variation, stratified by key demographic groups, and changes in the intensity of care for fee-for-service beneficiaries in the last 1, 3, and 6 months of life were also assessed.

Results  The sample consisted of 68 374 904 unique Medicare beneficiaries (fee-for-service and Medicare Advantage). All-cause mortality for all Medicare beneficiaries declined from 5.30% in 1999 to 4.45% in 2013 (difference, 0.85 percentage points; 95% CI, 0.83-0.87). Among fee-for-service beneficiaries (n = 60 056 069), the total number of hospitalizations per 100 000 person-years decreased from 35 274 to 26 930 (difference, 8344; 95% CI, 8315-8374). Mean inflation-adjusted inpatient expenditures per Medicare fee-for-service beneficiary declined from $3290 to $2801 (difference, $489; 95% CI, $487-$490). Among fee-for-service beneficiaries in the last 6 months of life, the number of hospitalizations decreased from 131.1 to 102.9 per 100 deaths (difference, 28.2; 95% CI, 27.9-28.4). The percentage of beneficiaries with 1 or more hospitalizations decreased from 70.5 to 56.8 per 100 deaths (difference, 13.7; 95% CI, 13.5-13.8), while the inflation-adjusted inpatient expenditure per death increased from $15 312 in 1999 to $17 423 in 2009 and then decreased to $13 388 in 2013. Findings were consistent across geographic and demographic groups.

Conclusions and Relevance  Among Medicare fee-for-service beneficiaries aged 65 years or older, all-cause mortality rates, hospitalization rates, and expenditures per beneficiary decreased from 1999 to 2013. In the last 6 months of life, total hospitalizations and inpatient expenditures decreased in recent years.

Trying to break the cycle that creates health care ‘super-users’

From CT Mirror:

“Many of these people fall between the cracks of many service provision systems, but the one place where they keep emerging is in the emergency room,” said Lydia Brewster, assistant director for community services at St. Vincent de Paul Middletown, which operates a supportive housing program and a soup kitchen. “The emergency room knows they’re not solving the problem. They’re getting the person band-aided together.

There are broader implications for the health care system too. Nationwide, 5 percent of patients accounted for half of total health care spending in 2012, according to federal data. Some health experts view focusing on “super users” as a key strategy in the quest to improve care while controlling health care costs.

Hospital and emergency services employees are often targets of violence

From WOWK:

The number violent crimes in hospitals across the United States went up in 2014.

Thomas Hospital in South Charleston was put on lock down in July when someone came into the emergency room and threatened violence.

Mike Jarrett, with the Kanawha County Emergency Ambulance Authority, said ambulance crews are also often the target of physical violence.

American College of Emergency Physicians “Saving Millions” Public Service Announcement

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South End brewery owner inspired by Ebenezer Scrooge, leaves career in emergency medicine

From the Charlotte Business Journal:

Tabu Terrell says he learned from the lessons of Ebenezer Scrooge.

This former emergency room doctor, 42, saw that job demands began to put pressure on his health and kept him away from his family. That was compounded by the fact that his wife, Jennifer, is also an emergency-room physician.

Together, they formulated a way to fast-forward their one-day retirement plans to open a brewery now, making it Tabu’s new career path.

“It was time, I think,” he says. “When you start to get burnt out, you’re not the doctor that you want to be. The post-retirement plan got moved up to a career change.”

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