Farm bill would allow rural hospitals to refinance debt

From Becker’s:

The $867 billion farm bill passed by Congress allows for the refinancing of certain rural hospital debt, according to the American Hospital Association.

farm bill conference report states that the legislation authorizes the refinancing of debt obligation of rural hospitals as an eligible loan or loan guarantee “if the assistance would help preserve access to health service in a rural community and meaningfully improve the financial position of the hospital.”

Americans in this region have longest travel time to a hospital

From Becker’s:

Americans living in the census region known as the West North Central have the longest average travel time to the nearest hospital, according to a survey conducted by the Pew Research Center, a nonpartisan fact tank based in Washington, D.C.

1. People in the West North Central region — comprising Kansas, Iowa, Minnesota, North Dakota, South Dakota, Nebraska and Missouri — have an average travel time of 15.8 minutes to the closest hospital.

Price of Naloxone Device to Plummet

From US News:

A generic version of an overdose-reversing auto-injector will be available next year for a fraction of the brand-name product’s list cost, the pharmaceutical company that makes the devices announced Wednesday.

The move comes on the heels of a congressional report that found Virginia-based Kaleo had raised the price of its Evzio take-home naloxone kit by more than 600 percent as the nation was in the throes of the opioid crisis. Kaleo said Wednesday it will release an authorized generic version of Evzio at a list price of $178 per carton – down from the branded product’s more than $4,000 – by midyear 2019.

The company also said it will immediately offer Evzio at $178 per carton for “government agencies, first responders, health departments and other qualifying groups on the front lines of the nation’s opioid overdose crisis” who purchase the product directly from Kaleo or authorized distributors.

A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze?

From the Emergency Medicine Journal:

Objectives Diverting patients away from the emergency department (ED) has been proposed as a solution for mitigating overcrowding. This systematic review examined the impact of interventions designed to either bypass the ED or direct patients to other alternative care after ED presentation.

Methods Seven electronic databases and the grey literature were searched. Eligible studies included randomised/controlled trials or cohort studies that assessed the effectiveness of pre-hospital or ED-based diversion interventions. Two reviewers independently screened the studies for relevance, inclusion and risk of bias. Pooled statistics were calculated as relative risks (RR) with 95% confidence intervals (CI) using a random effects model.

Results Fifteen studies were included evaluating pre-hospital (n=11) or ED-based (n=4) diversion interventions. The quality of the studies ranged from moderate to low. Patients deemed suitable for diversion among the pre-hospital studies (n=3) ranged from 19.2% to 90.4% and from 19% to 36% in ED-based studies (n=4). Of the eligible patients, the proportion of patients diverted via ED-based diversion tended to be higher (median 85%; IQR 76–93%) compared with pre-hospital diversion (median 40%; IQR 24–57%). Overall, pre-hospital diversion did not decrease the proportion of patients transferred to the ED compared with standard care (RR 0.92; 95% CI 0.80 to 1.06). There was no significant decrease in subsequent ED utilisation among patients diverted via pre-hospital diversion compared with non-diverted patients (RR 1.09; 95% CI 0.99 to 1.21). Of the three pre-hospital studies completing a cost analysis, none found a significant difference in total healthcare costs between diverted and non-diverted patients.

Conclusion There was no conclusive evidence regarding the impact of diversion strategies on ED utilisation and subsequent healthcare utilisation. The overall quality of the research limited the ability of this review to draw definitive conclusions and more research is required prior to widespread implementation.

Changes in Sex, Race, and Ethnic Origin of Emergency Medicine Resident Physicians from 2007‐2017

From Academic Emergency Medicine:

Diversity among residents in particular, and among the emergency medicine workforce in general, is a goal of both specialty societies and accrediting agencies.1,2 The proportion of medical students and residents who self‐identify as female has increased over the last few decades, but the proportion who are racial and ethnic minorities remains low.3‐6 The percentage of emergency physicians and emergency medicine residents who are women and minorities are known to be lower than that of the general population.

Iowa Study: Telehealth Saves Money, Improves Recruitment

From Care for Iowa:

A new study from the University of Iowa (UI) finds rural hospitals that use telehealth to back up their emergency room (ER) health care providers not only save money but find it easier to recruit new physicians.

Marcia Ward, study author and professor of health management and policy in the UI College of Public Health, says the results suggest that expanded use of tele-emergency services could play a key role in helping small, rural Critical Access Hospitals maintain their emergency rooms.

“The study finds that expanding options for provider coverage to include telehealth in some rural emergency departments has noticeable benefits,” says Ward, whose study was published Dec. 3 in the December issue of the journal Health Affairs. “This supports the viability of Critical Access Hospitals at risk of closing and leaving their communities without local emergency care.”

Feasibility of Expanded Emergency Department Screening for Behavioral Health Problems

From the American Journal of Managed Care:

Objectives: Behavioral health conditions and social problems are common yet underrecognized among emergency department (ED) patients. Traditionally, ED-based behavioral health screening is limited. We evaluated the feasibility of expanded behavioral health screening by a trained nonclinician.

Study Design: Prospective observational study of a convenience sample of ED patients.

Methods: A research assistant (RA) approached a convenience sample of adult ED patients within an integrated healthcare delivery system. Patients completed a paper screening instrument (domains: mood, anxiety, alcohol use, drug use, sleep, intimate partner violence, and chronic pain) and reviewed responses with the RA, who shared positive screening results with the treating ED physician. We abstracted behavioral health and medical diagnoses from the electronic health record (EHR), comparing the screened cohort with the eligible population. We used χ2 tests to assess differences in demographics and comorbidities between screened patients and the eligible group and differences between self-reported symptoms and EHR diagnoses among screened patients.

Results: Among 598 screened patients, the prevalence of self-reported symptoms was higher than that of associated EHR diagnoses in the year prior to the ED visit (anxiety, 45% vs 19% [<.001]; depression, 40% vs 22% [P <.001]; drug use, 7% vs 4% [= .011]; risky alcohol use, 12% vs 5% [P <.001]; chronic pain, 47% vs 30% [P <.001]; and sleep problems, 47% vs 4% [P <.001]).

Conclusions: A dedicated RA was able to integrate screening into patient idle times in the ED visit. The prevalence of behavioral health problems was higher than indicated in the EHR.