Fewer U.S. hospitals can care for children

From Reuters:

The research showed consolidation of care into regional centers for both adults and children over the decade studied. But the move to regional care for children far outpaced that for adults.

The likelihood of a hospital completing a child’s care without a transfer dropped by 65 percent from 2004 to 2014, while the likelihood of a hospital completing an adult’s care without a transfer fell by 11 percent, the study found.

Dr. Nicholas Mohr, a professor at the University of Iowa Carver College of Medicine in Iowa City, said doctors have seen the trend in hospitals throughout the U.S. But the number of children transferred between Massachusetts hospitals surprised him.

“Fewer children are being cared for in community hospitals,” he said in a phone interview. “The big question is whether that’s good or bad.”

What does $15 billion in overdue bills mean for doctors and hospitals in Illinois?

From Modern Healthcare (hat tip: Dr. Menadue):

Illinois may finally have a budget, but it could take months, even years, for the state to pay down its $15 billion in overdue bills.

What does that mean for health care providers? Be patient. You’re in for a long wait.

Of the bill backlog that swelled amid the state’s epic budget war, about $3 billion is owed to health insurers contracted to cover the bulk of the state’s Medicaid recipients. That debt has created a domino effect: Insurers have slowed or completely stopped making payments to doctors, who have struggled to pay their staff and been forced to turn away the state’s most vulnerable patients.

Embedded Clinical Decision Support in Electronic Health Record Decreases Use of High-cost Imaging in the Emergency Department: EmbED stud

From SAEM:


The objective was to evaluate the impact of evidence-based clinical decision support tools integrated directly into provider workflow in the electronic health record on utilization of computed tomography (CT) brain, C-spine, and pulmonary embolism (PE).


Validated, well-accepted scoring tools for head injury, C-spine injury, and PE were embedded into the electronic health record in a manner minimally disruptive to provider workflow. This was a longitudinal, before/after study in five emergency departments (EDs) in a healthcare system with a common electronic health record. Attending ED physicians practicing during the entire study period were included. The main outcome measure was proportion of CTs ordered by provider (total number of CT scans of a given type divided by total patients seen by that provider) in aggregate in the pre- and post intervention period.


There were 235,858 total patient visits analyzed in this study with an absolute decrease of 6,106 CT scan ordering for the three studies. Across all sites, there was greater than 6% decrease in utilization of CT brain and CT C-spine (–10%, 95% CI = –13% to –7%, p < 0.001; and –6%, 95% CI =–11% to –1%, p = 0.03, respectively). The use of CT PE also decreased but was not significant (–2%, 95% CI = –9% to +5%, p = 0.42). For all CT types, high utilizers in the pre-intervention period decreased usage over 14% in the post-intervention period with CT brain (–18%, 95% CI = –22% to –15%, p < 0.001), CT C-spine (–14%, 95% CI = –20% to –8%, p = 0.001), and CT PE (–23%, 95% CI = –31% to –14%, p < 0.001). For all three studies, the average utilizers did not change their usage practices. For CT brain, the low utilizers also did not increase usage but for CT C-spine and CT PE usage was increased (+29%, 95% CI = 10% to 52%, p = 0.003; and +46%, 95% CI = 26% to 70%, p < 0.001, respectively).


Embedded clinical decision support is associated with decreased overall utilization of high-cost imaging, especially among higher utilizers. It also affected low utilizers, increasing their usage consistent with improved adherence to guidelines, but this effect did not offset the overall decreased utilization for CT brain or CT C-spine. Thus, integrating clinical decision support into the provider workflow promotes usage of validated tools across providers, which can standardize the delivery of care and improve compliance with evidence-based guidelines.


41% of Rural Hospitals Operating with Negative Margins

From RevCycleIntelligence:

Approximately 41 percent of rural hospitals faced negative operating margins in 2016, a recent Chartis Group and iVantage Health Analytics study of over 2,100 rural hospitals revealed.

Researchers added that rural hospitals located in states that elected not to implement a Medicaid expansion program operated with lower margins compared to their peers in expansion stated.

Antimicrobial Stewardship in the ED: The Buck Stops Here

From Urgent Matters:

Emergency physicians have a unique vantage point to affect antimicrobial stewardship in inpatient and outpatient settings.

The initial choice of antibiotic in the Emergency Department (ED) has important downstream implications. ED clinicians routinely prescribe antimicrobials for patients with skin and soft-tissue infections, urinary tract infections, bloodstream infections, as well as upper and lower respiratory infections. Broad-spectrum antibiotics are sometimes overused in EDs and other ambulatory settings, and in observational studies have shown significant overprescribing for acute bronchitis and other conditions.

Antimicrobial stewardship in ED settings is particularly challenging due to the high rates of ED crowding, the rapid rate of patient turnover, the need for quick decisions without consultation, the shift-based scheduling format of providers, and higher staff turnover rates than in other clinical settings. In addition, there are provider-centered factors that impact stewardship. This includes a perceived lack of efficacy, concerns about resource availability and reimbursement, as well as perceived hindrance to operational efficiency. Providers are also concerned about medical liability and patient satisfaction, which has shown to be an important facet of antibiotic prescription in the ED.