Observation units can aid throughput, cut readmissions and make patients happy

From H&HN:

At a time of hospital and emergency department overcrowding, squeezed Medicare payments, and payer audits and denials, hospitals more than ever must make sure they’re utilizing each inpatient bed to the fullest extent. That means not admitting patients who could have been seen safely in a different setting. For a particular type of patient, that setting is an observation unit.

Emergency room protest by doctors? Not happening, docs say

From the Seattle Times:

Over the weekend, a Twitter conversation made the rounds suggesting that doctors here planned to occupy emergency rooms in protest on April 1, the day the state plans to stop reimbursing hospitals and doctors for Medicaid patients’ non-emergency visits.

Dr. Nathan Schlicher, a Tacoma emergency doctor who is leading the effort by the state’s emergency doctors and the Washington State Medical Association to stop the state from enacting its budget-cutting plan, says no such “#doccupy” protest is planned.

Assessment of Medicare’s Imaging Efficiency Measure for Emergency Department Patients With Atraumatic Headache

From the Annals of Emergency Medicine:

Computed tomography (CT) use has increased rapidly, raising concerns about radiation exposure and cost. The Centers for Medicare & Medicaid Services (CMS) developed an imaging efficiency measure (Outpatient Measure 15 [OP-15]) to evaluate the use of brain CT in the emergency department (ED) for atraumatic headache. We aim to determine the reliability, validity, and accuracy of OP-15.


This was a retrospective record review at 21 US EDs. We identified 769 patient visits that CMS labeled as including an inappropriate brain CT to identify clinical indications for CT and reviewed the 748 visits with available records. The primary outcome was the reliability of OP-15 as determined by CMS from administrative data compared with medical record review. Secondary outcomes were the measure’s validity and accuracy. Outcome measures were defined according to the testing protocol of the American Medical Association’s Physician Consortium for Performance Improvement.


On record review, 489 of 748 ED brain CTs identified as inappropriate by CMS had a measure exclusion documented that was not identified by administrative data; the measure was 34.6% reliable (95% confidence interval [CI] 31.2% to 38.0%). Among the 259 patient visits without measure exclusions documented in the record, the measure’s validity was 47.5% (95% CI 41.4% to 53.6%), according to a consensus list of indications for brain CT. Overall, 623 of the 748 ED visits had either a measure exclusion or a consensus indication for CT; the measure’s accuracy was 16.7% (95% CI 14% to 19.4%). Hospital performance as reported by CMS did not correlate with the proportion of CTs with a documented clinical indication (r=–0.11;P=.63).


The CMS imaging efficiency measure for brain CTs (OP-15) is not reliable, valid, or accurate and may produce misleading information about hospital ED performance.

Hospital CEO sued for allegedly embezzling $850K

From FierceHealthcare:

The former CEO of Powell (Wyo.) Valley Healthcare faces a lawsuit for allegedly embezzling nearly $850,000 while he was head of the nonprofit hospital system, the Powell Tribune reported.

HealthTech Management Services Inc., the company that provides management services to Powell Valley, employed Paul Cardwell to oversee the company’s operations and filed suit Thursday against him. The lawsuit alleges that Cardwell authorized spending $847,934 between March and September to recruit physicians and other personnel to Powell Valley Healthcare and that the money was sent to a “straw company,” set up by Cardwell’s acquaintance, which then kicked a “substantial” amount of Powell Valley Healthcare’s money back to Cardwell.