How RFID Technology Improves Hospital Care

From the Harvard Business Review:

When redesigning the new and expanded emergency room at the Mayo Clinic’s Saint Marys Hospital in Rochester, Minnesota, Mayo leaders didn’t just want to add more rooms and square feet. They saw it as an opportunity to completely transform the operation to improve care and the patient experience and to lower costs. To that end, they decided to have a team study how care is delivered, identify the barriers to smooth operations, and fix the barriers. In other words, they created a living lab of the Clinic’s largest emergency department.

The successful experience illustrates the role that relatively simple technology (e.g., an RFID system) and a multidiscipline team of clinicians and people from other fields can play in improving the quality and cost of care delivery processes and the steps that can ease the way to applying such an approach. The project was launched in 2013, and the RFID system was rolled out in stages starting in the summer of 2015. It was fully integrated into emergency room operations at St. Marys during the fourth quarter of 2015.

Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems

From the Rural Health Research Gateway:


In January, 2015, Department of Health and Human Services (HHS) Secretary Burwell announced new goals and timelines for moving Medicare reimbursement from fee-for-service to value-based payment. These payment changes are driving delivery system reforms (DSR) by making health care organizations more accountable for patients’ health as well as population and community health. Payment and delivery system reform, however, is concentrated in urban centers, and Medicare rural payment policies that were designed to strengthen rural health providers and systems are now complicating payment and delivery system reform in rural areas. The inclusion of rural providers in Medicare payment reform is critical for the program and for the 23 percent of Medicare beneficiaries who reside in rural areas. Rural Medicare beneficiaries should have the same opportunity as their urban counterparts to benefit from payment reform’s positive effects including strengthened primary care, embedded care coordination, and improved clinical quality. In this paper, we describe five recommendations to facilitate rural inclusion in value-based payment and delivery system reform:

  1. Organize rural health systems to create integrated care.
  2. Build rural system capacity to support integrated care.
  3. Facilitate rural participation in value-based payments.
  4. Align Medicare payment and performance assessment policies with Medicaid and commercial payers.
  5. Develop rural appropriate payment systems

This Indianapolis ER doctor is really LinkedIn

From the IndyStar:

Profeta, an emergency room physician at St. Vincent Indianapolis, has a long history of voicing sometimes controversial perspectives on common situations. The piece he wrote that brought him to Cutter’s attention appeared in Nuvo in March 2014 and took on parents who push their children to excel at sports. Titled “Your kid and my kid are not playing in the pros,” the piece provides several examples of overzealous parents who prioritize their child’s athletic participation over their health.

Emergency room physicians such as himself have a unique window onto the world, said Profeta, who has worked at St. Vincent since 1993.

Opioid Abuse: A Primary Care-Created Problem?

From Medscape:

One point that I found surprising is that the CDC guideline recommends that primary care physicians preferentially prescribe immediate-release opioids rather than extended-release or long-acting formulations, at least at the start of therapy. I usually try to transition my patients with chronic pain to long-acting formulations as quickly as possible and reserve immediate-release opioids for breakthrough pain. However, the guideline found that long-acting formulations are associated with a higher risk for overdose among patients initiating opioid therapy. There is also no evidence that continuous use of scheduled long-acting opioids relieves pain better than intermittent dosing of short-acting opioids.

Another recommendation that I will consider incorporating into my practice is prescribing naloxone to patients at increased risk for opioid-related harms, such as patients with a history of overdose or a history of substance abuse, patients using benzodiazepines, and patients using more than 50 morphine milligram equivalents per day. The New York City Health Department provides a useful online calculatorto convert doses of various opioids into morphine milligram equivalents. Although only community-based naloxone distribution has been shown to prevent opioid overdose deaths, writing prescriptions for naloxone rescue kits to high-risk patients in primary care settings feels no less appropriate than writing prescriptions for epinephrine autoinjectors for patients at high risk for anaphylactic reactions.

Temple study finds opioid prescribing guideline significantly decreases prescription rates

Press Release:

Emergency medicine physicians at Temple University Hospital have found that an opioid prescribing guideline had an immediate and sustained impact on opioid prescribing rates for minor conditions and chronic noncancer pain in an acute care setting. The results of the study are published in the January 2016 Journal of Emergency Medicine.

The United States is in the midst of a crisis regarding the abuse of prescription drug opioids. According to the Centers for Disease Control and Prevention, the U.S. death rate from prescription opioid overdose now exceeds the combined death rates from heroin and cocaine.

Acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain. Emergency physicians have identified themselves as targets for patients who seek opioids for nonmedical purposes. Given the difficulty in striking a balance that provides appropriate analgesia for patients without creating or exacerbating drug dependence, the U.S. Department of Health and Human Services recommends the synthesis of pain management guidelines and the creation of clinical decision support tools.

Temple University Hospital (TUH) and Temple University Hospital-Episcopal Campus (TUH-Episcopal) were among those that created a guideline for prescribing opioids in order to maximize safety and avoid misuse.

“The impact of this type of guideline had never been studied in an acute care setting,” says Daniel del Portal, MD, FAAEM, Assistant Professor of Clinical Emergency Medicine at the Lewis Katz School of Medicine at Temple University, Assistant Director of Clinical Operations at TUH and Jeanes Hospital, and principal investigator of the study. “We hypothesized that the rate at which opioids were prescribed in the emergency department for dental, neck/back and chronic pain would decrease after adoption of the guideline. We also hypothesized that physicians would support the use of the guideline.”

The retrospective observational study compared the rate of opioid prescriptions for dental, neck/back and chronic noncancer pain before and after adoption of the guideline in January 2013. The research team used data from 13,187 patients aged 18 years or older who met the diagnosis criteria and were discharged from the emergency departments at TUH and TUH-Episcopal.

The team also administered a survey to the faculty emergency medicine physicians who were practicing in the two emergency departments.

Results showed the prescribing guideline had an immediate and sustained impact in reducing opioid prescribing rates for all age groups and for each of the three categories of complaints with a high degree of statistical significance. Also, 100% of physicians surveyed supported implementation of the voluntary guideline. Most (97%) felt the guideline had facilitated discussions with patients when opioids were being withheld, and nearly three-quarters of respondents reported encountering less hostility from patients since adoption of the guideline.

“Emergency physicians and other acute care providers can use various tools to promote the rational prescribing of dangerous opioid medications,” adds Dr. del Portal. “In contrast to electronic prescription drug monitoring programs, which show promise but require significant infrastructure and regulation (and are as yet unavailable to prescribers in Pennsylvania), an easily implemented guideline empowers physicians and protects patients from the well documented dangers of opioid misuse.”


Other physicians contributing to the study include Dr. Robert M. McNamara, Dr. Megan E. Healy and Dr. Wayne A. Satz from the Department of Emergency Medicine at the Lewis Katz School of Medicine.

About Temple Health

Temple University Health System (TUHS) is a $1.6 billion academic health system dedicated to providing access to quality patient care and supporting excellence in medical education and research. The Health System consists of Temple University Hospital (TUH), ranked among the ‘Best Hospitals’ in the region by U.S. News & World Report; TUH-Episcopal Campus; TUH-Northeastern Campus; Fox Chase Cancer Center, an NCI-designated comprehensive cancer center; Jeanes Hospital, a community-based hospital offering medical, surgical and emergency services; Temple Transport Team, a ground and air-ambulance company; and Temple Physicians, Inc., a network of community-based specialty and primary-care physician practices. TUHS is affiliated with the Lewis Katz School of Medicine at Temple University.

The Lewis Katz School of Medicine (LKSOM), established in 1901, is one of the nation’s leading medical schools. Each year, the School of Medicine educates approximately 840 medical students and 140 graduate students. Based on its level of funding from the National Institutes of Health, the Katz School of Medicine is the second-highest ranked medical school in Philadelphia and the third-highest in the Commonwealth of Pennsylvania. According to U.S. News & World Report, LKSOM is among the top 10 most applied-to medical schools in the nation.

Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System (TUHS) and by the Katz School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents.

Disclaimer: AAAS and EurekAlert! ar

Key Performance Indicators Help EDs Remain Profitable

From McKesson:

Emergency departments face special challenges when it comes to managing the revenue cycle. Not only are many of their patients uninsured, but the documentation requirements for coding to the appropriate level of service typically are more rigorous and complex in the ED than in other specialties.

To help groups stay sharp, Simpson has identified some key performance targets that all emergency medicine groups should strive to achieve:

  • Chart Completion Percentage: End of Month-95% and at Month 2-100%

    Groups should develop a systematic process for monitoring patient charts to make sure that all necessary documentation is included. McKesson, for example, has developed a proprietary platform that collects data needed to file claims and flags practices regarding any open issues.

    “What you’re trying to avoid are charts that are sent back from coding because they’re missing critical information. That can really kill timely reimbursement and consistent cash flow,” Simpson said.

‘Chest pains’: secret password to full-scale emergency room treatment

From Newsworks:

No one likes going to the emergency room. It generally means that the day isn’t exactly going your way. For interminable hours, you’ll thumb through back issues of Yachting World in a room full of people seething with anxiety, micro-organisms and resentment. If you ever wondered what magic words will allow you to jump ahead in line, past the 6-year-old with an action figure stuck up his nose, the guy with the steak knife protruding from his forehead, and the woman going into labor with triplets, here they are: “chest pains.”

That was what I said to the receptionist in the ER on an otherwise lovely Friday night. I was whisked so quickly into a private room you would’ve thought I had said, “Ebola.” Suddenly, the entire cast of “Grey’s Anatomy” was hooking me up to machines that beeped and booped.


When are you dead? It may depend on which hospital makes the call.

From the Post:

…. the American Academy of Neurology issued new guidelines for hospitals for determining brain death — the condition that legally demarcates life from whatever lies beyond. Those standards, according to Yale University,  neurologist David Greer, who worked on them, are meant to ensure that no patient is declared dead unless they really are beyond all hope of recovery.

“This is truly one of those matters of life and death, and we want to make sure this is done right every single time,” he told NPR.

But five years later, according to a study led by Greer that was published in the journal JAMA Neurology Monday, not all hospitals have adopted the guidelines.

Many continue to receive opioid prescriptions after overdose

From Reuters:

Almost all people who overdose on prescription opioids continue to receive prescriptions for these painkillers, according to a new study.

The researchers used Optum, a national commercial insurance claims database, to identify almost 3,000 patients who experienced a nonfatal overdose between 2000 and 2012 while taking long-term opioids prescribed for chronic pain not related to cancer. Opioids include drugs like codeine, oxycodone, hydrocodone, hydromorphone, and tramadol.

Just over 90% of these patients continued to receive prescription opioids after the overdose. More than half got the prescription from the same doctor.

Opioid addiction treatment argued as ‘essential’ insurance benefit

From Modern Healthcare:

Physicians, social workers and consumer advocacy groups are putting pressure on the CMS to require all health plans sold on the federal exchange to cover medications used to treat people with opioid addictions.

More than 28,600 people died in 2014 due to overdoses from prescription painkillers, heroin and other opioids, according to a recent analysis from the Centers for Disease Control and Prevention. The federal government has viewed opioid abuse as a “public health crisis” and last month asked healthcare experts if medication-assisted treatment (MAT) for opioid addiction should be included within the healthcare law’s mandated insurance benefits to help address the problem.

Numerous hospital associations, psychiatrists, primary-care physicians, executives at drug-abuse treatment centers and recovering opioid addicts supported the idea in comments to the CMS this week, although several large insurers and pharmacy benefit management companies argued the benefit should be left up to their discretion.