Illinois is running last in the race to provide telehealth to rural communities

From the News-Reporter:

In many states across the U.S. — and even countries around the world — telehealth has proven itself a good way to provide key healthcare services to rural and underserved populations, but Illinois is running last in that race.

“They actually put out grades for states and Illinois has been down in the D, sometimes towards the F, in the grades,” said Suzanne Hinderliter, vice president of telehealth services for OSF HealthCare. “We have not come into the 21st century with this.”

It’s not for lack of technology, but, in part, a problem with legislation. Parity laws need to be passed to guarantee reimbursement for telehealth services, said Hinderliter.

“We have healthcare insurance companies that will not reimburse for telehealth services. And although we do get reimbursement from medicare and medicaid, it’s fairly limited,” she said. “In order for us to provide the care to the patients when and where we need it, we have to get reimbursed for that or it becomes a problem for us in order to provide that care.”

Personal Injury Law Firms Are Serving Ads to People While They’re in the ER

From Gizmodo:

Injury lawyers have historically used catchy jingles and memorable slogans to entice recovering patients to secure their services. Now, the 20-second TV or radio spot might soon be replaced with ads sent directly to the phones of patients as they sit in emergency rooms.

NPR reports law firms specializing in personal injury are working with at least one digital marketing company to set up “geofences,” virtual perimeters that can be used to connect ad technology with a cellphone’s physical coordinates. Geofencing marketing is used to serve ads to people in small, specific geographical areas. In other cases, festivals or concert venues. In this case: hospitals. Marketer Bill Kakis told NPR that his company has geofenced “pretty much” every hospital in downstate New York and has now closed deals to advertise injury attorneys to people seeking medical care in the Philadelphia area.

Is There a Doctor on the Plane? Increasingly, Airlines Hope Not

From Bloomberg:

A medical emergency sets in motion a high-altitude calculation with human lives in the balance. While pilots are the ultimate decision-makers, airlines have earth-bound medical consultants that help bypass on-board volunteers — reducing expensive emergency landings, but with the potential of providing expert decisions in real time.

Why airlines hope physicians aren’t on board during medical emergencies

From Becker’s:

Physicians and other clinicians are called upon to help passengers during in-flight medical emergencies, but airlines often prefer the guidance of on-the-ground consultants in order to avoid diversions, according to Bloomberg.

A medical emergency occurs once every 604 flights, with 7.3 percent leading to diversions that ground the plane, according to a study The New England Journal of Medicine. While it is standard protocol to first find out if a medical professional is on board before calling a consultant, a diversion can cost as much as $200,000, and airlines look to avoid these diversions whenever possible.

Passenger clinicians are more likely to recommend diversions, so airlines rely on contracted consultants on the ground, who are less likely to recommend to such action, to guide pilots. Though the final decision rests with pilots and dispatchers, they rely heavily on the advice of consultants.

Best Buy tests remote home monitoring services for seniors

From Becker’s:

echnology retailer Best Buy wants to build onto its tech support services by keeping its older customers healthy, and it is beginning with a new pilot service called Assured Living, according to CNBC.

Although Best Buy is often tied to televisions and computers, it told investors on its most recent earnings call that it is exploring health tools as part of its strategy to address “key human needs in areas such as entertainment, productivity, communication, food preparation, security, and health and wellness.”

“We already assort a variety of health-related products and technology products designed for seniors like specially designed phones and medical alert systems,” CEO Hubert Joly said, according to CNBC. “One of the things we’ve talked about is how technology can help people stay in their home for longer and there’s a lot of excitement around helping people do that. … [Technology] improves people’s health and wellness and reduce[s] healthcare costs for the country.”


Current practices and safety of medication use during rapid sequence intubation

From the Journal of Critical Care:


  • Rapid sequence intubation medication practices vary amongst providers throughout the United States
  • Medications are often used inappropriately based on patient hemodynamics and contraindications
  • Ketamine was associated with hypotension post-RSI
  • Succinylcholine was given to 67% with baseline bradycardia and was significantly associated with bradycardia post-RSI
  • Sedation practices post-RSI were not consistent with national guidelines in the majority of patients



Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events.

Materials and methods

This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation.


A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%). During RSI, 21%, 87%, and 77% received pre-induction, induction, and paralysis, respectively. Significant differences in medication use by provider type were seen. Etomidate was administered to 58% with sepsis, but was not associated with adrenal insufficiency. Ketamine was associated with hypotension post-RSI [RR = 1.78 (1.36–2.35)] and use was low with traumatic brain injury/stroke (1.5%). Succinylcholine was given to 67% of patients with baseline bradycardia and was significantly associated with bradycardia post-RSI [RR = 1.81 (1.11–2.94)]. An additional 13% given succinylcholine had contraindications. Sedation practices post-RSI were not consistent with current practice guidelines and most receiving a non-depolarizing paralytic did not receive adequate sedation post-RSI.


Medication practices during RSI vary amongst provider and medications are often used inappropriately. There is opportunity for optimization of medication use during RSI.

Achieve Work-Life Balance: Move to the Country!

From MedPage Today:

Most of my professional life has been spent working in rural or semi-rural hospital emergency departments. After my residency in a large urban trauma center, I moved to the rural Southeast and worked in a 10-bed ED with a yearly volume of about 23,000 per year. The facility grew, the group grew and so did the volume. Eventually, I left that job for locums work. Although I worked in hospitals of various sizes, I tended to focus my locums activities on smaller, often “critical access” facilities.

I have spent a lot of time (and ink) trying to convince physicians to practice in the small hospitals of rural America. But why should they? Before I attempt to say why rural practice is wonderful, I need to honestly address the difficulties.

ACEP Proposes a Physician-Focused Alternative Payment Model

From ACEP Now:

In August 2015, after MACRA passed, ACEP established a task force to help develop an APM geared toward emergency medicine. Until that point, most alternative payment arrangements were not designed to include emergency care in any meaningful way. The APM Task Force spent its first year evaluating numerous concepts centered around improving value and quality of emergency services. After intense internal work by the task force and inclusion of additional data analysis performed by a retained consultant, ACEP submitted a proposal for a new APM, the Acute Unscheduled Care Model (AUCM): Enhancing Appropriate Admissions, to the PTAC in September 2017. If recommended by the PTAC and then approved by the secretary, the AUCM will serve as an advanced APM, allowing emergency physicians who choose to participate to potentially be eligible to receive a five percent Medicare Part B payment bonus. (Advanced APMs are APMs that meet certain criteria established by MACRA, including the requirement that participants take on a nominal amount of financial risk for the services they provide under the model.)

How a Tiny Kansas Town Rebooted Its Struggling Hospital into a Health Care Jewel

From Politico Magazine:

Four years ago, Kearny County Hospital had to turn away patients because it didn’t have enough doctors to treat them. It was losing $100,000 a year in its maternity ward. County commissioners wanted to avoid the fate of other rural communities, which have lost 83 hospitals across the country in the past eight years. Often, the solution is to stop delivering babies. More than half the rural counties in the country no longer have a labor and delivery unit in their hospitals; in Kansas, nine rural obstetrics units have shut down in the past 10 years, and six more are planning to close soon, says Michael Kennedy, associate dean for rural health education at the University of Kansas School of Medicine.

But Kearny County went the other way.

Sepsis Treatment Through Outpatient Follow-Up Yields Positive Outcomes in Some Patients

From Contagion Live:

When patients are diagnosed with sepsis in the emergency department, they are usually admitted to the hospital as the swiftest course of action to treat the life-threatening condition. Investigators on a new study have found, however, that a small subset of patients who are diagnosed with sepsis in the emergency department are discharged after initial treatment, and then seen through outpatient follow-up without a negative impact on patient outcomes.

According to the study, which was presented at the 2018 American Thoracic Society Conference, May 18-23, 2018 in San Diego, California, and conducted by investigators from Intermountain Medical Center in Salt Lake City, Utah, about 16% of patients diagnosed with sepsis in the emergency department are released for outpatient management. Principal investigator Ithan Peltan, MD, MSc, a pulmonary and critical care medicine specialist and researcher from Intermountain Medical Center in Salt Lake City, remarked on this in a news release on the study, stating, “We found that many more emergency department patients with sepsis are discharged from the ED than previously recognized, but by and large these patients had fairly good outcomes.”