U.S. telehealth industry eyes Medicare for its next big check

From Reuters:

After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions.

Four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the United States’ huge over-65 health program Medicare from reimbursing doctors’ and medical visits, which often start over the phone.

The bills come at a time when the industry’s claims of cost savings – powered by apps and mass smartphone usage – have begun to gain traction with private insurers striving to save on healthcare costs.

What Do Emergency Department Visit Data Say About Risk?

From Healthcare Analytics News:

When Seattle Children’s Hospital researchers set out to examine how to identify social complexity risk factors in children using various state data, they hoped that pinpointing kids with notable challenges early on could lead to better health supports, helping families build resilience and addressing unmet needs.

Soon, investigators turned to data on emergency department visits, confident that the numbers might provide insights into how these populations were using the facilities and how healthcare stakeholders could better serve them.

Looking at emergency department visits, they theorized, could confirm that social complexity risk factors—like homelessness, involvement with the child welfare system, and mental health issues in their parents—were associated with adverse outcomes, says Kimberly C. Arthur, MPH, a clinical research scientist at the hospital and a co-author on the corresponding study.

Physician coalition ‘taking on the insurance industry’ in battle over surprise medical bills

From Fierce Healthcare:

Surprise medical bills and narrow networks aren’t just a problem for patients, they’re a problem for physicians. Now a coalition of doctors is taking aim at the problem and pressing for more states to adopt legislation to solve it.

 Physicians for Fair Coverage is a nonprofit, nonpartisan, multispecialty alliance of physician groups that got its start in 2016 and has been advocating to end the surprise insurance gap and improve patient protections. The group includes tens of thousands of emergency physicians, anesthesiologists and radiologists from across the country who each year serve tens of millions of patients.

“We’re really taking on the insurance industry,” Michele H. Kimball, the group’s President and CEO, said in an interview with FierceHealthcare.

The physicians’ group has taken up the fight as patients’ out-of-pocket medical expenses are increasing and insurance coverage is narrowing.
For some patients, that’s resulting in surprise medical bills, created when a patient seeks care at an in-network hospital but is then surprised the doctor treating them is out of their insurance company’s network—a fact they usually find out when they get the doctor’s bill.

It’s a costly and aggravating situation for patients and for doctors who are waiting to get paid.

When doctors need to learn “webside” manner

From Marketplace:

Wait times in emergency rooms are often extremely high, partly because so many people use the emergency room as their regular doctor’s office. And that can be expensive. A study from the Network for Excellence in Health Innovation found that overuse of emergency rooms by people seeking routine care leads to $38 billion in excess spending each year.  

One hospital dealing with this is New York-Presbyterian in Manhattan, where at least 30 percent of ER visitors are there for nonurgent medical issues, like a rash or cold. Now for those less serious cases, the hospital is offering patients a chance to see a doctor via telescreen. It’s one of several new digital programs the hospital is offering.

“If you’ve ever been to the emergency department, the actual interaction with the physician could be five, 10 minutes,” said Dr. Rahul Sharma, who’s leading the program. “There’s some patients that wait 30, 45 minutes at times just to leave the emergency department.”

In a telemedicine visit, Sharma said that checkout time is eliminated. But getting patients through quickly and safely means that getting that initial triage right is going to be critical. Sharma said it’s worked with the patients so far. One who has tried it out is Dwayne Grayman, an actor who lives in Harlem.

Rural communities recruiting foreign workers for hard-to-fill local jobs

From the Missoulian:

Cherie Taylor, CEO at Northern Rockies Medical Center (NRMC) in Cut Bank, currently has four Filipina nurses on her staff. The rural health facility employs a total of 12 full-time registered nurses, which includes 10 floor nurses and two nursing administrative positions.

“We have a national registered nurse shortage and all the U.S. nurses cannot fill the vacancies,” she said. “Thank goodness a lot of Baby Boomers are hanging on and not retiring, or we would be in a national crisis right now.”

NRMC might be recruiting a fifth nurse from the Philippines if a final vacancy isn’t filled with a nurse from the United States.

Sepsis: the Achilles’ heel of health care

From STAT (opinion):

As health care systems look to lower costs and improve patient outcomes, controlling sepsis is a great place to start. Ignoring that opportunity is a huge mistake.

Sepsis is caused by the body’s exuberant response to an infection. It is the No. 1 inpatient hospital expense in the United States, with costs tripling over the last decade to $27 billion. Nearly half of all hospital deaths are caused by sepsis. And the problem is growing — it’s now one of the top five causes of hospitalization in age groups over 18. This is why a comprehensive plan to detect, treat, and prevent sepsis must be an essential pillar of any serious effort to improve care and drive down costs.

An empirical approach to assessing training needs for emergency department management of intentional self-harm and related behaviors in the United States

From the J Educ Eval Health Prof.

The emergency department (ED) is the only healthcare setting that guarantees a same-day mental health evaluation, making this location a viable option to patients in imminent need. As such, the ED is frequently the first place of contact for patients to seek and/or receive care for mental health needs [1]. Despite the prevalence of mental health concerns that emergency medicine residents are expected to manage, residents often receive inadequate training in this area [2,3]. There is a need for empirical approaches to evaluate training needs and progress. Moving forward, it would be helpful for studies to assess detailed aspects of care for which residents may report that they need more targeted training. This data-based approach to improvement would ensure that the often-limited resources of residency training programs (e.g., time and faculty allotment) can best be used to improve the capacities in the greatest need of support. The primary purpose of this paper is to demonstrate how training programs can use a short, empirically-driven survey to evaluate their training needs. We hypothesized that such an instrument would yield a breadth of information applicable for assessing our training program’s needs. This study presents the approach of an emergency medicine residency training program to develop an instrument for the evaluation and formative assessment of emergency medicine residents throughout the course of residency. We present data from this training program’s first iteration of using this instrument to assess current attitudes towards and knowledge of patients with mental health-related issues.

Nebraska hospital transitions away from full-service care

From the Independent:

A hospital in eastern Nebraska has completed a transition from being a full-service operation to one focused more heavily on ambulatory surgery.

The changes to Midlands Hospital in Papillion are part of a national move to provide more outpatient care as opposed to inpatient services, the Omaha World-Herald reported .

Midlands opened a $2.4 million ambulatory surgery center last year as part of a larger $4.4 million renovation. The center has a dozen private patient rooms, four operating rooms and one procedure room. Patients tend to stay at an ambulatory center less than 24 hours.

“We’re not going anywhere,” said Dr. Patricia Murdock-Langan, vice president of medical operations at Midlands and Lakeside Hospitals. “We’re here for the community. But we are changing. We want to make sure we’re on the forefront, not the back side.”

Frequent Utilizers of Emergency Departments: Characteristics and Intervention Opportunities

From Psychiatric Annals:

Patients who frequently use emergency departments (EDs) have been termed “frequent or high utilizers.” They disproportionally account for almost one-quarter of all ED visits and pose a tremendous socioeconomic and staff labor burden to health care systems. Although there is no agreed upon definition of how many ED visits define frequent use, this patient population shares common sociodemographic, diagnostic, and service use characteristics, in addition to high incidences of mental health and substance abuse problems. Various interventions have been successfully employed to reduce frequent ED visits. Case management (CM) is the most successful intervention. Although primary care access is a necessary element for EDs, successful reduction models must encompass additional interventions, including proper identification of frequent visitors, intensive CM with staff skilled in mental health and substance abuse interventions, partnership with community mental health and substance abuse treatment entities, and referrals to stable housing. This article reviews the common characteristics of ED frequent utilizers and reduction interventions.


Geisinger, Dignity Health among first hospitals to pilot Apple’s medical records system

From Becker’s:

Danville, Pa.-based Geisinger Health System, San Francisco-based Dignity Health and Baltimore-based Johns Hopkins Medicine will be among the first 12 hospitals nationwide to pilot Apple’s medical records system, The San Diego Union-Tribune reports.

  • While many hospitals and health systems already provide patient portals and other programs for patients to access their health information, Apple aims to embed patient data from multiple providers into the iPhone’s main system. This “deep integration” function could help improve smartphone users’ health by allowing patients to grant permission for other app developers to use the data to help provide the best deals on medications and connect patients taking the same medications, among other features, the report states.
  • Because the health records are stored on the patient’s device, users can send that information to any provider they choose — even those whose EHR systems are not directly compatible with the system the patient’s primary provider uses, according to Cheryl Pegus, MD, director of the division of general internal medicine and clinical innovation at the New York City-based NYU School of Medicine.