Rural Hospitals Closing at an Alarming Rate

From HealthLine:

By increasing the number of people with health insurance, the Medicaid expansion directly benefitted rural hospitals.

In states that expanded Medicaid, “we saw two important trends — reduction in uncompensated charity care and a reduction in the number, or the velocity, of the rural hospital closures,” Dr. Daniel Derksen, director of the Arizona Center for Rural Health, told Healthline.

Nineteen states, though, opted not to expand Medicaid. In those states, the suffering among rural hospitals is palpable.

The Chartis report found that Mississippi, Louisiana, Georgia, and Texas all have particularly high rates of vulnerable rural hospitals. At the time the report was released, none of those states had expanded Medicaid.

“Surprise” Gaps in Health Insurance Coverage Need Solutions

Press Release:

ACEP Calls for Fair Coverage for Patients in New England Journal of Medicine

“Insurance companies have been taking gross advantage of patients and emergency medical providers for years and with greater frequency since the enactment of the Patient Protection and Affordable Care Act, by raising deductibles and arbitrarily slashing payments to physicians by as much as 70 percent. They are able to do so because the Emergency Medical Treatment and Labor Act (EMTALA) requires 100 percent of emergency patients be seen, regardless of insurance or ability to pay,” wrote Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians (ACEP) in a letter published in the New England Journal of Medicine (NEJM).

In her letter, Dr. Parker pokes holes at a recent NEJM perspective article about out-of-network billing, saying it “fails to provide a fair assessment of so-called ‘surprise billing’ in emergency care,” and calls into question the reliability of the data used by Yale University researchers Zack Cooper, PhD., and Fiona Scott-Morton, PhD in their Nov. 17th article [Out-of-Network Emergency-Physician Bills – An Unwelcome Surprise].

“As soon as we saw the outrageous claim that patients received thousands of dollars in balance bills from emergency physicians we knew we had to respond strongly and quickly” said Dr. Parker. “It’s simply not true. We know that as an industry the balance bills of emergency physicians are less than $200 on average. Our state-based data demonstrates this and sets the record straight.”

Additionally, an analysis of out-of-network emergency billing in Florida found the practice of balance billing to be rare, according to Dr. Parker.

“The true story is that our patients are being saddled with high-deductible plans that cover very little,” said Dr. Parker. “Emergency physicians and ACEP have a long history of standing up for emergency patients when the insurance companies default on their moral obligations to cover patients in their greatest hours of need. From the anti-dumping legislation in the 1980s known as EMTALA to the HMO era of the 1990s and prudent layperson emergency physicians are speaking up for their patients and against the abuses of the for profit insurance industry.”

The solution to out-of-network billing, according to Dr. Parker, is the newly implemented Connecticut law that uses an independent and transparent charge database.

“Emergency physicians are calling for transparency by insurance companies and use of independent databases, such as Fair Health (www.fairhealth.org],” said Dr. Parker. “We’ve made it clear that patients need affordable health care that covers them when they need it most – during an emergency. Our patients deserve fair coverage. Their lives depend on it.”

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

ACEP Outlines Top Priorities for Replacing ACA, Following President Trump’s Speech to the Nation

Press Release:

Maintaining emergency services as a covered benefit and preserving the federal “prudent layperson” standard are top priorities for emergency physicians as Congress debates repeal and replacement of the Patient Protection and Affordable Care Act (ACA), according to Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians (ACEP).  Dr. Parker today urged Congress to enlist the help of the nation’s emergency physicians in the replacement process, following President Trump’s speech to the nation last night.

“Emergency physicians care for more than 140 million patients each year, and more than 500 emergency physicians will be in Washington, DC two weeks from now to meet with members of Congress and to advocate on behalf of our patients,” said Dr. Parker.  “I and the 35,000 emergency physicians I represent want to work with Congress and the Trump Administration to cultivate a health care system that expands access for all patients, encourages innovation and ensures the continued availability of health care providers and services.”

Dr. Parker said the nation’s emergency departments focus on the traditional mission of providing urgent and life-saving care, although the role has expanded over past decades to encompass safety net care for uninsured and under-insured patients, as well as public health surveillance, disaster preparedness and filling gaps in care caused by physician shortages.

ACEP issued the emergency medicine health care reform principles that it considers indispensable to any replacement legislation.  The principles are aimed at maximizing access to medical care while improving its quality and lowering its costs.

  • Maintain emergency services as a covered benefit for any insurance plan.
  • Ensure the federal Prudent Layperson Standard extends to Medicaid fee-for-service and that compliance measures are in place for all other health plans.  The prudent layperson standard requires health insurance companies to cover claims based on a patient’s symptoms, not the final diagnosis.  It means, for example, if a patient has chest pain, but the diagnosis is a less urgent medical condition, such as a panic attack, the health insurance company must cover the emergency visit.
  • Require health insurance transparency of data used to determine in- and out-of-network reimbursement rates for their patients’ medical care. Ensure appropriate reimbursement rates for emergency services.
  • Eliminate need for prior authorization for emergency services and guarantee parity in coverage and patient co-payments for in- and out-of-network emergency care services.
  • Retain protections for pre-existing conditions, no lifetime limits and allowing children to remain on their parents’ insurance plan until age 26.
  • Enact meaningful medical liability reforms, including protections for physicians who provide federally-mandated EMTALA-related services, care for patients in a federally declared disaster area and who follow clinical guidelines established by national medical specialty societies.
  • Ensure any continuation or expansion of Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Association Health Plans (AHPs) and Individual Health Pools (IHPs) provide meaningful health insurance benefits and coverage for individuals and families, including access to emergency care services.
  • Repeal the Independent Payment Advisory Board (IPAB) and the excise tax on high-cost employer health benefit plans. Delay repeal of the Center for Medicare and Medicaid Innovation (CMMI) until at least 2020 or amend to eliminate mandatory provider participation in Medicare models. This will allow an adequate transition period for the Transforming Clinical Practice Initiative (TCPI) grants aimed at lowering costs, improving health outcomes and delivering more effective care.
  • Acknowledge the role of freestanding emergency centers and other health care delivery models as crucial to encouraging coverage innovation.
  • Protect the most vulnerable populations in this country by making sure Medicare, Medicaid and CHIP remain available and solvent for current and future generations.

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

 

Emergency doc training important to improving transgender care

From ReutersReuters:

The negative experiences of transgender and gender nonconforming patients in U.S. emergency departments could be avoided with better training for doctors, suggests a new study.

Based on survey responses from 240 transgender and gender nonconforming people, researchers say negative experiences were often attributable to doctors’ lack of knowledge.

“The biggest recommendation that came out from what we saw and what participants actually said was training,” said Dr. Makini Chisolm-Straker, the study’s lead author from the Icahn School of Medicine at Mount Sinai in New York. Training of medical staff “should be systematic and it should be required.”