Tag: "ER"

A Market is Emerging for ER Care


Medical entrepreneurs are remaking the emergency room experience. They’re pulling the emergency room out of the hospital and planting it in the strip mall.

It’s called a “free-standing ER,” and some 400 of them opened across the country in the past four years.


The waiting room, furnished with brown leather armchairs and a coffee station worthy of a spa, is empty because patients are usually seen right away.


Free-standing ERs can make a lot of money because they charge ER prices. A visit that might have cost $200 at an urgent-care center can cost four or five times as much at an ER.

Source:Kaiser Health News.

ER vs. Doctor’s Office, and Other Links

Do low-income patients go to the emergency room rather than a doctor’s office because they prefer the emergency room?

Patients in Medicare Advantage plans got expensive balloons and stenting to clear coronary arteries at a rate 31 percent lower than patients in traditional Medicare, and angiography procedures were 36 percent lower. But geographical variation is still large and we don’t know if this was good for patients.

45% of the nation’s nearly 28 million uninsured workers are employed by large firms, subject to the ObamaCare mandate.

Oregon Helps Reduce Health Care Costs, and Other Links

Oregon is reinventing the Jeffrey Brenner techniques; maybe they should meet Dr. Brenner.

Can a blood test reveal your life expectancy?

Should Medicare pay for a $3,000 test that allows early diagnosis of Alzheimer’s disease?

The Market for Pain Relief


Overdose deaths

ER Costs

Source: The New York Times.

Maybe This is Why You Have to Wait So Long

The emergency department would seem, at first glance, to be one of the more bustling spaces in medicine. With multiple patients in critical condition, it seems like it would be hard for doctors and other health providers to find a spare minute.

Except it’s apparently not that hard at all: A new study (flagged by Michael Ramlet of The Morning Consult) finds that for every hour emergency department workers use a computer, they spend an average of 12 minutes on Facebook — and that time on the site actually goes up as the department becomes busier.

From Sarah Kliff.

ER: The Gateway to Hospitalization

A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009. During that time, hospital admissions grew only 4% — not even keeping pace with population growth. But ER-related admissions jumped 17%. (ModernPhysician.com)

Why this is important: about half of the newly insured under ObamaCare will get insured by Medicaid, and Medicaid patients use the emergency room twice as often as privately insured patients. Also, hospitals are buying doctors, who will be pressured to admit patients once they get to the emergency room.

A Million-Dollar Patient

This is what happens when the government ignores Dr. Jeffrey Brenner:

For more than two decades, Wanda Remo has battled one illness after another. Asthma, chronic lung disease, heart disease, high blood pressure, arthritis, depression, chronic pain, strokes. Specialists treat her lungs, her heart and her joints.

Her litany of ailments brought her to emergency rooms six times last year, between numerous additional visits to a federally subsidized health clinic in South Los Angeles.

“You are one of the million-dollar patients,” her doctor, Derrick Butler, tells the 57-year-old as she leans on her walker during one appointment. (LA Times)

Headlines I Wish I Hadn’t Seen

At least 28 former Max Baucus aides are now tax lobbyists.

Obama to health insurance executives: We are now “joined at the hip.”

ObamaCare regulations: photo.

Return emergency room visits after discharge not counted in readmission rates.

What Did He Expect?

Michael Millenson on the government’s attempt to get everyone to use electronic health records:

Now we come to the behavior that really should inspire the outrage. We as a nation paid out billions in bribes because so many physicians simply refused to believe they could benefit from an EHR that the hospitals dependent on those doctors for admissions refused to buy computerized records no matter what the evidence. The vendors, aiming to ease the transition when hospitals did buy, designed clumsy interfaces based on provider habits and inefficiencies from the paper world. When the market finally changed, all the bad stuff got baked in: difficult interfaces and missing functionality that frustrated physicians; poor customer service from vendors puffed up with profits; absurd flaws ­— a medical record less searchable than a ten-year-old PC ― that were never corrected while piled-on new features created a kluge-job catastrophe.

Then there were the unintended consequences that occur when any innovation is taken to scale. Is it any surprise that academics focusing on efficiency and clinical improvement were blindsided by sharpies who focused, instead, on how EHRs could help game the reimbursement system to make more money? Is it a surprise that a new technology deployed in a hurry can be downright dangerous as well as helpful? Unfortunately, painting a picture of a panacea was useful for public relations purposes, but prompted a widespread backlash when reality set in.

Hospitals Game the System

One hospital group encouraged its docs to exaggerate the severity of patient conditions and needlessly admit patients from the ER to hospital beds in order to bill more for their treatment. Another hospital group that owns three hospitals and also partially owns an ambulance company was making patient transfers (using their own ambulance company despite slower response times) a top priority — to the extent that a doctor’s transfer rate was a factor in bonuses and performance reviews. An admin email stated that “the performance we are looking for are transfers.”

This is from Roy M. Poses.