Small But Mighty: Rural Hospitals Cope With Many Challenges

From dotMED.com:

As politicians in Washington duke it out over health care, rural and community hospitals are certain to be a focus. The mission of primary care, the need for chronic disease management and caring for the uninsured are priorities for small hospitals and for national health policy. Whatever form reform takes, the nation’s rural hospitals are likely to benefit, or at least not be overlooked (Policy Update: Government Agencies Showing New Focus on Rural Health).

This sector is no stranger to bureaucracy. No matter what regulations Uncle Sam throws at them, small and rural hospitals, particularly the nation’s designated Critical Access Hospitals (CAHs) are experts at meeting regulatory requirements. Unlike large hospitals that are paid according to diagnoses, CAHs are reimbursed more fully, providing a cushion in hard times that helps to serve a disadvantaged patient base.

“The PPS or prospective payment hospitals are paid on a DRG or diagnosis related group. CAHs are paid on a cost basis,” said Lora Key, CEO of Sabetha Community Hospital, a CAH in Kansas. “Through the year, Medicare will set an interim rate for us. Depending on our patient loads, they may be underpaying us or overpaying us. That Medicare cost report is like a tax return-at the end of the year either we owe them or they owe us.”

See the rest of the article here.

New Rural Family Practice Residency Program in Enid, OK

From Enid (Oklahoma) News:

Enid has two new residents — physician residents that is.

The newest addition to Integris Bass Baptist Health Center is its residency program. The residency program started July 1 and currently has Aaron Sizelove, D.O., and Joy Ekpo, D.O., as residents.

The residency program at Bass is a community partnership with health care facilities located in Enid. The three-year program is designed to train physicians to provide quality pa-tient care in the context of rural family and community health care.

Gary Patzkow-sky, D.O., program director, said the program will train and retain physicians for the area.

“The Northwest Family Medicine Program is a community program designed to train family physicians,” he said. “Our goal is to establish a program of academic excellence to provide training for family physicians and to retain them for our community and surrounding communities.”

An ER Doc Grapples With ‘Unnecessary’ Hospital Admissions

From the WSJ Health Blog:

It’s all well and good to talk about reducing unnecessary hospital admissions to help control health costs. But the definition of “unnecessary” gets a lot more complicated when you’re the one doing the admitting, ER doc Jesse Pines writes in a column on WSJ.com.

He describes the case of a woman with a probable case of lung cancer who needed a comprehensive evaluation. She was on Medicaid, the government health insurance for the poor, which meant she’d have a hard time finding specialists to treat her as an outpatient. So Pines admitted her to the hospital, even though she wasn’t acutely ill.

In the hospital, she got a biopsy, a formal diagnosis of lung cancer and a plan for outpatient treatment. She met with a psychiatrist and a social worker. Pines argues that it was the best outcome, though more expensive than it would have been for her to be treated as an outpatient.

“She was not sick enough to need a hospital bed,” he writes. “But I believe admitting her was the right decision.”

Health Blog Questions of the Day: Who should decide when hospital admissions are necessary? Are there any instances where public insurance shouldn’t pay for a hospital admission?

EMS competition has international appeal

From Utica Observer Dispatch:

EMS teams from two countries will try to demonstrate world-class skills this weekend as they compete in the second annual International Emergency Medical Services Road Rally and Ambulance Competition.

The contest will pit teams from the United States and Poland against each other on Friday and Saturday in a race to find and treat various staged medical emergencies ranging from trauma injuries to hazardous materials. The winning team receives a 10-day, all-expenses-paid exchange trip to either Poland or the United States to tour medical facilities, said Dr. Richard Chmielewski, founder and CEO of EMS Global, Inc.

Chmielewski’s non-profit organization began the competition last year as a way to bring pre-hospital medical care providers together to exchange ideas, he said. The group is dedicated to assisting in “the development and modernization of emergency medicine internationally.”

Beyond the Books–Continuing EMS Information Resources

From EMS1:

Although the educational world is changing, printed textbooks remain a core feature of EMS education. There are four or five good EMT-level textbooks out there, and several paramedic textbooks. Writing and publishing a paramedic textbook, such as my books Paramedic Care: Principles an Practices and Essentials of Paramedic Care, are gargantuan tasks that involve my co-authors and a whole gaggle of editors, artists, and similar professionals. The time it takes to write a textbook as comprehensive as ours takes years — literally. A textbook revision in which the book is updated can take many months. It is not a fast process.

However, textbooks do have their limitations. There is no way that a textbook can keep you abreast of the changing science and practices in EMS. The best source for current EMS science is the scholarly journals. Scholarly journals are peer-reviewed publications. Articles submitted to these journals undergo a rigorous review process and must meet certain guidelines. The principal peer-review journal for EMS is Prehospital Emergency Care. It is coordinated through the National Association of EMS Physicians and is published quarterly. Other emergency medicine journals such as Annals of Emergency Medicine, Academic Emergency Medicine, and American Journal of Emergency Medicine are also good sources of EMS science and practices.

Many in EMS find it difficult to access the scientific literature. The best source is an Internet database called PubMed. This service is provided by the United States National Library of Medicine and the National Institutes of Health and possesses over 18 million citations. The system is easily searchable using key words and Boolean logic. Generally, when you enter a keyword, you will get numerous “hits” of articles that match your keyword. You can look through these entries to find the articles that meet your needs. When you click on these articles, the citation and abstract is displayed. Some of the full text articles are accessible through PubMed (either as PDF files or HTML files), while others are not.

As House and Senate Negotiate, Obama Fine-Tunes His Pitch

From the Washington Post:

President Obama on Wednesday will take his plea for health-care reform to audiences in North Carolina and southwest Virginia, armed with a bullet-point-style message that his aides are hoping will be persuasive.

The re-tooled pitch highlights eight ways that, the White House says, health-care consumers would be treated better by insurance companies if reform efforts pass. It isn’t exactly prime sound-bite material — the catchiest title we could come up with is ‘Eight No’s, an Extension and a Guarantee,’ which doesn’t exactly roll off the tongue.

But the message is the latest attempt by the White House to cut through dense policy discussions in a way that busy, distracted citizens can understand.

Obama is also increasingly adding personal details to his pitch, telling an audience of retirees Tuesday about the experiences of his late mother and grandmother when they were seeking health care and revealing that he and first lady Michelle Obama both have living wills.

As the president tries to sell his reform message, lawmakers from both houses of Congress continue to debate different proposals for how to reform the health-care system. House leaders emerged from nearly seven hours of closed-door talks late Tuesday without a deal, while a bipartisian group of senators
moved closer to consensus.

Obama has struggled mightily to articulate why he believes that people who already have insurance will benefit from changes to the system, which would cover millions of uninsured people and attempt to lower overall health-care costs to the government and society.

On his travels Wednesday — to an audience at a high school in Raleigh, N.C., and at a supermarket in Bristol, Va. — the president will unveil the eight-part message, designed to convince the insurance masses that reform will be good for them. Here, according to White House aides, are the key points:

* No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

* No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

* No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

* No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

* No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

* Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

* Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

More Than a Year Later, New AMA Conflicts Policy Still in Works

From the WSJ Health Blog:

For more than a year, the American Medical Association has been drafting a new ethics policy aiming to limit industry influence on continuing education for doctors.

Apparently that’s not enough time.

Early this month, Sen. Herb Kohl sent  a letter to the AMA for a status report. The AMA  wrote back saying it is still at work. The organization’s House of Delegates has rejected two proposals, and its ethics committee will take up the issue again in late August, the group said.

“There is often more than one round of revisions,” AMA Executive Vice President Michael D. Maves wrote. An AMA spokeswoman said the organization didn’t have “anything else to add.”

The  first proposal from the AMA’s ethics committee recommended that doctors and others “must not accept industry funding to support professional education activities.” The reason: “existing mechanisms to manage potential conflicts and influences are not sufficient” to address concerns.

Drug company funding of CME quadrupled between 1998 and 2006 to $1.2 billion, almost half of CME’s total income, according to a 2008 article in the Journal of the American Medical Association. The sums involved, and examples of doctors’ failures to disclose industry funding, has sparked criticism that patient care is suffering because of skewed financial interests.

The letters were provided by the Senate Special Committee on Aging, which Kohl chairs and is holding a hearing today on conflicts in continuing medical education.

Kohl, a Wisconsin Democrat, has been investigating conflicts of interest in medicine and, with Sen. Charles Grassley, pushing legislation that would require public disclosure of industry gifts and payments to physicians.