Join the walk to save rural hospitals

From Rural Health Voices:

Fifty-three rural hospitals have closed; 283 more are on the brink of closure.

Since January 2013, more rural hospitals have closed than in the previous 10 years combined.

It’s clear continued cuts in hospital payments have taken their toll, forcing closures and leaving many of our nation’s most vulnerable populations without timely access to care.

Led by Mayor Adam O’Neal, a group of advocates from 11 states are walking 283 miles – one for each at-risk hospital – from rural Belhaven, N.C., and arriving on June 15 at the U.S. Capitol to draw attention to the dire situation rural hospitals and communities are facing.

If Congress doesn’t act to stop the bleeding and prevent further closures of rural hospitals, 700,000 patients would lose direct access to care; patients and local economies will suffer.

Without congressional intervention, layoffs, reduced wages, economic loss, reduced services, or worse, closed doors will occur in more rural communities across America.

The National Rural Health Association invites you to the conclusion of The Walk on June 15 at 11 a.m. on the east grounds of the Capitol, between the Capitol building and the Supreme Court building. This is a free event and all are encouraged to attend to show their support for rural hospitals.

If you are unable to attend, join NRHA’s Virtual March for Rural Hospitals on June 15. Call, email, Tweet and Facebook your members of Congress, and ask them to protect rural hospitals and patients.

Be sure to also:

• Attend town halls. Be prepared to ask questions and share your stories about rural hospitals.

• Write a letter or op-ed to your local media.

• Invite your members of Congress and health legislative assistants to tour your facility.

• Hold a press conference about what these programs mean to your hospital and town.

For more information and ways to #SaveRural hospitals and patients, visit NRHA’s Save Rural Hospitals Action Kit.

EMS agencies need resources to meet rising demands for service

From EMS1:

Issues of rising call volume, delays at emergency departments and suboptimal number of staffed units are cited by this article. Add to this diminishing insurance reimbursement, an increasingly overwhelmed workforce, and increasing wear and tear on vehicles and equipment, and I think one can guess where this scenario is heading.

These issues are complex, interrelated and often caused by conditions that occur far outside the EMS universe. The bigger picture is that the safety net of the U.S. health care system – EMS – is unable to keep up with the increasing numbers of people who are still unable to access health care, even in this era of the Affordable Care Act. There is an increasing number of reports of patients not able to see a primary care provider for months, if at all; many medical groups can’t or won’t accept new patients. The number of new general practitioners are not enough to offset the ones who are retiring or leaving the practice entirely.

Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score

From 7th Space:

Fast and accurate chest pain risk stratification in the emergency department (ED) is critical. The HEART score predicts the short-term incidence of major adverse cardiac events (MACE) in this population, dividing it in three risk categories.

We aimed to describe the population with chest pain, to characterize the subgroup of patients with acute coronary syndrome (ACS) and to assess the prognostic value of Manchester triage system and of HEART score.

Methods: Retrospective observational study including patients admitted to the ED of a tertiary hospital with chest pain as the presenting symptom. The primary outcome was a composite of all-cause mortality, myocardial infarction or unscheduled revascularization at 6 weeks.

Conclusions: Chest pain patients have very different levels of severity and the discriminatory power of Manchester triage system should be used in the assessment of this population. The HEART score seems to be an effective tool for risk stratification in the ED.

AMA tables telemedicine guidelines amid pressure

From Modern Healthcare (hat tip: Dr. Menadue):

Proposed ethical guidelines for telemedicine services were tabled Monday during the annual meeting of the American Medical Association House of Delegates.

That decision comes a day after a delegate urged the committee to consider rules established by the Texas Medical Board that require patients have an initial face to face consultation.

“There is no requirement here of any form of inpatient, face-to-face interaction,” said AMA Alternate Delegate Dr. Arlo Weltge. “For physical diagnosis, there needs to be a physical exam that can be done either with an initial face-to-face, or it can be done with a presenter who is seeing the patient in consultation.”

The Texas Medical Board is being sued over its ruling by telemedicine provider Teladoc. Weltge said the AMA guidelines, “as currently written, potentially would create a major conflict in Texas and with litigation ongoing active” in his state.

Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?

From Becker’s (referencing a Hastings Center article):

The report lists the following unintended consequences that patient satisfaction surveys could cause:

  1. Providers giving unnecessary or inappropriate care. “An emphasis on patient satisfaction as an indicator of healthcare quality may lead to an excessive emphasis on patients’ perspectives and wishes,” the authors wrote, and could cause healthcare professionals to cater to those wishes, even if it’s not medically necessary.
  2. Clinicians telling patients what they want to hear. The authors cited a study that “suggests that the threat of low patient satisfaction scores may lead providers to permit, or even encourage, false beliefs among their patients” because patients tend to rate physicians more poorly if they deliver bad news.
  3. “Teaching to the test.” This phenomenon happens when hospitals strive to meet high patient satisfaction scores and put processes in place to “manipulate” patient responses on the HCAHPS survey. The authors say this practice “raises the question of whether higher HCAHPS scores truly represent higher patient care.”
  4. An ultimate decrease in healthcare quality and increase in costs. The report cites a 2012 study in the Archives of Internal Medicine that directly ties high satisfaction scores to higher overall healthcare costs.

“Ultimately, patient satisfaction surveys may lead healthcare astray, undermining the provision of optimum care for all,” the authors conclude.

AMA Introduces “STEPS Forward” Practice Transformation Series

Press Release:

CHICAGO – Building on its prominent study with RAND Corp. confirming that the administrative burden of modern medicine is a root cause of physician burnout, the American Medical Association (AMA) today launched an ambitious new effort aimed at helping physicians redesign their medical practices to minimize stress and reignite professional fulfillment in their work.

AMA STEPS Forward is an interactive practice transformation series offering innovative strategies that will allow physicians and their staff to thrive in the evolving health care environment by working smarter, not harder. Physicians looking to refocus their practice can turn to AMA STEPS Forward for proven, physician-developed strategies for confronting common challenges in busy medical practices and devoting more time to caring for patients.

While doctors are inclined to always do what is necessary to take care of patients, the AMA-RAND report found that the satisfaction physicians derive from their work is eroding as they spend more time on grueling administrative rules, regulations and paperwork than caring for patients. The report noted that many physicians say that the bureaucratic obstacles to providing patients with high-quality care are major contributors to symptoms of burnout, including emotional fatigue, depersonalization, loss of enthusiasm and early retirement.

“Research shows that rates of overall burnout among U.S. physicians approach 40 percent, more than 10 percentage points higher than the general population, which is why the AMA is taking a hands-on approach to meeting their day-to-day concerns through a new online practice transformation series called AMA STEPS Forward,” said AMA Executive Vice President and CEO James L. Madara, M.D. “Physicians can find transformative solutions for their medical practices that can foster professional fulfillment by freeing them to enjoy one of the central reasons they chose a career in medicine – to spend more time with their patients and ensure they receive the highest-quality care.”

Physicians can access the collection of interactive, online educational modules to help address common practice challenges at, and also earn continuing medical education credit. There are 16 modules that include steps for implementation, case studies and downloadable videos, tools and resources. More than 25 modules are expected to be available by year’s end.

Current modules address four key areas:

  • Practice efficiency and patient care
  • Patient health
  • Physician health
  • Technology and innovation

As part of the AMA STEPS Forward launch, the AMA and the Medical Group Management Association have issued a practice innovation challenge seeking more high-value, easy-to-adopt, transformative medical practice solutions.

This challenge provides an opportunity for out-of-the-box thinkers to propose solutions that will also help physicians adapt to the changing health care environment. The best solutions will be eligible for one of several $10,000 prizes in addition to having their idea developed into future STEPS Forward modules.

Additional details, submission requirements and evaluation criteria are available To enter the challenge, proposals must be submitted by September 1, 2015.

AMA STEPS Forward is the latest initiative in the AMA’s ongoing strategic commitment to lead and advance the delivery of high-quality and affordable health care. From revitalizing medical practices to ensuring that digital health helps provide high-quality patient care, our goal is to help physicians navigate and succeed in a continually evolving health care environment. Learn more at

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