CHI battles the Blues in Nebraska

From the Hub:

“Ongoing negotiations create an illusion for purchasers that we are going to be in the network, but we may not be. We wanted people to have clarity now,” he said.

He reiterated that anyone who comes to a CHI Health institution in an emergency will be treated, and “if Blue Cross refuses to pay in-network rates for the treatment, we will appeal and advocate for the patient, and if we have to eat the extra costs, we will,” he said.

“We want people to understand that the law requires our emergency room to take care of patients who show up, and the law requires insurance companies to pay in-network benefit. The key is the definition of ‘emergency.’ It’s what a prudent lay person thinks of as an emergency. If you think your child isn’t breathing right, and you think it’s an emergency, come to the ER. We will take care of you. If the patient must be hospitalized, you will get in-patient rates,” he said.

Providers coordinate to stop the cycle of excessive emergency room use

From the Journal:

“Super utilizers” refers to people who use the emergency room excessively. They’re also called “frequent flyers.” Nationally, they are the sickest 5 percent of patients and, according to the foundation, responsible for more than 60 percent of health care costs. The project’s aim was to coordinate these patients’ health care so its quality, and their health, improved enough to keep them out of the ER. It was based on an approach developed by a family practitioner in Camden, New Jersey.

Patients were added to the program throughout the two-year period, so data for many of them are still being crunched. But raw results for 18 of the patients revealed a 70-percent drop in their emergency room visits in the six months after joining the project, compared with visits the six months before, and a corresponding nearly 100 percent drop in unreimubursed costs. And, post-project, new initiatives have arisen to continue working with people who use the ER too much, using lessons learned in this pilot project.

Coordination of Emergency Care Ups STEMI Survival Rates

From MPR:

Improved coordination between paramedics and hospitals can reduce ST-segment elevation myocardial infarction (STEMI) deaths nearly five-fold by getting patients quicker treatment, according to research of an initiative to be presented Wednesday at the annual meeting of the American Heart Association, held from November 15–19 in Chicago.

The initiative, called Mission: Lifeline and coordinated through Duke University, was conducted with 484 hospitals and 1,258 emergency medical service agencies in 16 cities. Researchers found it resulted in slight reductions in the time it took to get patients from their first contact with a medical professional into an operating room. But those small reductions had enormous benefits: death rates were dramatically reduced by getting people into surgery even 15 minutes sooner than normal.