57% of Americans have been surprised by a medical bill, most say insurers are to blame

From Becker’s:

Fifty-seven percent of Americans say they’ve received a surprise medical bill they thought would be covered by insurance, according to a recent survey conducted by NORC at the University of Chicago.

NORC polled 1,002 individuals from a nationally representative sample of Americans using the AmeriSpeak Panel, a probability-based panel NORC designed to be representative of the U.S. household population.

The survey also asked respondents which groups — payers, hospitals, physicians or pharmacies — are most responsible for surprise medical bills. Here’s the proportion of respondents that said each group was “very” or “somewhat” responsible:

  • Payers: 86 percent
  • Hospitals: 82 percent
  • Physicians: 71 percent
  • Pharmacies: 64 percent


Highmark to pay ambulance companies for treating patients outside hospital

From Becker’s:

Highmark and Allegheny Health Network, both in Pittsburgh, launched a pilot program under which Highmark will reimburse ambulance companies for some calls where patients are not taken to a hospital, according to Trib Live.

Under the new “treat-and-release” program, which the organizations announced Aug. 29, Highmark will contract with 16 emergency medical services. The health insurer will reimburse the companies for treating adult patients with seizure disorders, low blood sugar and asthma attacks outside the hospital. This bypasses a requirement that ambulance companies only receive payment when a patient is taken to an emergency department.

Is the Wage Gap Between Doctors and CEOs Why Healthcare Is So Expensive?

From Motley Fool:

The relatively small proportion of spending on prescription drugs and the absence of widening margins for big insurers raises an important question: What else could be to blame for increasing healthcare costs? According to a recent study, the answer might be wages for doctors and healthcare CEOs.

Analyzing pay trends at 22 major health systems between 2005 and 2015, researchers at University Hospitals Cleveland Medical Center and Case Western Reserve University found that the average compensation for medical center CEOs surged 93% to $3.1 million during the period, a rate that far exceeded the 3% average increase in registered nurses’ pay.

Video games make physicians better in emergency decisions, study finds

From STAT:


Doctors who played the game Saulnier designed did a better job on a separate virtual simulation designed to test their clinical judgement about trauma transfers than those who used a text-based app or nothing at all, according to new research published Monday in the Proceedings of the National Academy of Sciences. The study found a similar result for doctors who played a story-based adventure game from Schell Games, also for the iPad.

What’s driving America’s rural doctor shortage?

From the Lown Institute:

Salary and lifestyle considerations also play a large role in determining where doctors practice. Residents of rural counties are generally older, lower-income, and in worse health than people who live in urban areas. Therefore doctors in rural areas are more likely to be reimbursed through Medicare or Medicaid, which pays less than private insurance, and could be punished financially for having a sicker and poorer patient pool. Also, counties that have difficulty attracting residents have difficulty bringing in doctors, many of whom are young and may be looking for a more fast-paced lifestyle.

HHS’ OIG ponders new legal protections for value-based care models

From Modern Healthcare:

HHS wants to encourage providers to enter value-based care agreements with each other, and it’s researching whether it can offer new legal protections for those arrangements.

HHS’ Office of Inspector General will accept comments from stakeholders on how it can modify or add new safe harbors to the anti-kickback statute to prevent providers in value-based pay models from facing civil money penalties, according to a notice issued Monday.

“OIG has identified the broad reach of the anti-kickback statute and beneficiary inducements (civil monetary penalties) as a potential impediment to beneficial arrangements that would advance coordinated care,” the agency said in the notice.

Revitalizing Health in Rural Appalachia

From Route Fifty:

“We started talking about potential solutions,” he said. “I thought the best solution, instead of the people from Sequatchie County coming to Erlanger for health care, was Erlanger coming to them. But, initially, people at Erlanger didn’t think what I was suggesting was even feasible.”

Winick, along with county officials, worked to get federal and state authorization to reopen the emergency department. After years of negotiations, investments of $250,000 from ARC and the county, and a long-term lease agreement for $1 per year, Erlanger reopened the 12,000-square-foot facility in July 2014, featuring 24-hour care for children and adults. Doctors could treat common ailments, from broken bones and sports injuries to bouts of the flu, while patients suffering from more serious issues—stroke, heart attack—could be air-lifted to other facilities.

EHRs Leave Docs, Patients Unsatisfied, Study Shows

From Healthcare Informatics:

Even after full implementation, electronic health records (EHRs) are leaving doctors and patients unsatisfied, according to a new study.

The study, by researchers at Lehigh University and the Lehigh Valley Health Network in Pennsylvania, surveyed physicians, mid-level providers and non-clinical staff at ob-gyn practices where EHRs were installed and analyzed survey answers given by patients. While there have been several studies looking at how EHR implementation affects provider and patient satisfaction, the researchers attest that this is the first study of how the integration of outpatient and hospital EHR systems affects provider and patient satisfaction.

Published in the Journal of the American Medical Informatics Association, the study tracked two ob-gyn practices and a regional hospital from 2009 to 2013, during implementation of an EHR system and its subsequent integration with the hospital system. The EHR was installed in 2009 and information began flowing from the hospital to the ob-gyn practices in mid-2011. Full two-way exchange of clinical information was achieved a year later.

While initial frustrations are expected after an implementation, researchers in this study found that even after the EHR was established, both doctors and patients still expressed dissatisfaction. In the early stages, doctors and staff expressed frustration at learning a new system and the time it took to enter information. By the end of the study, staff appreciated ease with retrieving information and doctors felt communication and care were improved. Doctors, however, were also less satisfied by the system overall, citing the time it took to enter data, changes to workflow and decreased productivity.

The Top 10 Changes to ATLS 10th Edition

From SGEM:

Here are the top 10 changes to ATLS 10th Edition according to Dr. Parry. You can listen to the SGEM podcast on iTunes to hear Neil expand on all the points listed below.


Top 10 Changes to ATLS 10th Edition

#1 – No More Lectures

All interactive case – based discussions

Students need to read manuals!

True adult education – no spoon feeding

#2 – New Skills Stations

Case-based unfolding scenarios for A,B,C,D,E’s

No longer anatomy based

More student interaction

A Two-Center Validation of “Patient Does Not Follow Commands” and Three Other Simplified Measures to Replace the Glasgow Coma Scale for Field Trauma Triage

From the Annals of Emergency Medicine:

Study objective

Out-of-hospital personnel worldwide calculate the 13-point Glasgow Coma Scale (GCS) score as a routine part of field trauma triage. We wish to independently validate a simpler binary assessment to replace the GCS for this task.


We analyzed trauma center registries from Loma Linda University Health (2003 to 2015) and Denver Health Medical Center (2009 to 2015) to compare the binary assessment “patient does not follow commands” (ie, GCS motor score <6) with GCS score less than or equal to 13 for the prediction of 5 trauma outcomes: emergency intubation, clinically significant brain injury, need for neurosurgical intervention, Injury Severity Score greater than 15, and mortality. As a secondary analysis, we similarly evaluated 3 other measures simpler than the GCS: GCS motor score less than 5, Simplified Motor Score, and the “alert, voice, pain, unresponsive” scale.


In this analysis of 47,973 trauma patients, we found that the binary assessment “patient does not follow commands” was essentially identical to GCS score less than or equal to 13 for the prediction of all 5 trauma outcomes, with slightly superior positive likelihood ratios (eg, those for mortality 2.37 versus 2.13) offsetting slightly inferior negative ones (eg, those for mortality 0.25 versus 0.24) and its graphic depiction of sensitivity versus specificity superimposing the GCS prediction curve. We found similar results for the 3 other simplified measures.


In this 2-center external validation, we confirmed that a simple binary assessment—“patient does not follow commands”—could effectively replace the more complicated GCS for field trauma triage.