Retooled two-midnight rule gets mixed reviews

From Modern Healthcare:

Providers and policy experts are split on the Obama administration’s proposal to salvage the controversial two-midnight rule with a series of modifications intended to mollify its many critics.

In a proposed payment rule posted in July, the CMS said it plans to allow physicians to exercise judgment to admit patients for short hospital stays on a case-by-case basis. The CMS also said it would remove oversight of those decisions from its administrative contractors and instead ask quality improvement organizations to enforce the policy. Recovery audit contractors, meanwhile, would be directed to focus only on hospitals with unusually high rates of denied claims.

The American Medical Association still argues the CMS should scrap the policy because of the considerable administrative burden of documenting a physician’s judgment about whether a patient needs to be admitted to the hospital. The policy, the AMA says, “remains an artificial construct reflecting a flawed approach that gets in the way of the physician-patient relationship.”

Ethical Pain Management in the ED

From Physicians Weekly:

According to published reports, up to 75% of ED patients present with pain-related complaints, and more than half come to the ED with severe or moderate pain. Pain management is a fundamental component of emergency medicine, but there are barriers to providing effective pain control in the ED. “There is growing tension between the ethical and professional obligations of emergency physicians (EPs) to treat pain and their reluctance to contribute to the growing problems of opioid abuse and diversion,” explains Arvind Venkat, MD.

A more in-depth understanding of how to resolve issues surrounding ethical pain management in the ED may help EPs in their efforts to treat pain. In an article published in Academic Emergency Medicine, Dr. Venkat and colleagues proposed an ethical framework to address the clinical dilemmas surrounding the management of pain in ED patients. “Given the frequency of ED patients presenting with pain and the barriers to effective pain relief, it’s important to recognize the ethical issues that can affect the treatment of pain in this setting,” says Dr. Venkat.