Online doctor visits can be easy, but Congress thinks they increase costs

From the Washington Post:

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it. Anthem and a health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient.

Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers.

Should Families Watch CPR in the Emergency Department?

From ACEP Now:

Staff education and preparation are critical to successful family presence during resuscitations. It is important to develop an institutional policy or structured guidelines that will formalize the process and optimize the experience.11Currently, few institutions have such specific policies or guidelines.12 A protocol may include guidelines regarding family assessment, preparing the family, the facilitator’s role, postevent family support, and postevent staff support. Development of institutional guidelines should include clinicians, advanced practice providers, nursing staff, pastoral care, social services, and patients. Following policy development, staff education and preparation is essential. Training may include facilitator-training workshops to employ simulation with mannequins and/or actors portraying patients and families.13–15 A designated supportive staff member (SSM) is important for a successful experience for families. The SSM may be a social worker, nurse, chaplain, or other dedicated personnel. The SSM should be trained and committed to the supportive process during resuscitative efforts. The SSM should initially communicate with family members prior to entering the resuscitation area. Family members should be given the option to be present and prepared for the visual and emotional stress of the clinical scenario. They should be instructed where to stand at the bedside to be close to their family member without interfering with the delivery of care. If there is uncertainty about crowd control or ability to function appropriately, or if there is suspicion of abuse, it may not be appropriate for family to be present. Ideally, there should be a designated area that provides adequate seating for the family as well as a direct line of vision to the patient and the delivery of care. Family members should be allowed to leave and reenter the room if they become uncomfortable with the situation. The SSM should be solely dedicated to the family throughout the resuscitative efforts and should provide appropriate education and communication regarding clinical status andmedical interventions. Following unsuccessful resuscitative efforts, support of family through the bereavement process is essential. The health care team and the SSM should facilitate compassionate communication and support, which may include spiritual support, psychosocial support, and open dialogue about the events of the resuscitative efforts.