Study: Nearly half of all ER physician care goes uncompensated

From the Orlando Business Journal, via Chris Perrin:

Increased numbers of uninsured patients coming into Florida emergency rooms may worsen overcrowding, adversely affect quality of care and lead more ERs to close their doors, a new University of South Florida study shows.

USF researchers surveyed 188 Florida hospital emergency physician groups about the uncompensated care they provided in 1998. The 83 physician groups responding provided substantial uncompensated emergency care, ranging from 26 to 79 percent with an average of nearly 47 percent.

Uncompensated services are those for which no payment is received from either the patient or from a public or private insurer, such as charity care for patients who cannot afford to pay, bad debt from patients who choose not to pay their portion of the bill and denial of payment for emergency services by health plans.

The study also shows that emergency physician groups providing the highest levels of free care tended to practice in urban hospitals serving large populations of Medicaid and uninsured patients.

Verichip files for an IPO

From The Street:

Verichip, the Applied Digital (ADSX:Nasdaq – commentary – research – Cramer’s Take) unit that makes and sells radio-frequency chips for use in humans, filed for an initial public offering Friday.

“We believe that our patient identification solution is compelling for emergency room physicians as well as for patients who have cognitive impairment, chronic diseases or implanted medical devices,” the prospectus says. “Using our scanners, an emergency room physician can rapidly obtain the patient’s name, primary care physician, emergency contact and other pertinent pre-approved data, such as personal health records. We expect that this rapid and accurate identification process will reduce the risk of a patient being misdiagnosed and the potential liability associated with medical errors.”

Blue Cross & Blue Shield strikes deal with emergency room doctors

From Boston.com

Dozens of emergency room doctors reached an agreement with Blue Cross & Blue Shield to remain in the insurance company’s network.

Fifty doctors at Miriam Hospital, Rhode Island Hospital and Hasbro Children’s Hospital planned to leave Blue Cross’ network on Jan. 1 because they were unhappy with the payment rates the company offered

But the two sides announced an agreement Thursday that will allow Blue Cross to cover doctors’ services and emergency-room care at those hospitals. Had the doctors left the network, patients would have still been able to receive emergency treatment at the hospitals but would have faced more paperwork and higher costs.

A two-paragraph statement announcing the agreement did not say what led to the deal, but says Blue Cross and the doctors had “agreed to work cooperatively to address issues of mutual interest such as appropriate use of emergency department services.”

Patient Attacks Officer in the ED

From KATU.com


PORTLAND, Ore. – A hospital patient is under arrest after police say he tried to stab a corrections deputy with a knife in an attack that was caught on tape.

The incident happened Tuesday around 2 p.m. inside the emergency room at Portland Adventist Medical Center.

Police say the patient, 35-year-old James Edward Stevens, approached a Multnomah County Sheriff’s Deputy who was in the emergency room supervising an inmate (not Stevens) and asked him to step out into the hallway.

Police say Stevens then tried to stab the deputy with a knife. The deputy was able to quickly disarm him by shooting him with a Taser.

Here’s a link to the video

CPT and ICD-9 Changes

From ACEP:

The American Medical Association recently released its annual refinement of the Current Procedural Terminology (CPT) codes and descriptions. For 2006, paramount CPT changes for emergency medicine concern emergency department after-hours services and moderate (conscious) sedation. The previous related codes were frequently denied by payors as not being applicable to the emergency department or the emergency physician. CPT has clarified these services by creating new codes, which should decrease emergency physician denials for these commonly provided services. Providers must account for these changes starting Jan. 1, 2006.

JAMA Study on Anticoagulant Therapy

From the NY Times:

Patients being treated for heart attacks involving narrowed arteries and clots that reduce blood flow to the heart are often given overdoses of powerful blood-thinning drugs in the emergency room, increasing their risk of serious bleeding, a study has found.

Excessive bleeding occurred at catheter sites, from existing stomach ulcers and in the brain, where it was particularly dangerous, said Dr. Karen Alexander, a researcher at Duke University and the lead author of the study, which is to be published Wednesday in The Journal of the American Medical Association.

Of 30,136 heart patients treated last year at 387 hospitals in the United States, 42 percent were given excessive doses of blood thinners. Those given extra amounts of two blood thinners – low molecular weight heparin and glycoprotein IIb/IIIa blockers, which are sometimes called super-aspirin – had about a 30 percent greater chance of major bleeding than those given the recommended dose.

"Presenteeism"

From MedPage Today:

Sometimes it’s better for everyone if dedicated, hard-working employees stay home from the job if they’re under the weather.

We’re not just talking about use of the occasional “mental health day” — calling in sick even though there’s really nothing much wrong but the worker just can’t take it any more.

But we are also looking at the flip side of the equation, the employee who grits his or her teeth and marches into the office, despite chronic or acute illness.

In the best-case scenario, “presenteeism” — coming to work when you shouldn’t — results in a job that’s not done as well as it could be. In the worst case, it causes a cascade of illness that depopulates the office — and the job is still not well done.

“It’s really perverse,” said Graham Lowe, Ph.D., a sociologist and consultant whose Kelowna-based company analyzes workplace health issues. The phenomenon extends to physicians and nurses.

During his research career at the University of Alberta, Dr. Lowe found that the positive motivations that drive medical professionals also lead them to come in when they’re sick.

“Nurses on teams feel an incredible commitment to their patients and to their co-workers,” Dr. Lowe says. “And it’s good that they’re committed to their patients, good that they have strong bonds with their co-workers.”

But “the unintended consequence is that they put their own health as a second priority.”

It’s pretty easy to see why absenteeism is a concern to employers. According to one survey, unscheduled absences cost the boss nearly $700 a year for every employee.

“Presenteeism” is a lot harder to nail down, although the Harvard Business Review last year estimated that the cost could be as high as $150 billion a year in the U.S., with workers fighting through a range of illnesses, including allergies, asthma, headaches, depression, back pain, arthritis, and gastrointestinal disorders.