Rural Telemedicine for Mental Health Surges

From MedPage Today:

The use of telemedicine to deliver mental health services in underserved, rural areas of the U.S. has risen dramatically in recent years, but state-to-state distribution remains uneven, researchers reported.

An analysis of nationwide Medicare fee-for-service claims between 2004 and 2014 showed an average annual 45% increase in telemedicine single visits among rural patients, with dramatic variations across states.

Recognizing and Managing Elder Abuse in the Emergency Department

From Emergency Medicine:

An ED visit may offer the only opportunity to identify victims of elder abuse. Addressing elder mistreatment may dramatically improve quality of life or save the lives of these vulnerable patients.

VIDEO: Man demands drugs at gunpoint from Emergency Physician

From Fox 17:

Body cameras capture the tense moments when police encounter an armed man holding Emergency Room staff at gunpoint.

The dispatcher’s call to police, “all units be advised he has not fired the weapon he does have a pistol demanding money and drugs,” sent Gallatin Police Officer, Jared Roach racing to Sumner Regional Medical Center.

“When i got on scene drew my weapon exited vehicle and ran inside the ER,” said Roach..

The body camera on his vest records his search for the armed man.

“The suspect looked at me and what felt like about an hour was about two seconds. He drop the gun put his hands up. I ordered him to lay on the ground on his stomach and he complied with my commands,” said Roach.

The suspect, Terry Christenson dropped his weapon.

“If you have a minor health problem, don’t expect Anthem to pay for your ER visit”

From the Post-Dispatch:

Anthem Inc. says it will begin enforcing a policy in Missouri of refusing payment for certain visits to emergency rooms.

Starting this summer, if a Missourian with Anthem insurance shows up at an emergency room with a minor ailment such as a common cold that could have been treated at an urgent care center, the patient will be on the hook for the entire bill.

Anthem, the nation’s second-largest insurer and one of two companies still providing coverage on the state’s Obamacare exchange, has cited increasing costs related to inappropriate ER use as a need for tough stance on payment.

Iowa Tort Reform Signed Into Law

From the Iowa Medical Society:

Earlier today, Governor Branstad signed SF 465 – the IMS-crafted tort reform legislation. This legislation marks the culmination of decades of work by countless physicians throughout our state. “Today’s historic achievement is a victory for every physician, resident, and medical student in the state of Iowa. This success would not have been possible without the tireless work of so many individuals to give the house of medicine a strong voice in the legislative process. I am delighted to begin my tenure as President of the Iowa Medical Society with enactment of these sweeping reforms.” said newly-installed IMS President Joyce Vista-Wayne, MD, DFAPA.

SF 465, which will take effect July 1, 2017, enacts the following reforms:

  • A $250,000 Cap on Noneconomic Damages, With Some Exceptions
  • Strengthened Expert Witness Standards
  • A Certificate of Merit in all Medical Liability Suits
  • Expanded Candor Protections


The Role of Medicaid in Rural America

From the Kaiser Family Foundation:

This brief describes Medicaid’s role for 52 million nonelderly children and adults living in the most rural areas in the United States and discusses how expansions or reductions in Medicaid could affect rural areas. It shows:

  • Rural populations face significant challenges to their health care coverage and access. People who live in the most rural counties of America are spread across almost 2,500 counties that are heavily concentrated in the South and Midwest. Individuals living in rural areas are less likely to be employed and more likely to be low-income than individuals living in other areas. Individuals in rural areas also face significant barriers to accessing care, including provider shortages, recent closures of rural hospitals, and long travel distances to providers.
  • Medicaid plays a central role in helping to fill gaps in private coverage in rural areas. Although private insurance accounts for the largest share of health coverage in rural areas, nonelderly individuals in rural areas are less likely to have private coverage compared to those in urban and other areas (61% vs. 64% and 66%, respectively). Medicaid helps fill this gap in private coverage, covering nearly one in four (24%) nonelderly individuals in rural areas. Further, in many states, Medicaid coverage rates are higher in rural areas than in urban or other areas of the state. In some cases, these differences are large. For example, in California, the Medicaid coverage rate in rural areas is 16 percentage points higher than in urban areas, and Hawaii has a 13 percentage point difference between Medicaid coverage rates in rural and other areas. Similarly, rural areas in Arizona, Arkansas, and Florida have a Medicaid coverage rate that is about ten percentage points higher than the rate in urban or other areas.
  • The Affordable Care Act (ACA) Medicaid expansion led to coverage gains in rural areas. Prior to the ACA Medicaid expansion to low-income adults, rural areas in Medicaid expansion and non-expansion states had similar rates of Medicaid coverage. However, in rural areas that expanded Medicaid, the Medicaid coverage rate increased from 21% to 26% between 2013 and 2015, while it increased by just one percentage point, from 20% to 21%, in rural areas of non-expansion states. As a result, as of 2015, nonelderly individuals in rural areas within non-expansion states were nearly twice as likely to be uninsured as those living in expansion states (15% vs. 9%).

Additional action to expand Medicaid within the 19 states that have not yet adopted the Medicaid expansion would likely lead to further increases in coverage among individuals living in rural areas. These non-expansion states are home to 59% of nonelderly uninsured individuals living in rural areas. Conversely, cuts to Medicaid could disproportionately affect people living in rural areas given the large role of the program in these areas.


“10 best and worst states for nurses” (Wisconsin is #1, Iowa is #3)

From Becker’s:

To identify the best and worst states for nurses, WalletHub analysts compared the 50 states and the District of Columbia based on 18 metrics that speak to the opportunities for nursing jobs in each market. Each metric was graded on a 100-point scale, with 100 representing the most favorable conditions for nurses.

Here are the 10 best states for nurses based on the analysis.

1. Wisconsin — score of 59.55 out of 100

2. New Mexico — 58.61

3. Iowa — 58.49

4. Texas — 57.98

5. Colorado — 56.55