Loaded gun found hidden in Children’s Healthcare ER

From Atlanta Journal Constitution:

Police are trying to determine why an unregistered, .40-caliber Glock handgun with two fully loaded clips was hidden in the emergency room of Children’s Healthcare of Atlanta at Hughes Spalding.

The gun was discovered early Monday morning by a cleaning woman as she changed trash bags in an ER bathroom, according to an incident report filed by Atlanta police. The weapon was placed between the bag and the trash can.

APD spokesman Curtis Davenport said investigators are still gathering evidence as to who may have left the gun there, and why.

“There’s no good reason,” said gun safety expert Matt Podowitz. “It could have been placed to facilitate a shooting. It may have been a drop for an illegal gun swap.

Hero Dog Finds Missing Physician

From NBC New York:

Four days later, Chase, a 4-year-old German shepherd, found Nadler, covered with bug bites, lying in thick brush along a waterway in the park.

The hero Suffolk County police dog lay down beside him and did not get up until the man was found, though his handler was calling for him, police said.

6 Tiny Things Doctors Do That Can Save (Or End) Your Life

From Cracked:

Modern health care is a miracle, but it’s an expensive miracle. However the health care works in your particular country, a stay at the hospital is costing somebody thousands of dollars. But what price is too high when you need a surgeon to unblock your damned arteries?

Fortunately, the world is full of zero-cost solutions that save lives. It’s just a matter of convincing people to use them.

CMS Petitioned to Reconsider Observation Status Rules

From the American Health Care Association:

In comments submitted today to the Centers for Medicare & Medicaid Services (CMS), the American Health Care Association (AHCA) emphasized the outstanding need to resolve the challenges Medicare beneficiaries face due to prolonged hospital stays under observation status.

“We are very appreciative of the renewed interest that CMS has taken in the plight of beneficiaries denied Medicare coverage of post-acute care because the time they spent in the hospital was in an observation stay,” Elise Smith, AHCA Senior Vice President of Finance Policy and Legal Affairs, wrote in the comments to CMS Administrator Marilyn Tavenner. “We are asking CMS to now focus on the beneficiaries and assure that none of these policies hurts them.”

AHCA specifically asked CMS that all days an individual spends in a hospital count toward the three-day stay requirement for Medicare coverage of post-acute skilled nursing care. Currently, in order to receive coverage at a post-acute care facility, patients must be admitted to a hospital under inpatient status for at least three days. If a Medicare beneficiary is hospitalized under observation status, those days spent under observation do not count towards the three-day stay minimum, and the beneficiary can be denied Medicare coverage at a post-acute care facility.

“By adapting the Medicare minimum stay requirements to include observation stays, CMS would be directly improving access to quality care for millions of Americans,” said Mark Parkinson, President & CEO of AHCA. “This is not just a dilemma of nomenclature. When Medicare coverage is denied to those individuals who desperately need skilled nursing care, it forces an unfair decision on those beneficiaries to either to pay for care out of pocket or forgo the care they need to continue their health recovery.”

Medical Home Pilot Met Numerous Obstacles, Yet Saw Results Such As Reduced Hospital Admissions

From Health Affairs:

The Colorado Multipayer Patient-Centered Medical Home Pilot, which ran from May 2009 through April 2012, was one of the first voluntary multipayer medical home pilot projects in the country. Six health plans, the state’s high-risk pool carrier, and sixteen family or internal medicine practices with approximately 100,000 patients participated. Although a full analysis is currently under way, preliminary results show that the pilot significantly reduced emergency department visits and also reduced hospital admissions, particularly for patients with multiple chronic conditions. One payer reported a return on its investment of 250–400 percent in the pilot. However, participants also ran into numerous obstacles. Among them: Many practices were left providing extra services to a large fraction of patients whose employer-sponsored insurance plans declined to pay the enhanced fees necessary to cover the cost of the patient-centered medical home expansion. The experience demonstrates that creating patient-centered medical homes and enabling them to be successful will take strong commitments and collaborative efforts on multiple fronts.

Inappropriate helicopter emergency medical services transports: results of a national cohort utilization review

From Prehospital Emergency Medicine:

Background. Medical transport using helicopter emergency medical services (HEMS) has rapidly proliferated over the past decade. Because of issues of cost and safety, appropriate utilization is of increasing concern.

Objective. This study sought to describe the medical appropriateness of HEMS transports, using established guidelines, in a large national patient cohort.

Methods. A review was performed of all flights designated as inappropriate by a large national air medical company, Air Evac EMS Inc. (which operates Air Evac Lifeteam [AEL]), for the period from January 1, 2009, through December 31, 2009. Every flight was reviewed initially through a resource utilization process as well as a utilization review process. Medical appropriateness review criteria were derived from the Medicare Benefit Policy Manual and industry guidelines outlined by the Commission on Accreditation of Medical Transport Systems (CAMTS), Air Medical Physicians Association (AMPA) position papers, the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) Guidelines for Field Triage, and published clinical peer-reviewed articles, as well as previous interactions with Medicare contractors and reimbursement appeal decisions. Higher scrutiny was given to flights of <30 or >100 miles. Records indicating a possible inappropriate flight (i.e., review criteria were not satisfied, but special circumstances existed) were further reviewed by a senior quality assurance/quality improvement (QA/QI) nurse and/or senior medical director and were categorized.

Results. During the study period, 27,697 flights were completed and reviewed, with 582 (2.1%) flights identified for further review by a senior QA/QI nurse and/or senior medical director. Of those, 367 (1.3%) were determined to be medically inappropriate flights. Inappropriate flights were most often on-scene flights (59.9%), were most often for adult patients (92.9%; median age 56.9 years; 25-75% interquartile range 42-75 years), and most often represented medical diagnoses (57.8%).

Conclusions. Based on established criteria, only 1.3% of total flights were determined to be inappropriate. This large national cohort demonstrated compliance with current industry standards.