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Private emergency room opens in former Johnny Carino’s building – Waco Tribune-Herald

A privately owned emergency room called Express ER will open Saturday in the former Johnny Carinos building at 1411 N. Valley Mills Drive, where patients can receive treatment for everything from headaches to heart attacks, a spokeswoman said.

Express ER represents an alternative to the Premier ER and Urgent Care locations that have opened in Woodway and on Interstate 35 near University Parks Drive, also owned by private investors.

We considered several sites around Waco and looked hard at the travel counts along Valley Mills Drive, which we believe is an under-served area of Waco, said Paula Hatfield, regional administrator for Express ER, which operates other emergency facilities in Temple and San Antonio and plans another in Harker Heights.

Hatfield said the services of Express ER and Premier ER are similar, but she does not view the two medical providers as competitors.

We have the same model of concierge medicine, but were here for the patient, not to compare ourselves to Premier, she said. There is enough patient volume in Waco for us all to do well.

Five physicians, including three who previously worked in the emergency room of Providence Health Center, pooled their resources to create Express ER in Waco. They spent about $3 million to convert the vacant restaurant space into a 6,500-square-foot, full-service emergency facility, Hatfield said.

We do everything the traditional emergency room can do but we believe we do it more economically and more compassionately, Hatfield said. We usually can get you seen in less than 5 minutes and have you out in under an hour.

She said four to six doctors certified in emergency medicine will rotate through the shifts at Express ER, which will welcome patients 24 hours a day, seven days a week. Express ER does not accept patients transported by ambulance, though Premier ER does.

We will transfer patients to local hospitals if necessary, usually meaning they will need to stay longer than 24 hours, she said.

About 25 support staffers, including registered nurses, imaging technicians and front-office personnel, will join doctors in providing care at the emergency facility. They will have at their disposal an ultrasound machine, CT scanner, digital X-rays and a laboratory, according to information provided by Hatfield.

The facility will take all private health insurance but will not accept Medicare, Medicaid or Tricare, which is a civilian medical benefits program for members of the military, their dependents and retirees.

Doctors who partnered to create and staff Express ER in Waco include Matt Burge, Josh Parker and Chris Nelson, who previously practiced in the Providence ER; Robb Dies, who worked in the emergency room at Baylor Scott & White Hillcrest Medical Center; and Daniel Akers, who serves as general partner for all Express ER locations, including Wacos, Hatfield said.

She said each new Express ER typically has different investors.

Premier ER has opened two privately operated emergency facilities in Greater Waco, the latest arriving in the fall of 2016 next to Twisted Root Burger Co. restaurant and across Interstate 35 from Baylor University.

Like Express ER, it is staffed with physicians certified in providing emergency care. It also offers laboratory services, X-rays, CT scans and ultrasounds, according to Dr. John Hamilton, president and chief medical officer of Premier, which opened its first facility at 9110 Jordan Lane in Woodway in August 2014.

Josh Hamilton said an investment group that includes physicians owns Premier ER and Urgent Care. About a dozen doctors and seven physician assistants, or nurse practitioners, see patients at the two locations.

At Express ER, patients are seen exclusively by doctors, never by a physician assistant, Hatfield said.

Each Premier ER facility represents an investment of between $6 million and $8 million, Josh Hamilton said.

Paul Hamilton, vice president of Premier ER and an investor, said the two facilities in Greater Waco have seen 48,000 patients since the first location opened in 2014. About 70 percent of those were treated in the Urgent Care area that typically sees people suffering from sore throats, coughs, colds and simple lacerations.

Our busiest location is the one near downtown, Paul Hamilton said. Magnolia Market at the Silos had 171,000 visitors over spring break, and there were some minor health issues.

Original post:
Private emergency room opens in former Johnny Carino’s building – Waco Tribune-Herald


New policy impacts emergency room visits for customers of BCBS i … – WRCB-TV


The Affordable Care Act may survive next year, but North Georgia patients who depend on it are now learning there’s a catch. Starting in July, the health insurance provider Blue Cross Blue Shield of Georgia will stop covering emergency room visits it deems unnecessary.

The insurance provider sent letters explaining the new policy to patients. It said if patients with individuals policies go to the ER and it’s not an emergency they will be stuck footing the bill.

Everyone’s definition of an emergency is totally different, said Travis Marler.

Blue Cross Blue Shield of Georgia customers have a lot to say about a new policy meant to lower the number of ER visits. They’ll try and get you. The hospitals will get you, for a tiny aspirin, they will get you for it, said Kristie Digges.

The company is steering patients who do not need emergency care to their personal physicians or urgent care clinics. They don’t want people to use the emergency room as their primary health care.

“They are supposed to accept any kind of patient. Whether it is minor, whether it is major, or a child being born, they are supposed to expect.

There are some exceptions to the new policy. It won’t apply to kids under 13 years old, members who don’t have an urgent care clinic within 15 miles of their address, or visits on Sundays and major holidays. If a baby is sick, it is an emergency to a young mother. But if my son’s hurt at his rodeo and stuff it might not be an emergency to me, said Marler.

A spokesperson with the company said patients should use their best judgment. But some people are worried patients who belong in the ER may not go. I think it is crazy. If you get a cut this big and they are saying it is not an emergency and they expect you to pay, I think it is stupid, said Digges.

The company said it was forced to take action because of the rising cost of health care. North Georgia residents said the restrictions are one more challenge in affording health care. It is not fair how insurance is today. It is hard for most people to afford it with they make.

Channel 3 checked with Blue Cross Blue Shield of Tennessee. A spokesperson here in Chattanooga said no one with Blue Cross Blue Shield of Tennessee coverage will be impacted by this change.

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New policy impacts emergency room visits for customers of BCBS i … – WRCB-TV


Blue Cross in Georgia to limit emergency room coverage – MyAJC

The Obamacare exchangemay survive next year in rural Georgia. But patients who depend on its last remaining insurer are now learning theres a catch.

Over the past week letters have arrived at homes throughout the state giving patients a jolt. Blue Cross Blue Shield of Georgia, the only insurer on the exchange for 96 of the states 159 counties, is telling patients with individual policies that if they go to the emergency room and its not an emergency, theyll be stuck with the bill.

I am very concerned, said Dr. Matthew Keadey, who leads an organization of ER doctors. He fears patients who need the ER but arent sure they do will avoid it now. If this is fully implemented, I think were going to have deaths out there because of it.

Blue Cross move could stick Keadey and his colleagues with unpaid bills if non-emergency patients continue to come but cant pay. But patients also are concerned.

Really, like what the (heck)? said Sharon Tarver, a patient in Sumter County who has Blue Cross through the exchange, as she described her reaction when she first read the letter.

It was like, OK, well when you think about people that go when they dont have an emergency, they are taking up time for people who have an emergency, that does make sense, Tarver said. But in her area there are only two urgent care clinics, and they close at 8 p.m. and 9 p.m. She recalled two incidents in the past two years when she went to the emergency room, once with chest pain and once with a cough that reminded her of her mothers lung cancer. They both turned out to be something else.

Would she still go now, after the letter?

It depends. Its a half of one hand and half the other, she said.

Trying to change habits

A spokeswoman for Blue Cross said patients with a legitimate fear of an emergency would still be covered and that the company was forced to act by the rising cost of health care.

The policy defines an emergency as what a prudent layperson would think could pose a serious danger, and it says the insurer will decide what makes that cut. It takes effect July 1. Blue Cross says it wont apply to kids 13 and younger, members who dont have an urgent care clinic within 15 miles, or visits on Sundays and major holidays.

This is not to discourage somebody with an emergency condition who needs to go to an ER to go there, said the spokeswoman, Debbie Diamond. Health care is becoming more and more expensive. Its a way to make sure that people are getting quality and affordable care.

Many pressures may have forced the tipping point. Health care prices are always rising, and Obamacare insurance was more expensive to provide at first than companies thought. This year the Trump administration has especially rattled insurance companies by waffling on whether it would continuesubsidies key to funding Obamacare exchange plans.

Blue Cross parent company, Anthem, was reportedly leaning toward pulling out of many states exchange markets. But two weeks ago itsignaled it may stay in Georgias.

And the fact is that patients who use the emergency room like their personal clinic do waste money, a lot of it.

How much is not really known. Keadey quotes data saying a small percentage of ER patients should be getting their care somewhere else.State Rep. Terry England, a co-chairman of a committee that studied how to stabilize rural hospitals, said its much more. But neither disputes that the letter is at least partly aimed at shaking up those people who know they shouldnt be at the ER.

What Im interpreting is its because theyre trying to change habits and get people to focus on going to their physician and not to the ER, England said.

It kind of comes across as cold and callous maybe, the way that theyre doing it, he said. But at the same time, it may be one of the few ways that you actually are able to maintain hospitals andkeep the doors of hospitals openacross the state.

Keadey acknowledged the existence of problem patients. But his larger concern was patients who belong at the ER and may not go.

Patients are not trained to recognize emergencies, he said. What it really is is a barrier to emergency care. Patients will die because theyre going to think twice about going to the emergency department. One person goes and it turns out they just had reflux or a stomach problem; the next person has the symptoms and its a heart attack.

To me its one more way that were seeing the insurance company trying to take their financial responsibility and place it back on the patient.

Sore throat not enough

Diamond said Blue Cross understood patients had to use their best judgment. If you are having chest pains and it turns out to be indigestion, she said, you still thought you were having chest pains. So you could go to the emergency room.

On the other hand, she said, obvious examples where you should not go to the ER would be if you had cold symptoms; if you have a sore throat.

Blue Cross is steering those patients who dont need emergency care to their personal physicians, urgent care clinics or to Blue Cross 24-hour online medical service, LiveHealth Online. The service requires using an app on a computer or on a phone with internet service. It wont work off a rotary phone, for example.

Most people now have cellphones or computers, said Diamond, the Blue Cross spokeswoman.

Not everyone does. Middle-age policymakers might not understand that because a study by the Pew Research Center found that 95 percent to 99 percent of U.S. adults up to age 50 in 2016 used the internet one way or another. But with older people that number falls off a cliff. And with lower-income people and those in rural areas, it can be harder.

We have so many people that come to the library just to have access to a computer and the internet, said Kirk Lyman-Barner, an insurance agent in Sumter County. And thats closed in the evening of course.

Is it an emergency?

In a May 19, 2017, letter to customers, Blue Cross Blue Shield of Georgia said that starting July 1 it would no longer cover non-emergency visits to emergency rooms. This is the definition it gave for emergencies:

Emergency or Emergency Medical Condition means a medical or behavioral health condition of recent onset and sufficient severity, including but not limited to, severe pain, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness or injury is of such a nature that not getting immediate medical care could result in:

(a) placing the patients health or the health of another person in serious danger or, for a pregnant woman, placing the womans health or the health of her unborn child in serious danger;

(b) serious impairment to bodily functions; or

(c) serious dysfunction of any bodily organ or part.

Such conditions include but are not limited to, chest pain, stroke, poisoning, serious breathing problems, unconsciousness, severe burns or cuts, uncontrolled bleeding, or seizures and such other acute conditions as may be determined to be Emergencies by us.

Exceptions to the rule

According to Blue Cross, the rule will not apply if:


If it happens in Washington or under the Gold Dome, The Atlanta Journal-Constitution has somebody there to tell you what it means for all Georgians. Follow our coverage at

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Blue Cross in Georgia to limit emergency room coverage – MyAJC


Orioles’ Welington Castillo went to emergency room after ball hit … – Baltimore Sun (blog)

Orioles catcher Welington Castillo required a hospital trip Tuesday night into Wednesday morning and landed on the disabled list with a testicular injury after a pitch that hit New YorkYankees shortstop Didi Gregorius deflected down into his groin area, manager Buck Showalter said.

Castillo spent a lot of time in the emergency room last night, postgame, with the obvious contusion, whatever you want to call it, that he had last night that everybody knows about, Showalter said before the game.

Hes got a hematoma there in his groin that were going to monitor and see how it progresses. But we wouldnt use him tonight to catch, and now, were trying to decide whether were going to DL him or not. So weve got the possibilities in place, and were going to make a decision here shortly.

With Castillo not able to catch Wednesday and Caleb Joseph starting, plus the absence of emergency catcher Ryan Flaherty (shoulder), a move to add a catcher was required.

Francisco Pea, who was up with the team for two weeks earlier this month before being designated for assignment on May 17, was added to an open spot on the 40-man roster.

Showalter said the angle of the ball into that area was what made the impact worse for Castillo, comparing it to the angle of the foul ball that caught Joseph in the groin last year and required him to sit out a month with a testicular injury.

Both injuries occurred in the ninth inning of games on May 30, one year apart.

Most of the time, if you look at the ones that really are the problem are the angles, when you get a different angle, like the ball that Gregorius got hit by, Showalter said. Looking back at Calebs, it was very similar with the angle.

In Castillo, the Orioles are losing their most consistent hitter for the second time this season. Castillo missed 13 games earlier this month with shoulder tendinitis. Hes batting .317/.339/.467 with four home runs, the steadiest line of any regular on the club.

Joseph, who entered Wednesday batting .253/.271/.422 with a pair of home runs and 10 RBIs, thrives with regular time, which he could get if Castillo needs to sit out. He hit .333 with an .881 OPS during Castillos two-week absence earlier this month.

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Orioles’ Welington Castillo went to emergency room after ball hit … – Baltimore Sun (blog)


Overdoses flood area emergency rooms – The Columbus Dispatch

Encarnacion Pyle The Columbus Dispatch @EncarnitaPyle

Charlie Stewart knew just what to do and say after paramedics brought the woman to the Mount Carmel West hospital emergency department after she nearly died of a heroin overdose.

She was crying, scared and didn’t want to walk out of the hospital only to use again. But she was new to Columbus and didn’t know the resources or whether she had the strength to attempt recovery again.

“She was in a bad place,” Stewart said.

After getting to know her and her situation, he helped get her signed up for Medicaid and into a detox bed within a matter of days.

“I want people to know that there’s hope,” he said. “And I want them to see the potential I see in them.”

Stewart is not a doctor, nurse or social worker. He’s a recovering addict who, through training and experience, knows a thing or two about what to do to upright a life. It’s what makes him so effective, his hospital colleagues say.

The hiring of peer-support coaches, who have been addicts themselves,is just one of many ways that local hospitals are trying to better support patients struggling with addiction and ending up in their emergency departments.

Between 2009 and 2014, Ohio saw the greatest jump in opioid-related emergency department visits of 44 states,with a 106 percent increase, according to a report by a division of the U.S. Department of Health and Human Services.South Dakota came in second with a 95 percent increase; Georgia, third, with an 85 percent jump.

In addition to treating overdoses, emergency department staffers also see people with skin and soft-tissue infections caused by their drug use or, in more serious cases, heart and spinal infections, said Dr. Alan Gora, chairman of Mount Carmel West’s emergency department.

The rate of hospital inpatient stays in Ohio because of opioid use also increased 52 percent from 2009 to 2014, according to the latest available data fromtheAgency for Healthcare Research and Quality. It’s justanother piece of grim proof that the abuse of heroin and narcotic painkillers has hit alarming levels, officials say.

“I’d like to tell you that the percentages have fallen or flattened since 2014, but they haven’t,” said Amy Andres, a senior vice president with the Ohio Hospital Association.

From 2014 to 2015, there was a 39 percent increase in the number of Ohio emergency room visits due to opioids. Last year, there was a 41 percent jump, according to an analysis by the hospital association.

People alsocan sit on a waiting list for weeks before a detox bed opens up, and some recovery programstake only private insurance or pay, leaving those with fewer financial resources fewer options, experts say.

A few hospitals across the country have had early success with administering buprenorphine,a medication that blocks opioids from affecting the brain, to stabilize patients in the emergency department before referring them to medication-assisted drug treatment. But the practice is relatively rare and most local hospitals said they’ve only started talking about the possibility.

Central Ohio’s emergency responders are increasingly being overwhelmed by overdoses caused by heroin laced with potent synthetic drugs such as fentanyl and carfentanil, an animal tranquilizer so strong that a few grains can be lethal. There were a record 3,050 overdose deathsstatewide in 2015.

That figure is expected to be shattered when final 2016 numbers are released this year. According to figures compiled by The Dispatch from county coroners, there were at least 4,149 people who died of overdoses last year. That doesn’t include tallies from six small counties that didn’t respond to the newspaper’s requests.

“It’s devastating, and I don’t see it getting any better unless we can stem the flow of drugs getting into people’s hands,” said Dr. Terrill Burnworth, director of the emergency department at Licking Memorial Hospital in Newark.

The one piece of good news: More overdoses are being reversed than ever before.

The percentage of emergency department patients who died from opioid-related overdoses at hospitals statewide dropped from 21 percent in 2009 to 14 percent in 2014, largely due to getting naloxone in the hands of more people, Andres said. The medicationabruptlyand effectively counteracts deadly overdoses and is now being administered by paramedics,hospital staff and even family members who have received some basic training.

Since starting a pilot program in July, University Hospital East has dispensed 220 naloxone kits to patients who have been treated in the emergency department or their families, said Ken Groves, a nurse manager at the Near East Side facility.

“The best thing we can offer them is an element of hope and a feeling of being supported until they’re ready to seek treatment,” Groves said.

The hospital also has an addiction counselor who helps with emergency room and inpatient consultations, he said.

Since the end of March,OhioHealth has sent 36 patients treated at one of its four emergency departments in Columbus, Marion, Pickerington and Westerville home with naloxone, said Dr. Krisanna Deppen, a family physician who specializes in addiction medicine.

“I think there’s a lot of stigma associated with naloxone, and some people believe we’re enabling bad behavior,” she said.

But like other chronic diseases, such as diabetes, addicts can’t change their behavior overnight, Deppen said. And naloxone is just a tool to keep them alive until they can start to work on recovery, she said.

Similar toMount Carmel West, its Marion hospital is working with a local drug and alcohol addiction group to hirepeer-recovery coaches, whom they hope patients will trust because of the common experiences they share.

Stewart, 25, of Hilliard, said he started “drinking and partying a little too much” as a teenager. He also started taking painkillers after breaking his collarbone in a snowboarding accident.

A misdemeanor theft arrest in 2013 led him to the courtroom of Franklin County Municipal Court Judge Scott VanDerKarr, who at the time presided over a “drug court.”

Stewart said he has been clean and sober since and helping others seek treatment. He joined Mount Carmel in November and has been working with people struggling with addiction since January. He also has a personal-training business as part of his quest to get a “healthier body, mind and spirit.”

After discharge,Stewart helps patients with food stamp applications, housing, job searches or whatever they need to start down the path toward sobriety.

The one out-of-state woman he helped get into detox is in a day-treatment program now. He also helped get her brother into detox recently.

“Last week she sent me a text that said I had saved her life,” he said. “It’s just so humbling and amazing to touch people’s lives this way.”


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Overdoses flood area emergency rooms – The Columbus Dispatch


Northwest Healthcare breaks ground on Marana emergency department – Tucson Local Media

Northwest Healthcare has broken ground on a new free-standing emergency department adjacent to the Tucson Premium Outlets at Twin Peaks and I-10. The facility is expected to open in early 2018.

At a May 21 ceremony to commemorate the project, Marana Town Manager Gilbert Davidson said project was part of a very exciting time in the town of Marana.

We love watching dirt get turned, Davidson said. We literally have projects from the southern end to the northern end and this is a nice compliment in the middle.

The move to the new facility represents a shift in philosophy for Northwest Healthcare as it responds to a growing need. Over the past five years, there has been a 20 percent volume increase in emergency room visits. Although Northwest has two hospital-based emergency facilities in the area, the organization wants to get emergency care to areas with growing populations.

Our goal is to provide the communities of Marana, Picture Rocks, Red Rocks, Oro Valley and surrounding areas to easy access to emergency care, Northwest Healthcare Market CEO Kevin Stockton said.

The new facility, which has been named Northwest Emergency Center Marana, will be the healthcare companys second free-standing emergency department, joining a similar facility in Vail which opened in 2015. The Marana location will be open 24 hours a day, seven days a week to serve patients who experience medical emergencies.

The new emergency care center will be just like a hospital emergency room, equipped to treat patients with illnesses and injuries that require a higher level of care than urgent care facilities offer.

The facility will have 12 private patient rooms with radiology and lab services on-site. If a higher level of care is required, patients can be transported quickly to nearby Northwest Medical Center or to Oro Valley Hospital.

Marana leaders have an innovative vision for the future of the town and we are happy to be part of that growth, Stockton said. We have provided healthcare services in Marana for more than 11 years, and this new emergency center reinforces our long-term commitment to caring for this community.

As part of the move, Northwest Healthcare will close the Continental Reserve Urgent Care when the lease ends at the end of the year. The family medicine physicians currently located in the Continental Reserve Urgent Care building will move to new offices at Silverbell and Cortaro and, as Marana grows, Northwest Healthcare will continue to explore other options in the area.

The company also own 58 acres near Tangerine and Moore roads, but currently does not have plans to utilize the property.

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Northwest Healthcare breaks ground on Marana emergency department – Tucson Local Media


Uninsured In US Charged 4 Times What Medicare Pays For ER Visit – Bay Net

Uninsured In US Charged 4 Times What Medicare Pays For ER Visit
Bay Net
A nationwide analysis of medical bills shows that hospitals typically charge uninsured emergency room patients four times what they're willing to accept from Medicare for the same service, U.S. researchers say. That's more than double what those same …

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Uninsured In US Charged 4 Times What Medicare Pays For ER Visit – Bay Net


Would You Take Uber to the Emergency Room? – Healthline

In a segment on Jimmy Kimmel Live earlier this month, people on the street voiced their opinions about the new healthcare bills various provisions.

However, the segment, called Lie Witness News, was really a sketch made up by shows producers.

Those interviewed approved of proposals like deploying veterinarians to perform surgeries on patients who lacked insurance, and paying people to stitch up their own wounds using YouTube tutorials.

But one suggestion, which elicited peals of laughter from the studio audience, was not actually so far-fetched.

Lets talk about the bills provision replacing ambulances with Uber EMT, the interviewer said. A lot more drivers on the road obviously and time is of the essence. It doesnt really matter who drives.

Yeah, as long as you get to the hospital quick, reliable. I think that could be provided by regular people, said the young man on camera.

You support Uber EMT? asked the interviewer.

Id be in for that, he said.

Read more: The challenge of taking someone with dementia to the emergency room

While the government is not actually proposing that Uber replace ambulances, more and more people do seem to agree that regular people are capable of bringing someone to the hospital in the event of an emergency.

According to Stat News, and other outlets, hard data isnt available to quantify the trend, but Uber and Lyft drivers are encountering riders who need more than a ride home from the bar.

When I got there, to my dismay, I see him literally dragging himself toward my car, hand on his chest, stating he was having chest pains and was getting dizzy, wrote a driver on an online message board.

I offered to call 911, as the hospital he wanted to go to was over 15 minutes away, but he insisted for me to take him, the driver continued. Fortunately, I was able to get him to the hospital and he was admitted, but it made me wonder why someone in that situation would prefer an Uber over an ambulance the only rationale I can come up with is money.

Uber, Lyft, and medical experts would all agree that the mans situation was one that required an ambulance, not a rideshare.

In an ambulance, EMTs can administer treatment en route. Plus, their knowledge of the areas emergency rooms enables them to bring the patient to the hospital best equipped to handle the situation.

But there are occasions when ridesharing services are appropriate, and may even serve to fill a void in access to healthcare.

Last year, Uber partnered with Circulation, a company that arranges rides for people getting medical care.

And Lyft is entering the healthcare market in multiple ways, forging direct partnerships with providers like Blue Cross Blue Shield, and with traditional medical transportation companies like American Medical Response.

For us as an organization, healthcare aligns very, very well with our mission, with our values, Dan Trigub, head of healthcare and elder mobility solutions at Lyft, told Healthline.

People who get insurance through a company that has partnered with Lyft dont request a ride themselves. Their providers schedule a pickup through the companys stand-alone website, Concierge.

So whether they know it or not, a patient covered by one of these services may be taking an Uber or a Lyft to their next doctors appointment.

Read more: Hospitals open emergency rooms specifically for senior citizens

A 2005 report from the National Academies of Sciences estimated that 3.6 million Americans miss or delay healthcare due to lack of transportation.

Minorities, people with low incomes, and those with chronic illnesses are affected disproportionately.

The same report found that paying for transportation to make sure people get to their appointments would cut down on healthcare costs in the long run.

That reasoning fuels the federal requirement that Medicaid pay for its beneficiaries to take a cab, van, public transportation, or other mode of transport to the doctors office if the patient has no other way of getting there.

The Centers for Medicare and Medicaid Services (CMS) spent $2.7 billion on nonemergency medical transportation (NEMT) in 2013, according to the U.S. Government Accountability Office (GAO).

Most companies providing Medicaid services partner with transportation brokers, who in turn contract with cabs or other livery services to arrange rides. They then bill CMS for reimbursements.

But this system has come under scrutiny for being opaque, expensive, and ineffective. GAO officials identified NEMT as an area of high risk for fraud and abuse. Last year, New Jerseys Medicaid program failed an audit of its NEMT services for improper oversight and reporting.

There was clearly a need for something better, Robin Heffernan, chief executive officer of Circulation, told Healthline.

With the traditional service, you had to call several days in advance of the ride and then the broker would go take several hours to figure out whether they could accept your ride, and come back and give you a four-hour window for your patient to be ready, she said.

Its huge to be able to have one platform which can, in a more structured manner, deliver these rides, track them, and account for them, she said.

According to CareMore, a company that serves Medicare beneficiaries, its partnership with Lyft has cut both wait times and per-ride costs by about a third.

People no longer have to wait an hour or more to be picked up after their appointment ends, Dr. Sachin Jain, CareMores president and chief executive officer, told Healthline.

With Lyft, youre working with a driver who is proximate, theyre relatively close to where you are, so that wait time on the pickup ride is shorter, Jain said.

Jain said that CareMore provided senior sensitivity training to Lyft drivers to prepare for picking up a customer base that is not widely associated with using ridesharing services.

Read more: Rural hospitals closing at an alarming rate

But these services are not, however, replacing ambulances. At least not yet.

Unnecessary ambulance rides rose from about 13 percent to 17 percent between 1997 and 2007, according to a study from the University of Pittsburgh.

James Langabeer, a professor of health informatics at the University of Texas, said that people call an ambulance when they dont really need one for all sorts of reasons.

I think the emergency department is a place where you can go and you know youre going to get care, whereas if you call a provider and they say tell me about your insurance, its a barrier, he told Healthline.

Even people with insurance may not have a primary care doctor or medical home they feel comfortable visiting, he added.

Langabeer studied a pilot program run by the Houston Fire Department, called Emergency Telehealth and Navigation (ETHAN).

ETHAN allows EMTs to offer alternatives to patients who call 911 but do not require emergency services.

One solution is to offer cab vouchers for office visits, which the EMT can help schedule. Langabeer said he can imagine ridesharing filling a similar role.

But despite his interest in easing the burden on ambulances, Langabeer stressed that 911 is still the best option for anyone in medical distress.

Were not always as patients the best people to diagnose, or the right people to diagnose our own conditions, he said. On the other hand, we do know our body, and we know whats abnormal. And if you do know this isnt normal, and youre completely convinced, now how do you get there?

In those cases I say, Yeah, call any type of special transportation that can get you to those places and get you in.

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Would You Take Uber to the Emergency Room? – Healthline


Emergency room patients routinely overcharged, Johns Hopkins study finds – The Hub at Johns Hopkins

By Vanessa McMains

In emergency rooms across the U.S., people are charged on average 340 percent more than what Medicare pays for services and treatments, with minorities and uninsured patients bearing the brunt of overcharges, a new study from the Johns Hopkins University School of Medicine has found.

The study, published online today in JAMA Internal Medicine, illustrates the need for greater transparency in hospital pricing, says senior investigator Martin Makary, a professor of surgery at JHU’s School of Medicine.

“There are massive disparities in service costs across emergency rooms, and that price gouging is the worst for the most vulnerable populations,” Makary says. “Our study found that inequality is then further compounded on poor, minority groups, who are more likely to receive services from hospitals that charge the most.”

For the study, researchers examined medical billing records dated in 2013 for 12,337 emergency medicine physicians in nearly 300 hospitals in all 50 states, then cross-referenced those records with the 2013 American Hospital Association database to determine the size, regional location, and other details of the emergency department, such as urban/rural status, teaching status, and for-profit status. They compared the costs billed to patients and the Medicare allowable amountthe sum of what Medicare pays for a service or procedure.

The relationship the researchers uncovered between the charges billed to patients and the Medicare allowable amount was known as the markup ratio. A markup ratio of 4.0, for example, means that for a service with a Medicare allowable amount of $100, the hospital charged patients $400which would be 300 percent over the Medicare allowable amount.

Researchers found that emergency medicine physicians on average had a markup ratio of 4.4 compared to the Medicare allowable amountresulting in 340 percent more in charges. Emergency departments that charged patients the most were more likely to be located in for-profit hospitals in the southeastern and Midwestern U.S. and serve populations of uninsured African-American and Hispanic patients. Wound closure services had the highest median markup ratio at 7.0, and interpreting head CT scans had the greatest in-hospital variation, with markup ratios ranging between 1.6 and 27 within a single hospital.

“This is a health care systems problem that requires state and federal legislation to protect patients,” says Tim Xu, a fourth year medical student at JHU and the study’s first author. “Patients really have no way of protecting themselves from these pricing practices.”

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Emergency room patients routinely overcharged, Johns Hopkins study finds – The Hub at Johns Hopkins


Blue Cross Blue Shield To Launch Emergency Room Policy – WABE 90.1 FM

Starting in July, health insurance provider Blue Cross Blue Shield will stop covering emergency room visits it deems unnecessary.

And doctors and analysts have a lot to say about it.

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Blue Cross Blue Shield is enacting this policy because it doesn’t want people to use the emergency room as their primary health care.

“The cost of care’s been going up so much faster than people’s earnings. We have got to find a better way to do some of this stuff, taking some of that unnecessary spending out of the system,” says JeffFusile, president of Blue Cross Blue Shield.

Fusile says BCBS wants patients to use urgent care, retail health clinics and their LiveHealth app, which are all cheaper than an ER visit.

“What this policy is directed at is regular, run-of-the mill colds, maybe even influenza. But you don’t need to go to the emergency department to get tested for whether or not you have the flu and to get a Tamiflu prescription,” says JasonHockenberry, who teaches health policy at Emory University.

Hockenberry says, in his research, he’s found many people often use the emergency room inappropriately, for urgent care rather than emergency care.

“This is a real problem. Emergency departments are expensive; they’re there for a different reason. Blue Cross is clearly staking a claim here that we’re going to try to change patient behavior,” Hockenberry says.

Donald Palmisano, president of the Medical Association of Georgia, paints a different picture when it comes to this policy: Imagine a BCBS member has chest pains in the middle of the night. He thinks it might be a heart attack, so he goes to the ER. But it turns out that it was just indigestion. Under BCBS’snew policy, he gets charged for using the emergency room inappropriately. So the next time he has chest pains, he thinks, in case it’s just indigestion, he won’t go to the ER. But this time, it’s a heart attack, and he dies.

“Blue Cross is clearly staking a claim here that we’re going to try to change patient behavior.” – Jason Hockenberry

“That’s where our physicians are concerned. Because they’re like, you know, you’re putting the patient, who doesn’t have the clinical background, to determine whether their condition is of an emergency nature,” Palmisano says.

Palmisano says this policy also might disproportionately affect the elderly, those living in rural areas and adolescents over the age of 14.

“I have four children, and if there’s an injury and it’s hard to determine the pain they’re experiencing, it’s hard to determine whether to go to the emergency room or not. It puts that added stress because you’re dealing with a loved one and you’re putting parents in a very difficult situation,” Palmisano says.

But FusileofBCBS says he knows, in medicine, it’s not always black or white.

“There are lots of gray areas where the diagnosis wasn’t so bad after all, but you have to look at the situation the person was in at the time they were in it,” Fusile says.

Remember that scenario about the man who thinks he’s having a heart attack, but it’s just indigestion? Fusile says that falls into the gray area, too. He says a panel of doctors will assess claims to make sure everyone’s getting fair coverage.

But Palmisano and Hockenberry say they’ll have to wait until the policy is implemented to see how effective it really is.

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Blue Cross Blue Shield To Launch Emergency Room Policy – WABE 90.1 FM


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