Is Anthem’s ER policy legal? Health executives want state insurance director to weigh in

From the Post-Dispatch:

A few health care industry executives have sent a letter to Missouri’s insurance director, asking her to take a “hard and earnest look” at Anthem’s emergency room policy and whether it is legal.

This summer, Anthem began warning members that if they were to go to the ER for a minor ailment, then the patients would be stuck with the entire bill. Anthem said it would no longer cover emergency visits for such ailments as the common cold amid what Anthem said is an increasing trend of unnecessary ER visits by its members.

“We think this policy is unfair to policyholders, and downright dangerous for patients,” according to a letter dated July 27 and addressed to Insurance Director Chlora Lindley-Myers.

Virtual ER Cuts Down on Wait Times

From NBC Washington:

A Washington, D.C., hospital is using technology to cut down on emergency room waiting time.

Dr. Ethan Booker helped develop Tele-triage at MedStar Washington Hospital Center. From a command center in another part of the hospital, Booker can virtually visit patients who show up at the ER.

“The idea is that the patient will get seen by a doctor faster and will get blood work done, radiology done, and so by the time we have an open room, everything’s resulted and it expedites the care,” nurse Shannon Silsby said.

Since it began last year, Tele-triage has treated 15,000 patients. The hospital estimates ER wait times have been cut by more than 26 percent.

Doctor Competing in Ironman Performs CPR on Fellow Triathlete, Then Finishes Race

From People:

A doctor competing in an Ironman and trying to qualify for the sport’s world championships made an unexpected stop in the middle of the race, but not because of a flat bike tire or a leg cramp. Dr. Patrica DeLaMora spotted a fellow triathlete who had collapsed, so she jumped in to administer CPR. When the man was stable, she hopped back on her bike and finished the race.

While she doesn’t know what caused the medical emergency, she said she was “relieved, overwhelmed, happy” to later find out that the man survived.

“Any person who knows CPR or who’s medically trained would stop,” DeLaMora tells PEOPLE in an exclusive interview. “I think everyone should learn CPR.”

Billions in federal uncompensated-care funds to be cut starting in October

From Modern Healthcare:

Starting this October, the CMS could begin cutting billions in federal funds meant to help hospitals with uncompensated-care costs.

The Affordable Care Act mandated that Medicaid disproportionate-share hospital funds be cut by $43 billion between fiscal 2018 and 2025. During negotiations over the ACA, hospital lobby groups acquiesced to the cuts under the assumption that expanded coverage from the healthcare reform law would reduce the need for the funding.

Congress delayed the cuts, which were supposed to start in 2014, after hospitals complained that increased patient traffic wasn’t outpacing uncompensated-care costs. The most recent extension expires Sept. 30.

The agency announced its plans in a proposed rulemaking Thursday, sending shudders through the hospital industry since the Medicaid DSH program provides essential financial assistance to hospitals that care for the nation’s most vulnerable populations including the poor, children, the disabled and the elderly, according to Tom Nickels, executive vice president of the American Hospital Association.

Doctor: Helicopter ambulances are overused

From the Enterprise Journal:

Part of the problem with the air ambulance business is that it’s overused, said the medical director for the Center for Emergency Services at University Medical Center.

That and other issues, such as billing practices, eclipse the wonderful things helicopters do provide.

“We get way too many people that are flown for reasons that are less than needed,” said Dr. Damon Darsey, who is also an emergency medicine physician and former paramedic.