Patient Feedback More Important Than Ever to Hospitals

From ACHE News (referencing Pantagraph):

The latest trend in hospital patient care is to encourage patients and their relatives to express concerns, compliments or suggestions to medical staff before the patient is discharged or complications arise. Many hospitals have polled patients for some time, but more are publicly disclosing survey results as part of the federal Hospital Compare Web site. This Web site allows patients and their families to evaluate healthcare facilities based on the level of communication between staff and patients and whether patients would recommend the hospital to friends and relatives. Because treatment is administered more quickly, communication is critical for medical professionals to know whether the treatment is working or not. Mark Dabbs with OSF St. Joseph Medical Center in Bloomington, Ill., reports that patients need to speak up and ask questions so that they can get a realistic idea of what to expect in terms of treatment. Dabbs and Clinical Director Stephanie Moore with the BroMenn Regional Medical Center advise each patient to designate a family representative that staff can talk to if the patient is unable to receive information. Establishing good communication between patients and staff early on can reduce patient anxiety about raising concerns or asking questions about treatment. Experts recommend hospitalized patients ask questions about their condition, the recommended procedure, possible side effects and the duration of recovery. Other questions should touch upon pain management, length of hospitalization and when solid foods can be eaten.

Experts Predict Visits by Baby Boomers Will Soon Strain Emergency Departments

From ACHE News (referencing JAMA):

The U.S. Centers for Disease Control and Prevention reports a disproportional increase in the number of emergency department patients aged 65 years or older. Although emergency rooms are equipped to see patients of all ages, the aging of the Baby Boomer generation could lead to overcrowding because those patients are often sicker and more likely to be admitted. An analysis of data from the National Hospital Ambulatory Medical Care Survey found that overall visits by people between the ages of 65 to 74 increased by 33 percent between 1993 and 2003. The average admission rate did not change dramatically, which suggests the increasing number of emergency patients is related to an increase in emergency problems. Hospitals already facing staff shortages and budget cuts may not be able to provide the same level of care when emergency departments are overcrowded, say experts. Older patients require more attention, so hospital staff will be able to see less patients in a day, impacting care for all visitors. One expert suggests that hospitals develop new screening and intervention techniques to reduce the need for emergency services. Improved prescription education, better community services for the elderly and stronger relationships between primary care physicians and patients could help reduce the demand for emergency services. Critics warn that hospitals will need to offer higher pay and obtain Medicare reimbursement hikes for geriatric specialists in order to bolster the workforce to meet demand.

EMTALA Flexibility Proposed to Relieve On-Call Shortages

From ACHE News (referencing American Medical News)

In April, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed a modification to its on-call rules under the Emergency Medical Treatment and Labor Act (EMTALA). CMS proposed allowing hospitals with emergency departments to form community call plans. According to the rule change, community on-call plans would provide regions with greater care flexibility and ease the burden of physicians who find it hard to maintain their taxing emergency on-call schedule because of specialty shortages throughout the system. Additionally, experts believe the rule clarification will reduce Medicaid patient dumping. While the on-call change would allow one facility to be the on-call site for a particular period or service, or both, hospitals with emergency departments are still required to provide medical screenings and create patient care plans for emergency patients if an on-call physician is unavailable. Community call arrangements would not require pre-approval from CMS, but CMS would examine them if any EMTALA breaches occur, which can lead to fines and Medicare participation rights terminations. According to the EMTALA Technical Advisory Group, the added flexibility of community call plans would help alleviate hospitals’ on-call problems. However, some physicians, like American College of Emergency Physicians President-Elect Nicholas Jouriles, have expressed doubt about the effectiveness of community calls, especially in the absence of details from CMS.

House Blocks Medicare Pay Cut. What’s Next?

From the Wall Street Journal Health Blog:

Congress has made a habit of blocking Medicare pay cuts at the last minute, but this one’s really coming down to the wire.

The House of Representatives voted yesterday to block the looming 10.6% pay cut to doctors that’s set to take effect on July 1. Now it’s up to the Senate — where a similar bill stalled last week.

There’s been a fight over the Democrats’ plan to give more money to docs while cutting funding to the privately administered plans known as Medicare Advantage, which cost the government more than traditional Medicare.

The House bill could result in a $14 billion cut to those plans over five years, the Washington Post reports. The Bush administration, which supports Medicare Advantage, has threatened a veto.

Buried in all the details are questions over a special type of private Medicare known as “special-needs plans,” the WSJ reports. These plans were designed for the chronically ill, and now cover more than 1 million people.

House Votes to Block Cut in Doctors’ Medicare Fees

From the New York Times:

WASHINGTON — The House on Tuesday overwhelmingly approved a bill to prevent a 10 percent cut in Medicare payments to doctors that was scheduled to take effect July 1.

Despite a veto threat from President Bush, the bill passed by a vote of 355 to 59, with 129 Republicans and 226 Democrats supporting it. The no votes were all cast by Republicans, including the minority leader, Representative John A. Boehner of Ohio.

Besides blocking the cut in doctors’ fees scheduled to occur next week, the bill would increase Medicare payments to doctors by 1.1 percent next year. Under current law, doctors face another cut of about 10 percent in January, because of a complex formula that reduces payments when spending would otherwise exceed certain goals.

To help pay for the changes, the bill would reduce federal payments to private Medicare Advantage plans, offered by insurers like Humana, UnitedHealth and many Blue Cross and Blue Shield companies.

House Passes Bill Postponing Cut in Medicare Payments to Doctors

From the Washington Post:

By a surprisingly large bipartisan margin, the House voted yesterday to postpone a planned cut in payments to physicians who treat Medicare patients by approving a reduction in payouts to private insurers.

The House approved legislation, on a 355 to 59 vote, that forestalls a 10.6 percent cut in Medicare payments to doctors and hospitals for 18 months. Democrats warned that such a decrease would lead to many physicians opting out of treating Medicare patients.

“If we fail to enact this legislation, physicians will face a 10 percent pay cut that jeopardizes access to care for seniors and the disabled,” said Rep. John D. Dingell (D-Mich.), chairman of the House Energy and Commerce Committee, which helped write the bill.

The battle now shifts to the Senate, where it may be more closely fought.

What aren’t there more AED’s available?

From Dr. Wes:

Melinda Beck of the Wall Street Jounal, did a nice piece on the need for automatic external defibrillators (AEDs) in public spaces today and started to address some of the issues of why these amazing gizmo’s aren’t available more widely

So why aren’t these devices more readily available?

First and foremost: is cost. These devices are still expensive: the cheapest quoted goes for about $1300. But there are other costs not commonly discussed: like the cost of new batteries every 2-7 years (depending on the cost of the model) that can set folks back at least a $100 for each device. And what about those defibrillator patches placed on the chest? They contain a gel that improves the conductivity of the patches on the chest, making the devices more reliable at correcting the normal heart rhythm. That gel degrades and the patches must be replaced every two to seven years, too – to the tune of about $100 a set, too. These are the unspoken issues with AEDs that are never written about and schools and institutions must understand these additional costs and maintenance requirements if they are to assure the proper functioning of these devices.