Grassley amendment would boost reimbursement for rural docs

From Modern Healthcare:

Physicians working in rural areas would see a boost in Medicare reimbursement as part of a bipartisan deal struck by members of the Senate Finance Committee and attached to a broad health overhaul bill.

The amendment, sponsored by Sen. Chuck Grassley of Iowa, the senior Republican on the panel, essentially adds more money to help defray the payment differences between providers in rural communities and those practicing in more heavily populated one.

Under the amendment, HHS would adjust the practice-expense formula for 2010 and 2011 to better reflect the salaries and rents paid in rural communities.

The issue resonated with many on the committee because of their rural ties. But even senators from more populous states, such as Sen. Charles Schumer (D-N.Y.), voted to approve the measure because some areas in New York could benefit.

“Physicians in Iowa provide some of the highest quality of care and get some of the lowest reimbursement,” Grassley said.

Members of the committee worked over the weekend and through Monday to find a fix that would benefit rural areas without hurting payments in more populated communities.

Pilot program planned for hospitalist certification

From Modern Healthcare:

Details have not yet been released, but the American Board of Medical Specialties confirmed that it is preparing to launch as early as next year a five-year pilot program to establish a process for physicians to become board certified in hospital medicine.

“I think it’s a linchpin for hospital medicine in terms of establishing credibility and recognition within the healthcare environment,” said Rusty Holman, chief operating officer for Brentwood, Tenn.-based Cogent Healthcare, whose roster of about 350 physicians provides hospitalist services for facilities in 20 states. He added that Cogent will be “encouraging and facilitating their inclusion in the pilot program.”

Hospitalists would first be certified as internists, and they would then seek certification in hospital medicine sometime before the 10-year period of their internal medicine certification expires.

First Video Laryngoscopic Intubation Performed via Telemedicine

From JEMS:

BOTHELL, Wash. – The Department of Emergency Medicine at The University of Arizona College of Medicine Tucson, led by Dr. John C. Sakles, recently performed the first telemedicine-assisted video laryngoscopic intubation using the GlideScope® Video Laryngoscope to assist Northern Cochise Community Hospital, a small, rural healthcare facility in Southern Arizona.

An elderly patient, with a severe COPD exacerbation, presented to the ED at Northern Cochise Community Hospital in Willcox, Arizona. She was aggressively treated with conventional medical therapies and noninvasive ventilatory support, but failed to respond.

The decision was made by the treating physician, Dr. Jacob Poulsen in Willcox, to perform an emergent intubation using the GlideScope® Video Laryngoscope. Dr. Poulsen contacted the Tucson Telebation group at the University of Arizona for assistance. Receiving the call at 10:30 pm, Dr. Sakles, assisted by George Hadeed, MPH, arrived at the University Medical Center (UMC) telemedicine office to supervise the remotely-performed video laryngoscopic intubation.

Over the telemedicine network, Dr. Sakles was able to watch Dr. Poulsen in Willcox prepare the patient for intubation. After the rapid sequence intubation drugs were administered to the patient, and observed via the telemedicine camera view in Tucson, the monitor view was transferred to the view coming from the GlideScope® Cobalt Video Laryngoscope in use by the team in Willcox. The Tucson Telebation Team observed the airway view coming from the GlideScope® Cobalt in the hands of Dr. Poulsen, and provided real-time intubation guidance as the procedure took place.

The intubation went extremely smoothly with no complications, and once the patient was stabilized, she was flown by helicopter to a Tucson hospital for further intensive care management. “We were delighted that the system performed as we expected,” stated Dr. John Sakles, Professor, Department of Emergency Medicine, University of Arizona – Tucson. “The view coming in remotely from the GlideScope® video laryngoscope enabled us to clearly see the airway and provide feedback to the Willcox team during tube placement. We believe this case demonstrates the potential utility that Telebation has in assisting remote hospitals with difficult airways. This is a very promising technology and definitely warrants further study and development.”

Effect of introduction of electronic patient reporting on the duration of ambulance calls

From the American Journal of Emergency Medicine:

Objectives

We examined the effect of the change from paper records to the electronic patient records (EPRs) on ambulance call duration.

Methods

We retrieved call duration times 6 months before (group 1) and 6 months after (group 2) the introduction of EPR. Subgroup analysis of group 2 was fulfilled depending whether the calls were made during the first or last 3 months after EPR introduction.

Results

We analyzed 37 599 ambulance calls (17 950 were in group 1 and 19 649 were in group 2). The median call duration in group 1 was 48 minutes and in group 2 was 49 minutes (P = .008). In group 2, call duration was longer during the first 3 months after EPR introduction. In multiple linear regression analysis, urgency category (P < .0001), unit level (P < .0001), and transportation decision (P < .0001) influenced the call duration. The documentation method was not a significant factor.

Conclusions

Electronic patient record system can be implemented in an urban ambulance service in such a way that documentation method does not become a significant factor in determining call duration in the long run. Temporary performance drop during the first 3 months after introduction was noticed, reflecting adaptation process to a new way of working.

ACEP’s The Central Line Responds to “Excessive Care” Post

From The Central Line:
It’s All Excessive Medical Care In Hindsight

Buckle your seatbelts, kids, it’s going to be a bumpy ride.

In yet another installment of “emergency physicians don’t know what they’re doing,” KevinMD provides a guest post by gastroenterologist Michael Kirsch, entitled Does the bulk of excessive medical care happen in the ER? At its best, the piece is uninformed; at its worst, it’s insulting and unprofessional.

So let me answer you here, Dr. Kirsch: No, it doesn’t.

(Ed. Let’s just say it gets a trifle more heated from then on…)

Interruptions

From the NY Times:

So interruptions can be annoying. Can they also be dangerous? A 2001 study in The Annals of Emergency Medicine found that emergency room doctors experienced an average of 10 interruptions an hour, compared with 4 an hour for primary care doctors. Noting that interruptions and distractions are the most common cause of pilot error, the authors wrote, “Dire consequences may occur when the train of thought is broken during crucial tasks.”

“St. Joseph’s Medical Center emergency room doctor steals Rolex leaves patient to die”

Ed. Inflammatory headline, eh?

From Justice News Flash:

Stockton, CA—A St. Joseph’s Medical Center emergency room doctor is under fire by the family of a retired Manteca police Lieutenant who died from a heart attack last June. The family alleges the doctor did not resuscitate their father so he could steal his Rolex. The adult children of the retired police official filed a wrongful death lawsuit last week, as reported by KTXL.

According to the lawsuit, Jerry Kubena Sr. was rushed to the St. Joseph’s Medical Center on June 1st for heart problems. Emergency room physician Dr. Cleveland Enmon allegedly allowed Kubena to die from a heart attack after he noticed his Presidential Rolex watch on his wrist. Two nurses reportedly noticed the watch was missing from the body of Mr. Kubena, and that a bulge appeared in the doctor’s pocket. The nurses reported the missing watch to security, who then told everyone to remain where they are. The lawsuit claims Dr. Enmons somehow slipped outside the hospital and walked into the parking lot, which was caught on the hospitals security cameras. A nurse decided to follow the doctor, and witnessed him throw something from his pocket into a grassy area in the parking lot. The nurse reportedly brought security to the area where she saw Dr. Enmom throw something, and recovered Mr. Kubena’s Rolex. Dr. Enmon was apparently confronted with the hospitals security footage, and was fired on the spot.