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Going to the emergency room? Starting July 1, this insurer may not pay – Columbus Ledger-Enquirer


Columbus Ledger-Enquirer
Going to the emergency room? Starting July 1, this insurer may not pay
Columbus Ledger-Enquirer
Anthem Blue Cross/ Blue Shield of Georgia announced earlier this month in letters to some policyholders that it will no longer cover the cost of emergency room care if a prudent layperson would not consider the treatment an emergency. This is not to …
Medical Association Reacts To Blue Cross Blue Shield Of Ga. ER PolicyWABE 90.1 FM
America's opioid epidemic and its effect on the nation's commercially-insured population | Blue Cross Blue ShieldBlue Cross Blue Shield

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Going to the emergency room? Starting July 1, this insurer may not pay – Columbus Ledger-Enquirer

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WVMetroNews – Thomas move takes aim at emergency room waits … – West Virginia MetroNews

CHARLESTON, W.Va. Thomas Hospital System is trying to improve the cost and efficiency of emergency room visits by more clearly presenting lower-cost alternatives to patients determined not to be facing life-threatening illnesses.

Starting in the next few weeks, Thomas plans to start informing emergency room visitors deemed to not be facing a life-threatening illness that their visits will be subject to co-pays up front.

Emergency room personnel in the Thomas system will advise those patients that they could receive less expensive and potentially timelier care at an associated clinic or with an available family doctor.

Similar measures are alsotaking place elsewhere in attempts to keep costs and wait times lower in emergency rooms.

We are going to start doing screenings of patients when they present to the emergency room, said Dan Lauffer,president andCEO of Thomas Health System which owns Thomas Memorial Hospital and Saint Francis Hospital.

Were going to inform them about their condition whether its an emergent condition or something that could be seen in a care center or doctors office.

Lauffer added, Were doing it as a means of communicating to our patients the culture of delivery. We feel that many patients who representto the emergency room are using it as their primary source of healthcare.It would also improve their knowledge of their financial health as it relates to delivery of healthcare.

The Thomas system calculates that 30 percent of its emergency room visitors are deemed by doctors or nurses to not be in an emergency medical situation. That situation is costly to both patients and the hospital and also results in longer waits.

The biggest change for Thomas Health System will be charging co-payments to patients who choose to remain under emergency room care even after being told their conditions are not life-threatening. The collection of co-payment prior to services would begin in August.

Co-payments begin at $8 for Medicaid payments but can be higher depending on the patients insurance and the care being delivered.

Patients who have true health emergencies would be treated regardless of their ability to pay, hospital system representative said.

Patients would have another choice to make too. They could opt for care at a clinic associated with Thomas (or elsewhere) and be treated in order of arrival or remain under emergency room care but be treated in order of severity. A reference to a family doctor is also an option.

If you say I want to be seen by the emergency room we wont refuse you, but well ask you to pay the co pay and to be seen in the order of severity, Lauffer said.

If the patients visit is after the hours of clinics or associated family doctors, Lauffer said the hospital system would work with the patient for the earliest possible appointment time.

If theres any question about whether or not this may be life-threatening we most certainly will continue to see them in the emergency room, Lauffer said. We want to communicate with these patientsabout how these decisions impact their health and their financial well-being.

Thomas Health has invested more than $1 million into four Care Clinic locations in Kanawha and Putnam counties.

Thomas has tried all along to inform emergency room patients about alternative care and the potential for lower costs, Lauffer said, but this is a concerted effort.

In the past we have not been diligent about this, he said, but we feel it s necessary to educate our community about the decisions about where they see care has an impact not only on their pocketbook but also their health.

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WVMetroNews – Thomas move takes aim at emergency room waits … – West Virginia MetroNews

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LewisGale Montgomery unveils a new emergency room | WSET – WSET

by Breann Boswell & Annie Andersen

Dozens attended the ribbon cutting for LewisGale Montgomery’s new Emergency Room. (Photo: Annie Andersen)

BLACKSBURG, Va. (WSET) — Dozens gathered for the unveiling of LewisGale Montgomery’s new and expanded emergency room on Wednesday.

The remodeled ER has added four more rooms for different types of patients. Extra rooms will help on lowering the wait times.

Emergency Room Medical Director Edmond Sciullo says that more rooms will help to save lives.

“The key to most conditions is early diagnosis,” explained Sciullo. “The diagnosis then drives your treatment, so the earlier we can focus on your diagnosis, and make the correct diagnosis, the quicker we can treat you.”

For Blacksburg Mayor Ron Rordam this ribbon cutting had a personal connection for him. “10 or 15 years ago, I try not to remember the date … you get that call at 11:30, 12 o’clock at night; ‘Mr. Rordam, Mr. Rordam, your son is on his way to the ER. He’s had an accident,'” Rordam recalled.

The $6 million project also helped with upgrades to the surgery center including a Laparoscopic surgery device with a 3-D camera.

“When you see other communities out struggling to maintain their hospitals and hospitals are leaving and what that means to the economic development, but then to be in a place where the hospital is growing is so important,” Rordam said.

The New River Valley is one of the areas in Virginia experiencing major growth, according to the Virginia Employment Commission.

At a time when some hospitals in Southwest Virginia are cutting back services, LewisGale Montgomery is expanding.

The renovated ER is open and serves patients 24 hours a day.

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Heavy Rains Put Everglades in ‘Emergency Room’, Force Wildlife Officials to Make Tough Choices – The Weather Channel

The Everglades are in the midst of a catastrophic flood event.

So says Ron Bergeron, a 10-year commissioner with the Florida Fish and Wildlife Conservation Commission, who has watched heavy rains in South Florida over the past month push water levels in the conservation areas of the swamp to historic heights.

All but a few of the tree islands in the Everglades, which are used by white-tailed deer and other wildlife, are under water, Bergeron told the Florida Sun-Sentinel.

We have the highest water level ever since records were kept going into the rainy season, he said. This event, if its not addressed properly, will have the greatest impact to our wildlife, the environment, the habitat and the plant life that weve ever seen.

Bergeron told the Sun-Sentinel he had been in contact with Gov. Rick Scott, who issued an emergency order Friday to move water out of the Everglades water conservation areas, as well as the U.S. Department of the Interior, the U.S. Fish and Wildlife Service (USFWS), the South Florida Water Management District, and the U.S. Army Corps of Engineers.

While Scotts decree has helped some, its not enough, Bergeron says.

Its very scary, inflows that are three times greater than the outflows, he told the Sun-Sentinel. The level of the water conservation areas will rise close to one inch a day with those kinds of inflows and no rain. The water is so high above [where it should be at this time of the year] that if the inflows matched the outflows, and there was hardly any rain, it would take until December to get back to regulation.

Not everyone is on board with pumping water out of the conservation areas.

The USFWS is proposing to keep those spillways closed until July 15 to protect the endangered Cape Sable seaside sparrow, whose nesting areas would be in the path of the releases.

Larry Williams, state supervisor for USFWS, told the Palm Beach Post he agrees the Everglades animals are in a crisis and that some will die, but that the Cape Sable sparrow is the only species that could be wiped out forever.

Willaims told the Post there are between 2,000 and 3,000 Cape Sable seaside sparrows left in the Everglades, but if their population drops much below 300, they will likely go extinct.

The sparrows are close to extinction and if something goes extinct, it doesnt come back, Williams told the paper. The other populations will come back. We dont want to seem callous, but extinction, you dont recover from it.

On Friday, the South Florida Water Management District was granted emergency permission to back pump clean water into Lake Okeechobee to alleviate overflow in the conservation areas, the Post reports.

But Williams told the Post that even with the water pumping at maximum capacity, Williams said it will drain only a quarter-inch per week, and Bergeron told the Sun-Sentinel that if the water isnt moved quickly, there might not be an Everglades to restore.

When you have a 100-year Act of God, the weak may die and the strong survive and thats nature, Bergeron told the Post, but when you extend the duration and compound it with flood control, you put the Everglades in the emergency room.

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Heavy Rains Put Everglades in ‘Emergency Room’, Force Wildlife Officials to Make Tough Choices – The Weather Channel

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Family of nurse stabbed in emergency room says health is improving – WCVB Boston

SOUTHBRIDGE, Mass.

The family of a nurse who was stabbed while trying to help a patient is still reeling from the attack.

For 42 years, Harrington Hospital was Elise Wilson’s second home, but no one expected what would happen on June 14.

Wilson was in the emergency room trying to help a patient wielding a knife. Her son, Michael Wilson, said his mother told him her accused attacker was calm at first, but then something changed.

“She said she could see it in his eyes,” Michael Wilson said. “She said the look in his eyes just completely changed.”

She was allegedly stabbed multiple times and suffered life-threatening injuries. Elise Wilson was able to walk down the emergency room, get help, and was taken to UMass Memorial Hospital.

“She woke up for a quick second,” Michael Wilson said, recounting what happened before his mom went into surgery. “She told me she loved me and I told her she’d be OK.”

Her accused attacker, Conor O’Regan, is charged with assault with intent to murder and aggravated assault with a dangerous weapon.

The 65-year-old grandmother is improving and is set to be transferred to a rehabilitation facility as early as the end of the week.

“She’s a hard fighter. She doesn’t give up easily,” Michael Wilson said. “I can’t imagine the outcome being different. I don’t know what I’d do.”

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New standalone emergency room to open in Roanoke County later this year – WDBJ7

ROANOKE CO., Va. (WDBJ7) Rain cancelled the groundbreaking of LewisGale’s new standalone emergency room back in April, so dignitaries traded their shovels for sharpies to take part in a “beam-signing ceremony” Tuesday morning.

The construction they were celebrating is well under way, with the $12 million, 10,000 square foot facility now taking shape near Tanglewood Mall.

“It’s a logical step for us to grow and put an asset like this in this part of the county,” said LewisGale Regional Health System CEO Brian Baumgardner, “and bring the same level of service that we have in Salem to this part of the 419 corridor.”

This isn’t the first standalone emergency room that construction company CPPI has built. The contractor has worked on more than a dozen, including five for HCA, LewisGale’s parent company.

“It is absolutely a trend,” said CPPI Vice President Vinne Moreschi. “We’re noticing it throughout the country that hospital providers that we’re building for are building them all over the place.”

The benefit for the Roanoke Valley, LewisGale says, is the additional emergency room capacity, and the ability to see more patients more quickly.

Dr. Steve Pasternak is Medical Director of the Emergency Department.

“It just provides more emergency department beds,” Pasternak told WDBJ7. “We just don’t have enough in the Roanoke Valley. Both Carilion and LewisGale, we’re at capacity. We’re filled all the time so I think most importantly this presents more emergency department evaluation beds for the valley.”

Construction should be completed in November, with the new emergency room opening before the end of the year.

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How a legal battle is delaying emergency rooms in Carolina Forest – Myrtle Beach Sun News


Myrtle Beach Sun News
How a legal battle is delaying emergency rooms in Carolina Forest
Myrtle Beach Sun News
Carolina Forest has nearly as many people as Myrtle Beach, but no emergency rooms. And a legal dispute means it could be at least a year and a half before one is built. Horry County councilman Dennis DiSabato, who represents much of Carolina Forest, …

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Local emergency room visits rise as MediCal coverage increases – Eureka Times Standard

Emergency room visits in Humboldt County have increased substantially over the past five years which local health care officials attribute not only to expanded MediCal coverage under the Affordable Care Act, but also a lack of primary care doctors.

There has been, as I understand it, an exodus of primary care physicians from the area, St. Joseph Hospital Emergency Department Medical Director Marshall Eidenberg said Friday. And so if somebody is unable to get the care that they think they need in a timely matter from their primary care doctor, then the emergency department is always open. For some folks that look at the monetary financial aspects, there is no longer the financial worry as much because they are now covered.

The data comes as the U.S. Senate is considering draft legislation to repeal and replace the Affordable Care Act, including capping federal funding of the Medicaid program known as MediCal in California and shifting more of the programs costs to states. The federal-state program provides health care to the poor, disabled and many nursing home patients.

The bill would also phase out the Medicaid expansion, which covered about 18,600 more Humboldt County residents under the health care plan since 2014, according to Humboldt Countys MediCal provider, Partnership HealthPlan of California.

Local health care officials state that decreased MediCal coverage would result in a reduction in reimbursed health care costs, which they state would likely result in cuts to preventative care programs and lead to an increase in reactive care treatment in emergency rooms.

In 2012, Humboldt Countys four emergency rooms had nearly 46,500 visits, according to state data. Four years later, the number of visits had jumped to nearly 56,400.

California Office of Statewide Health Planning and Development data released this month shows emergency room visits by MediCal patients made up nearly 46 percent of all emergency room visits in Humboldt County in 2016 compared to just 30 percent in 2013 the year before the Medicaid expansion under the Affordable Care Act took effect.

In 2014, emergency room visits by MediCal patients increased by nearly 6,000 patients or about 12 percent compared to 2013, according to the data. The number of people in the county who paid out of pocket also significantly decreased, dropping from 15 percent of all ER visits in 2013 to nearly 7 percent by 2016, according to the data.

Partnership HealthPlan manages MediCal benefits for 14 northern California counties including Humboldt County. Since the MediCal expansion took effect, emergency room visits by individuals covered under the expansion decreased by 37 percent from January 2014 to December 2016, according to Partnership HealthPlan Public Information Officer Dustin Lyda.

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If you read the report, as members get educated on the use of their benefits, the emergency room use starts to go down, he said, adding that he expects emergency room visits to decline through time.

Lyda said they did not have county-specific data on ER use by its MediCal expansion population, but said Humboldt County makes up 29 percent of its membership.

MediCal patients are assigned a primary care physician through Partnership HealthPlan, but Lyda said finding enough physicians to cover the demand has been extremely difficult in rural counties. Wage competition in more populated counties as well as reduced physician residency programs in the county have been cited by local health care officials as reasons for Humboldt Countys difficulty in retaining and recruiting physicians.

While Partnership HealthPlan does assign each patient a primary care physician, Humboldt-Del Norte County Medical Society Executive Director Penny Figas said how soon patients are able to be seen by a physician is limited by the number of available doctors and clinics.

There are only so many hours in the day, and as we lose physicians and whoever is left to absorb those patients, there is only so much absorption that can happen, Figas said. … It may be more convenient for [the patient] to show up at the emergency room. Maybe they may not be able to get to the clinic for an appointment.

Eidenberg said he has been meeting weekly with staff to improve his emergency rooms performance and ensure patients are adequately cared for, but he said progress on that front can be strained by increased emergency room visits.

The episodic care versus the heroic care that the hospital and emergency department does is actually more cost effective, results actually in less testing, less radiation through X-rays, which can result in less long-term problems, Eidenberg said. Episodic care is actually to be preferred over the heroic care that the emergency department provides because we have a very different mandate in the ER: everything is terrible until we can prove it isnt.

But Figas said that the situation is going to improve. She said nine specialists and four primary care doctors have been brought into the county since October and that five new primary care physicians are committed to begin work in county health care clinics between now and September.

Its the first time in a long time that we have more physicians coming than going, she said.

St. Joseph Hospital and local clinics are also working to create a family practice residency program in order to train and retain local doctors, Figas said.

Lyda said that Partnership has brought on 29 new physicians since 2014 across its 14 counties, but said he did not specific data on Humboldt County doctors nor how many doctors have left during that time.

Eidenberg said that increased MediCal reimbursements through the MediCal expansion are a benefit in that they can pay for increasing the number of family care practitioners.

Which is truly whats needed, not just here, but in the country as a whole, he said.

Local health care officials are still reviewing the policies of the Republican health care bill that was released to the public and to most members of Congress on Thursday.

The bill could change in the coming weeks after five Republican senators came out against the legislation last week. The GOP can only lose two of the 52 Republican senate votes for the bill to pass due to Democratic opposition.

Decreased funding of Medicaid has led to opposition of Republicans such as Nevada Sen. Dean Heller, who said Friday that he cannot support legislation that takes insurance away from tens of millions of Americans and tens of thousands of Nevadans.

About 11 million Americans are covered under the Affordable Care Acts Medicaid expansion. The bill proposes to cap federal funding for the expansion, leaving states that participate in the expansion to figure out how to continue to fund their expanded Medicaid populations.

Lyda said that Partnership HealthPlan is currently conducting a review of the Senate bill, but has yet to complete its analysis of the impacts.

For Humboldt County, an immediate repeal of the Medicaid expansion which is not proposed in either the Senate or House of Representatives health care bills would result in a loss of $92.7 million in state and federal funding for MediCal benefits, a loss of $168.2 million in business revenue and over 1,000 jobs, according to Partnership HealthPlan.

By removing access to health care services, families will either have to forego needed care or risk financial uncertainty to unknown health costs, Partnership wrote in a statement about the Senate bill last week. Ensuring access to quality care prevents children from missing school, adults from getting and maintaining employment, and our vulnerable populations from spiraling into a health crisis.

St. Joseph Hospitals Emergency Department receives the majority of emergency room visits in the county. The departments new director of eight months, Eidenberg said that an increase of insured patients whether it be from MediCal or an employee health plan ensures the hospital will receive some form of payment or reimbursement.

But even if a patient is not insured, Eidenberg said they are obligated to treat them.

If someone doesnt pay that bill, that bill ends up getting assumed by the hospital and results actually in higher costs to everyone else that does pay, Eidenberg said. Because the money has to come from some place.

As states like California consider creating single-payer health care systems and Congress considers scaling back government funding to health care, Eidenberg said the nations health care debate has intensified.

Is it a business or is it a human right? And if its a human right then who pays for it? Eidenberg said.

Eidenberg said he thinks it is especially important to cover patients with preexisting conditions so that individuals and their families do not have to live in poverty to obtain health care.

What we should do as a nation is take care of those that are the broken, the poor and figure out what is the level that is necessary, he said. There is a lot to it. There is no one size fits all and Im sure every bill that Congress passes is going to piss off a sizeable portion of people, but we as a country havent figured out what we expect health care to do and to be.

The Associated Press contributed to this article. Will Houston can be reached at 707-441-0504.

ER Visits

Total number of visits to Humboldt County emergency rooms between 2005 and 2016 including the number of visits by patients covered under MediCal and self-pay patients.

2016

Total visits: 56,395

MediCal: 25,913

Self-pay: 3,792

2015

Total visits: 55,452

MediCal: 25,282

Self-pay: 4,603

2014

Total visits: 52,425

MediCal: 22,159

Self-pay: 6,289

2013

Total visits: 53,547

MediCal: 16,482

Self-pay: 8,042

2012

Total visits: 46,455

MediCal: 14,032

Self-pay: 6,793

2011

Total visits: 44,760

MediCal: 14,217

Self-pay: 6,354

2010

Total visits: 44,751

MediCal: 14,828

Self-pay: 6,434

2009

Total visits: 47,059

MediCal: 15,347

Self-pay: 6,671

2008

Total visits: 47,609

MediCal: 14,109

Self-pay: 7,802

2007

Total visits: 48,604

MediCal: 14,977

Self-pay: 7,865

2006

Total visits: 49,195

MediCal: 15,547

Self-pay: 7,534

2005

Total visits: 49,080

MediCal: 15,539

Self-pay: 7,326

Source: California Office of Statewide Health Planning and Development

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Just 21 Wild Emergency Room Stories – BuzzFeed News

Spoiler: there is no limit to what people will stick up their butts.

Posted on June 24, 2017, 18:46 GMT

“The man who tried to start his chainsaw with the tip resting on the ground. It kicked to life and then kicked back into his face. Missed his eye by a centimeter and he was able to go home (with a bunch of stitches).”

“A kid had shoved a popcorn kernel up his nose and didn’t tell his parents until it got too hot and steamy in his sinus cavity that it popped.”

“One time we had a kid who ate about 60 Legos.”

“A patient swallowed a fitness tracker and it was still recording the patient’s steps from their stomach.”

“A guy drove himself to the ER and handed me a bowl of ice with three of his fingers in it.”

“A 72-year-old patient was admitted due to kidney stones and eventually ended up with a catheter. Everyone noticed that he had tons of visitors, all of whom were blonde females under the age of 35. One of the nurses made a comment about how nice it was that his granddaughters were visiting him, at which point he laughed and said, ‘Granddaughters? Those babes are from OkCupid!’ Not sure why he thought that a date in the hospital watching him pee in a bag was particularly romantic, but I do hope that he landed a second date in the end.”

“A guy called the ER nurse hotline to see how he could prove that a local McDonald’s got blood on his burger rather than ketchup. He wanted an ER doc to run a DNA test so that he could sue McDonald’s.”

“This prisoner who got out of his handcuffs, took his clothes off, tried to escape, and then ran into a door, knocked himself out, and gave himself a head bleed.”

“A man caught himself and his bed on fire while smoking. He was wearing oxygen.”

“People come in with some pretty weird stuff stuck in their, uh, butts…one time someone came in with five UNCRACKED eggs up there.”

“One time a patient came in for rectal bleeding. They had stuck a glass candle up there and couldn’t get it out.”

“Someone walked into the ER with a cucumber stuck in their asshole.”

(Now is a good time to remind everyone of this helpful quiz from BuzzFeed Health: Should You Stick This Up Your Butt?)

“Chief complaint of, ‘I went to kill a spider and ended up with a broken hip.'”

“A girl called the ED at 3 a.m. because she lost her tampon after having sex with it still in.”

“One night when I was working my fourth grave in a row, one of the nurses had just gotten a call from local law enforcement that they were bringing in a patient for medical clearance before he went to jail. When they arrived, we placed him in a trauma room…turns out, the guy caught his wife with another man and he drove his car through the guy’s house. I’m talking about going in one side and driving through every single room. By some miracle he didn’t even have a scratch!”

“Catching a tonsil stone in my mouth….gross, horrible, life shattering, and I should probably go to therapy.”

“Delivering a baby to someone who didn’t know they were pregnant!”

“A patient took off their purple gown and bolted down the hallway out the door to the exit. Security brought him back after he grabbed a random lady on the street in a bear hug (he was still naked). Imagine being the lady.”

“I had a lady who had been shot multiple times. She had at least 15 individual gunshot wounds. All she could do was gripe about her hair clip digging into her scalp. Not a single complaint about the 20-30 holes in her body. (None of them hit anything very important.)”

“Obviously there is a thrill in knowing that you have just saved someone’s life and that’s always amazing, but the most memorable moments come from genuinely connecting with the people you care for. I once had a patient who was the only member of her family to survive the concentration camps. She gave me advice on how to overcome hardships and grief that I will never forget. Connecting with patients with life experience has given me some of the best life lessons.”

“While triaging a patient I asked the standard question about drug use. He told me that he stopped using five years ago, and that it was the staff in my ER who had motivated him to get clean. He had come in for a drug-related problem, and our staff was kind and compassionate, but also honest. We told him in no uncertain terms what his future would look like if he stayed on the path he was on. He got into rehab the very next day. Encounters like that are few and far between, but it’s one of the reasons most of us got into this line of work.”

Note: Submissions have been edited for length and/or clarity.

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Cody Rhodes Gets Stitched Up in the Emergency Room Following ROH World Title Win – Pro Wrestling Sheet (registration) (blog)

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Posted By: Ashley Leckwold June 24, 2017

The new Ring of Honor World ChampionCody Rhodes didnt get to celebrate his win for very long last night because he was in the emergency room getting stitches.

Cody posted a picture of himself getting stitched upafter the match andthe caption read, Thank you Lowell General Hospital Saints Campus for the speedy treatment. Weve got a celebration to plan

For those who missed it, Rhodes won the world title Friday night fromChristopher Daniels at Best in the Worldand becamethe first member of his family to win a world title in 31 years.

Rhodes win is also notable because he has not yet signed an exclusive deal with ROH.

Along with winning the ROH World Championship, Rhodes is set to face Kazuchika Okada for the IWGP Heavyweight Championship on July 1 at the G1 Special in Long Beach. He alluded to this fact during the match while attempting a Rainmaker on Daniels.

Congratulations to the new champ!

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