Ban on payment for “necessary” ED visits in Washington suspended by governor

From the Seattle Times:

A plan by the state Medicaid program to stop paying for emergency-room visits for all conditions deemed “non-emergency” – set to go into effect tomorrow — has been suspended by Gov. Chris Gregoire pending the outcome of budget negotiations now under way in the state Legislature.

Gregoire’s budget director, Marty Brown, said today that Gregoire on Friday stopped the Medicaid plan from going into effect, noting growing legislative support for a less drastic alternative.

Application of Statistical Process Control to Physician-specific Emergency Department Patient Satisfaction Scores

From Academic Emergency Medicine:

Objectives:  Emergency department (ED) patient satisfaction remains a high priority for many hospitals. Patient surveys are a common tool for measuring patient satisfaction, and process improvement efforts are aimed at improving patient satisfaction scores. In some institutions, patient satisfaction scores can be calculated for each emergency physician (EP). ED leaders are faced with the task of interpreting individual as well as group physician scores to identify opportunities for improvement. Analysis of these data can be challenging because of the relatively small numbers of returned surveys assignable to a single physician, variable numbers of surveys returned for each physician and high standard deviations (SDs) for individual physician scores. The objective was to apply statistical process control methodology to analyze individual as well as group physician patient satisfaction scores. The novel use of funnel plots to interpret individual physician patient satisfaction scores, track individual physician scores over two successive 8-month periods, and monitor physician group performance is demonstrated. Methods:  Patient satisfaction with physicians was measured using Press Ganey surveys for a 65,000-volume ED over two successive 8-month periods. Using funnel plots, individual physician patient satisfaction scores were plotted against the number of surveys completed for each physician for each 8-month period. Ninety-fifth and 99th percentile control limits were displayed on the funnel plots to illustrate individual physician patient satisfaction scores that are within, versus those that are outside of, expected random variation. Control limits were calculated using mean patient satisfaction scores and SDs for the entire group of physicians. Additional funnel plots were constructed to demonstrate changes in individual physicians’ patient satisfaction scores as a function of increasing numbers of returned surveys and to illustrate changes in the group’s patient satisfaction scores between the first and second 8-month intervals after the institution of process improvement efforts aimed at improving patient satisfaction. Results:  For the first 8-month period, 34,632 patients were evaluated in and discharged from the ED, with 581 surveys returned for 21 physicians. The mean (±SD) overall group physician patient satisfaction score was 81.8 (±24.7). Returned surveys per physician ranged from 2 to 58. For the second period, 34,858 patients were evaluated and discharged from the ED, with 670 patient satisfaction surveys returned for 20 physicians. The mean (±SD) overall physician score for all surveys returned during the second period was 85.0 (±22.2). Returned surveys per physician ranged from 8 to 65. Conclusions:  The application of statistical control methodology using funnel plots as a means of analyzing ED group and physician patient satisfaction scores was possible. The authors believe that using funnel plots to analyze scores graphically can rapidly help determine the significance of individual physician patient satisfaction scores. In addition, serial funnel plots may prove to be useful as a means of measuring changes in patient satisfaction, particularly in response to quality improvement interventions.

Report: Overuse Of Local ERs Costing Millions

From 10News:

Research conducted by 10News’ media partner U-T San Diego found out who is overusing San Diego’s emergency rooms and how much it is costing taxpayers.

We have people that literally will use the emergency department over a hundred times,” said James Dunford, the city of San Diego’s medical director and an ER doctor for 32 years.

That is more than 100 times in one year, and Dunford said about half of frequent users are homeless, but all have fallen through the cracks.

“They have very complicated medical problems, chronic diseases. They usually have some kind of mental problem, they often times have substance abuse [issues],” said Dunford. “This is a super-user problem that’s generating super bills.”

HOUSTON, TX—Wouldn’t you know it? Just as Mike Sanner got to the head of the lengthy emergency room queue, a guy with a power auger sticking out of his chest was wheeled in.

From The Onion

Ed. Sorry. That’s it. Just the headline. I thought it was funny.

Paramedics are probably right when they suspect strokes

From News-Medical:

If a paramedic suspects a patient is having a stroke, the paramedic is probably right, a Loyola University Medical Center study has found.

Researchers examined the records of 5,300 patients who were brought to Loyola’s emergency room by emergency medical services (EMS). Paramedics were able to identify stroke patients with a 99.3 percent specificity. (In diagnosing disease, a high specificity rate indicates there’s a high probability the patient actually has the disease.)

“If a paramedic thinks a patient is having a stroke, that should be a reliable indicator that the hospital’s stroke team should be activated,” said Dr. Michael Schneck, a co-author of the study, which will be presented at the 64th annual meeting of the American Academy of Neurology in New Orleans.

Wyoming hospital CEO indicted on fraud charges

From the Powell Tribune:

Former CEO Paul D. Cardwell and Michael J. Plake of West Lafayette, Ind., have been indicted by a federal grand jury in Wyoming’s U.S. District Court on 15 criminal counts — 12 of mail fraud, one of wire fraud, one of conspiracy to commit money laundering and one of conspiracy to commit mail and wire fraud, say documents obtained by the Tribune.

According to the indictment the Tribune received Wednesday, the counts are based on allegations that Cardwell conspired with Plake to defraud Powell Valley Healthcare out of nearly $848,000 between March and September 2011 — the time Cardwell was CEO.

The grand jury’s indictment alleges that Cardwell and Plake came up with a “fraudulent billing scheme” in which Cardwell would send money to Plake’s company, Plake and Associates, for the purported purpose of recruiting physicians and other staff to Powell. In reality, the indictment alleges, Plake was doing no work. Instead, he would send roughly 75 percent of the money back to Cardwell while keeping 25 percent for himself, says the indictment.

7 in 10 Ambulances Positive for Staph Isolates

From Health Leaders Media (Hat Tip: Steve Flugrad):

Drug-resistant strains of infectious bacteria are hitching a ride into hospitals through an under-appreciated path—the ambulance—according to a sample of 71 Chicago-area emergency response vehicles.

Hospitals investigate parody video made by ER staff

From The Spec:

Kitchener’s two hospitals are investigating a video made by local emergency department staff that parodies patients and was filmed in Grand River Hospital without permission.

The video was made for the annual Tri-City Emergency Medicine Conference, an independent event run by staff at Grand River, St. Mary’s General Hospital, Cambridge Memorial Hospital and Guelph General Hospital for people in the field of emergency medicine. This year’s event was held in Waterloo on Wednesday, although the video causing concern was created for a previous conference.

Health Care 911: A chronicle of frequent ER use

From the Center for Health Reporting:

I am waiting for the metal jailhouse door to open. The woman whose profile will be the last chapter in a five-part series on frequent users of the emergency room is about to emerge from behind it.

Her name is Joan Kloh.  And she has generously allowed us to make her the embodiment of a government/nonprofit effort to reduce taxpayer costs generated by frequent use. Almost as an aside, I wrote in the story, the effort will try to extract her from a life of substance abuse and homeless.

Discharged patient dies in police custody

From Los Angeles Times:

Anna Brown was homeless and had so much pain in her legs that she couldn’t walk.

When Brown, 29, refused to leave the emergency room at St. Mary’s Health Center in Richmond Heights, Mo., a suburb near inner St. Louis, the police thought she was on drugs and arrested her for trespassing. She’d already been examined, and a doctor said she was healthy enough to go to jail.

The police carried her into a jail cell by her arms and ankles, her body slackened. There were a couple of beds in the cell, but they left her on the concrete floor. A couple of officers stood by the door as she writhed and moaned, and then they walked away. “They thought she was a drug seeker,” an officer said later.

She had stopped moving within 15 minutes and was pronounced dead a short time later.

She’d had blood clots in her legs and lungs, an autopsy found, and no drugs in her system.