Hospitals Face Financial Squeeze

From the Wall Street Journal:

More than half of U.S. hospitals aren’t seeing enough patients to provide sufficient revenue to fund operations and are “teetering on the brink of insolvency” or already are insolvent, according to a study.

Restructuring firm Alvarez & Marsal said more than 2,000 of the nearly 3,900 acute-care hospitals the firm studied don’t make a profit treating patients. Nearly 750 hospitals that do turn a profit still don’t have enough to reinvest in improvements or other essential expenditures, the firm’s study found.

Experts Say Different Sports Require Different Helmets

From the Washington Post:

“Don’t forget to wear your helmet,” parents tell their kids now that warmer temperatures are luring them outside to cycle, skateboard, rock climb, kayak and ride horses. And with good reason. “Helmets basically keep your skull from cracking,” says pediatric neuropsychologist Gerard Gioia, director of the Safe Concussion Outcome, Recovery and Education Program at Children’s National Medical Center.

Can’t one all-purpose helmet suffice?

In a word, no, say medical experts. That’s because different sports subject the body to different forces from different directions — and sport-specific helmets are designed accordingly.

“If you think about riding a bicycle, people tend to fall off front first, so they are more at risk for the front of their head hitting the ground, or a wall, because they are moving forward,” Gioia says. A bike helmet has frontal protection to guard against this.

“But then you have kids that are on skateboards, and the more typical thing for a skateboard is the skateboard zipping out, and you fall backwards and hit the back of your head.” Skateboard helmets typically cover more of the skull and the back of the neck than bike helmets.


CDC: Flu season may be worst in four years

The 2007-08 U.S. flu season may be the most severe since 2003-04, the Centers for Disease Control and Prevention reported yesterday. Flu activity peaked in mid-February with widespread activity in 49 states. As of April 5, just six states reported widespread activity: Connecticut, Maine, Maryland, New York, Pennsylvania and Vermont. Early results from a study to measure the effectiveness of this season’s flu vaccine show an overall effectiveness of 44%, suggesting the vaccine provided substantial protection even though some of the viruses circulating differed from the strains in the vaccine, CDC said.

As Doctors Get a Life, Strains Show

From the Wall Street Journal

U.S. medicine is in the middle of a cultural revolution, as young physicians intent on balancing work and family challenge the assumption that a doctor should be available to treat patients around the clock.

At the same time, the attempt by new doctors to lead a less-pressured work life is putting additional strain on America’s health-care system. Many are eschewing fields such as internal medicine, pediatrics and family medicine, choosing instead specialties that offer both higher pay and more predictable work hours. In family medicine, for example, hundreds of medical residency positions go unfilled every year. But competition for slots in dermatology residencies is fierce.

Iowa Hospital License Fees Increase

From the Des Moines Register:

Since 1947, Iowa hospitals have paid $10 a year for their state licenses. That is one-third of what it now costs to license a bait shop in Iowa.

The inspections department has contended that the hospital license fee is unreasonably low, given the public cost of licensing and oversight.

The Legislature last week considered a proposal to increase the fee to $1,000. But in the closing hours of the 2008 session, an amendment introduced by Rep. Jo Oldson, D-Des Moines, changed the bill.

The amendment cut the proposed fee from $1,000 to $500 and stipulated that all revenue generated by the higher fee would be spent on “educational programs on regulatory issues for hospitals.”

The amendment also said those programs would have to be implemented in consultation with the Iowa Hospital Licensing Board, a state regulatory board made up of hospital officials.

Researchers Fault FDA Inaction On Risks of Blood Substitutes

Blood-substitute products have consistently resulted in deaths and heart attacks that could have been avoided had the Food and Drug Administration acted early enough, according to researchers who analyzed clinical studies of the products.

At issue are a class of experimental fluids, designed to replace donor blood, that the U.S. Army and Navy hope to use on the battlefield when donor blood is unavailable. Some trauma surgeons as well regard the oxygen-carrying products as potentially useful because they can be stored for long periods of time and don’t need to be cross-matched with a patient’s blood.

ER wait times posted on hospital website

Scottsdale Healthcare is the first in Arizona, and one of the first in the nation, to post real-time wait times for its hospital Emergency Rooms on its web site. Times posted on represent the time it takes to get a patient from the ER’s front desk to an exam room. Wait times are updated every 10 minutes for Scottsdale Healthcare Osborn, Scottsdale Healthcare Shea and Scottsdale Healthcare Thompson Peak.

Cuts in Oregon’s Medicaid Program Led to a 20-Percent Increase in Emergency Department Visits by Uninsured Patients; Visits by Uninsured Psychiatric Patients More than Doubled

From The American College of Emergency Physicians:

Washington, DC – Cuts in Oregon’s Medicaid expansion program in 2003 led to a 20-percent increase in emergency department visits by the uninsured, and a nearly 50-percent increase in hospital admissions of uninsured emergency patients; during the same period, visits by uninsured psychiatric patients doubled.  The findings are published online today in the Annals of Emergency Medicine (“Impact of Medicaid Cutbacks on Emergency Department Use: the Oregon Experience”).

House blocks Medicaid rules with veto-proof majority

In continuing coverage from previous editions of Morning Rounds, the Wall Street Journal (4/24, A4, Zhang) reports that on Wednesday, the U.S. “House voted overwhelmingly to block Medicaid rules that would cut federal healthcare spending on the poor, and likely shift billions of dollars of costs to states.”  While President Bush has threatened to veto the legislation, the 349 to 62 vote represented “two-thirds of Republicans and all Democrats in the chamber,” making it veto-proof. But, whether “Congress can override a Bush veto…depends on the Senate.” President Bush intends the “regulations to stop states from abusing the program, and to keep the Medicaid program afloat.” Still, “[g]overnors of all states and state Medicaid directors” believe “the new regulations would stop longtime practices, such as the use of federal Medicaid funds to pay for physician training.” Moreover, the proposed rules “would also limit federal payments to some hospitals and nursing homes.”

Rural Emergency Care Needs Transfusion


Rural ambulance services in Oklahoma are dying, leaving thousands of rural Oklahomans stranded without quick and dependable emergency medical care.

“It is a crisis,” said R. Shawn Rogers, Emergency Medical Services division director for the Oklahoma State Department of Health. “All across the state, we’ve got a very dicey situation.”

Since 2000, about 50 rural ambulance services in Oklahoma have closed, and 13 communities in the state have no dedicated ambulance service.

“Medicare has really knocked the pins out from them,” Rogers said.

Rising gas costs, a higher number of uninsured patients and Medicare reimbursement cuts have fueled the downward spiral for services that play such a critical role for rural Oklahoma.