Study: Rural health care costs rising at an ‘unsustainable trajectory’

From the Iowa Independent (via RACnews/Twitter):

A new white paper released by The Iowa Policy Project focuses on the disparities at play when rural residents seek health care insurance.

“[This report] really highlights that the need for health reform that isn’t limited to people who are working outside their home — that it is a big issue for those who are self-employed and for people across the country,” said Andrew Cannon, a research associate with IPP and author of the study. “It’s not just an urban issue. It’s not just a rural issue. It’s an issue that touches Americans from all walks of life. Health reform needs to address the needs of all populations, including America’s rural population.”

Nearly 20 percent of America’s uninsured live in rural areas, according to the study, and are more likely than residents of urban areas to purchase their insurance on non-group, private markets where they typically pay higher costs.

“The situation really is not sustainable barring some sort of reform,” Cannon said. “What we’ve seen over the past 10 to 20 years is that medical inflation, and health insurance inflation in particular, far out-stripping wage inflation.

Airway management and initial resuscitation of the trauma patient

From Current Opinion in Critical Care:

Purpose of review: This review will analyze and comment on selected recent literature pertaining to airway management and initial fluid resuscitation in the trauma patient. It will also review airway devices currently being used in the trauma setting.

Recent findings: Although a recent study has questioned the efficacy of manual inline immobilization, this technique continues to be endorsed by trauma guidelines and is safely used in most trauma centers. Clinicians have also incorporated the use of videolaryngoscopy and other adjuncts for difficult airway management in trauma patients. However, no single airway management tool has proven to be superior in this setting. Crystalloid solutions remain frontline therapy for the initial resuscitation of the hemorrhagic trauma patient, as studies with hypertonic saline and vasopressors have not shown superior results. Conversely, increased amounts of fresh frozen plasma and fibrinogen have been reported to increase survival in trauma patients.

Summary: As trauma continues to be a major cause of morbidity and mortality worldwide, the use of newer airway adjuncts needs to be specifically investigated in trauma patients, as this population frequently has airway management difficulties. Further research is also required to elucidate the type and amount of fluid that will provide an adequate organ perfusion without increasing nonsurgical bleeding.

CMS Announces Hospital Outpatient Public Reporting Policy

From the EDPMA:

In 2010, CMS intends to publicly report hospital outpatient quality measure data.   These data will include those that are submitted by subsection (d) hospitals reimbursed under the Outpatient Prospective Payment System (OPPS) to fulfill requirements of the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) as well as those submitted by Critical Access Hospitals (CAHs) and other selected hospitals whose payment is not affected by HOP QDRP requirements.

Claims-based measures are also expected to be reported. All hospitals will have an opportunity to preview data before release to the public.   For the HOP QDRP, CMS is implementing a policy that differs from the inpatient data reporting policy that will affect non-OPPS/non-subsection (d) hospitals’ ability to control publication of their data.   Currently, hospitals not reimbursed under the Inpatient Prospective Payment System (IPPS) that submit quality measure data are currently able to request that a measure or measures be suppressed from public reporting.

Under the HOP QDRP, non-OPPS/non-subsection (d) hospitals that submit data will be given the opportunity, on an annual basis only, to indicate to CMS that their data in total are not to be used for public reporting in the subsequent year; there will be no “by measure” suppression process.  In the absence of this election, all submitted HOP QDRP data will be publicly reported.

Mental patients stuck in emergency rooms for days

From the Charlotte Observer :

Across North Carolina, mental patients are routinely languishing for days in emergency rooms ill-equipped to care for them, waiting for a bed to open at one of four state-run psychiatric hospitals.

Often, they pass the time handcuffed or sedated. Law-enforcement officers assigned to guard patients at community medical centers such as Grace Hospital in Morganton have occasionally resorted to using Tasers to shock them into submission.