Tag: "ER"

Saturday Night Special?

This Phil Galewitz piece ran in the Washington Post back in August, but it’s still timely:

“Many hospitals are actively recruiting people to come to the ER for non-emergency reasons,” said Anthony Keck, South Carolina’s Medicaid director, citing facilities that tout their speedy ER service on highway billboards. “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims,” he said.

Dallas-based Tenet Healthcare Corp., a large hospital chain some of whose facilities have seen a surge of patients using the ER for primary care, recently began accepting online appointments to make it easier for patients to use the ER. It’s also promoting average waiting times on the Internet and on billboards…

Medicaid officials in Washington state were so concerned by hospitals’ ER marketing that they issued new rules making it harder for hospitals to qualify for Medicaid bonus payments if they promote their ER for primary care. “They sure don’t help us when we are trying to get word out that the ER is not the place you go for primary-care diseases like treating asthma or diabetes,” said Jeffrey Thompson, chief medical officer for the state Medicaid program.

HT to Trudy Liberman at The Health Care Blog.

Oct 24, 2011 | 3 comments | by

Hospital ER Visits Up Since Mass Health Reform Enacted

To determine whether any changes in ED utilization in Massachusetts reflected the effect of Massachusetts’ reform or were merely representative of broader regional trends in ED utilization, we used New Hampshire and Vermont as control states…

The data on combined inpatient and outpatient ED [Emergency Department] use (top graph) suggest that the Massachusetts reform did not change the state’s trend in total ED utilization relative to that in states where no such reform was enacted. The continuous upward trend in ED utilization throughout the three periods is remarkably consistent from state to state; if we didn’t know which state had implemented the reform law, we could not guess on the basis of these data….. In summary, ED use increased in Massachusetts after reform but also increased by similar amounts in New Hampshire and Vermont, states that did not implement insurance expansions.

NEJM article here.

Sep 19, 2011 | 5 comments | by

Making Cigarette Smoking Uncool

Pause to consider the logic here. We decide it is not a good idea to let the government ban this product, or to require a doctor’s prescription to consume it. We think everyone should be allowed to consume it if they choose. But, we also decide it is a good idea to let government to decide if this product can seem “cool.”

Actually, I see a fundamental contradiction in the idea of government regulating “cool.” While we have many social processes which tell us about what others might approve or disapprove, the “cool” process seems inherently decentralized, and not to be mediated by authorities. We the masses are supposed to each decide what we think is “cool,” and we are not supposed to accept declarations by teachers, employers, etc. on the subject. Whatever authorities recommend as a good idea, it can only accidentally be “cool.”

“Cool” just doesn’t seem the sort of thing government can actually regulate.

This is from Robin Hanson. See also Megan McArdle, plus gruesome pictures.

Jun 27, 2011 | 8 comments | by

Here’s How to Reduce ER Traffic

Play reruns of American Idol. This is David Henderson, at Econlog:

Last night, my wife, who’s recovering from a bad cold, suddenly had trouble breathing. At about 10:00 p.m., I took her to the local emergency room. When she was giving her data to the nurse who checked her in, I commented on how few people were in the ER compared to the number I expected. She answered, “American Idol must be on tonight.”

“Really?” I said.

“Oh, yes,” she said. “When American Idol is on or when football playoff games are on, we get way fewer people coming in. Also, we have a lot of ‘regulars’ and that number tends to drop off when American Idol, or football games, or the Grammies are on.”

Feb 04, 2011 | 9 comments | by

Quality Low at Notable University Hospitals

In terms of overall quality of care, for instance, many notable facilities–including George Washington University Hospital, Stanford Hospital, Johns Hopkins Hospital and the University of Chicago Medical Center–performed in the bottom 25 percent of all hospitals nationwide. Nearly 90 percent of all university hospitals performed below the national average for orthopedic care, while 85 percent were below the national average for general surgery, according to the study, which was published on behalf of healthcare information service company.

Full article on university hospital quality here. HT to Michael Ramlet.

Nov 08, 2010 | 3 comments | by

Expect Emergency Room Visits to Soar

One of the most oft-repeated arguments for health reform is that uninsured patients make costly and delayed trips to the ER when they do not have a health plan that pays for care at physicians’ offices. Insure the uninsured, it is said, and they will decrease their reliance on the ER and get prompter, less costly care elsewhere.

Yet, as an AP story reported the other day, ER traffic in Massachusetts is higher than ever before. And as I predicted at the Health Affairs Blog, the number of such visits under the new national health reform is likely to soar.

Read More » »

Jul 21, 2010 | 13 comments | by

Emergency Room “Frequent Fliers” Have Health Insurance

A survey of the literature found 85% of emergency room “frequent fliers” have health insurance.  Most of these had seen a primary care physician in the past year.

Sixty percent of frequent ER users (four or more visits per year) were enrolled in public coverage — either Medicaid or Medicare — compared with only 36% of occasional emergency room users.

Apr 16, 2010 | 7 comments | by

In Defense of Emergency Room Care

  •  While the past decade has seen dramatic increases in the use of emergency care and ER crowding, ER care is but a tiny portion of the U.S. health care pie: less than 3 percent. 
  • The claim that unnecessary visits are clogging the emergency care system is untrue: Just 12 percent of ER visits are not urgent. 
  • The marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors. 
  • Despite the belief that the uninsured and undocumented flood ERs, most emergency room patients are insured U.S. citizens. 
  • ER abuse (such as the tale of nine patients in Texas, eight of them drug users, who were responsible for a whopping 2,700 ER visits in six years) is the exception, not the rule.
  • Most “frequent flyers”—a pejorative term used to describe patients who stop by ERs a lot—tend to be the very sick, those with severe asthma, heart failure, or diabetes.

 Full article on unnecessary ER visits.

Mar 23, 2010 | 8 comments | by

More Quality Competition

Across the nation, hospitals are trumpeting shortened wait times in ERs in hopes of attracting more patients:

  • In Arizona, Scottsdale Healthcare System advertises emergency room wait times for its four hospitals online and on a flat screen in each hospital’s emergency waiting room.
  • Edward Hospital in Naperville, Ill., sends text messages back to prospective patients with its wait times.
  • Some Healthcare Corp. of America hospitals in west Florida post wait times on billboards, according to reports from the St. Petersburg Times. “Accidents happen fast. Emergency care should, too,” reads one electronic billboard, which also lists wait times.
  • Other hospitals are testing a service where patients register online and pay a fee to hold their spot while they wait at home.
  • The Hospital of Central Connecticut has an iPhone application listing wait times and directions to the hospital.

Full article on more efficient hospital emergency rooms.

Mar 23, 2010 | 6 comments | by

One of the Nation’s Most Efficient Emergency Rooms

The old system whereby patients were triaged by a nurse, registered by a clerk and then sent back to the triage nurse and the waiting room was thrown out. Instead, hospital staff spend much of their time moving around the patients. For example, blood tests and blood pressure tests are now often done in the waiting room and a mobile suture cart means patients can be stitched up where they sit.

Full article on Seven Oaks ER.

Mar 08, 2010 | 3 comments | by
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