Page 112

All posts tagged a-heart-attack

Anthem asks Missourians to think twice before going to the emergency room – KCUR

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics or 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

Read more here:
Anthem asks Missourians to think twice before going to the emergency room – KCUR

Read More...

Emergency room patients shouldn’t have to worry about coverage – STLtoday.com

In the wake of Anthem Blue Cross/Blue Shield notifying Missouri plan participants that non-urgent emergency room visits would no longer be covered, the Post-Dispatch published an article (June 23) asserting that St. Louis residents use the ER too often for unnecessary care. Unfortunately, there were serious methodological flaws in their study. This policy from Blue Cross/Blue Shield may violate federal law regarding the national “prudent layperson” standard.

This standard requires insurance coverage be based on a patients symptoms, not final diagnosis. Anyone seeking emergency care suffering from symptoms that appear to be an emergency should not be denied coverage.

Burning in the chest may be heartburn; however as emergency physicians, we know not infrequently it actually ends up being a heart attack.

If you have an Anthem Blue Cross/Blue Shield health insurance plan in Missouri, be aware that nearly 2,000 diagnoses which the company consider to be non-urgent would not be covered in the emergency room. Heart disease, cancer, asthma, stroke, diabetes, influenza and pneumonia are among the top eight causes of death in the United States. All of these illnesses can cause life-threatening conditions that require emergency care.

Missouri participants need to fight for their right to have access to emergency care as protected by the “prudent layperson” standard.

Patients should be able to seek emergency care immediately without wondering if insurance will cover the ER visit. The vast majority of patients who come to the emergency department seek care appropriately.

Dr. Kristen Mueller St. Louis

Member, Missouri College of Emergency Physicians

Read the original post:
Emergency room patients shouldn’t have to worry about coverage – STLtoday.com

Read More...

Blue Cross Blue Shield Of Georgia To Launch Emergency Room … – WABE 90.1 FM

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

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

Like us on Facebook

Blue Cross Blue Shield of Georgia 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,” JeffFusile, president of Blue Cross Blue Shield of Georgia, said.

Fusile said the insurance provider 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,” JasonHockenberry, who teaches health policy at Emory University, said.

Hockenberry said, 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,” he said.

Donald Palmisano, president of the Medical Association of Georgia, paints a different picture when it comes to this policy: Imagine a BCBSGa 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 BCBSGa’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 said.

Palmisano said 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,” he said. “It puts that added stress because you’re dealing with a loved one and you’re putting parents in a very difficult situation.”

But FusileofBCBSGa said 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 said.

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

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

Clarification: This report has been edited to clarify that Blue Cross Blue Shield of Georgia is enacting the new emergency room policy and not the larger entity Blue Cross Blue Shield.

Read more from the original source:
Blue Cross Blue Shield Of Georgia To Launch Emergency Room … – WABE 90.1 FM

Read More...

Major Insurance Company’s Payment Decision Angers ER Doctors – NBCNews.com

It hurts when you take a deep breath. Is it a heart attack? A blood clot in the lung? An infection?

Emergency room doctors are questioning letters than have gone out to some Anthem Blue Cross/Blue Shield members in three states that threaten a crackdown on reimbursements.

“Save the ER for emergencies or cover the cost,” reads a letter sent last month to Blue Cross and Blue Shield of Georgia members.

“Going to the emergency room (ER) or calling 9-1-1 is always the way to go when it’s an emergency. And we’ve got you covered for those situations,” it reads.

“But starting July 1, 2017, you’ll be responsible for ER costs when it’s NOT an emergency. That way, we can all help make sure the ER’s available for people who really are having emergencies.”

Similar letters have gone out to members of plans owned by Anthem, Inc. in Missouri and Kentucky.

Anthem, Inc. said it’s trying to steer patients to proper care. “What we are really trying to do is make sure that people are seeing their doctors first,” said Joyzelle Davis, communications director for Anthem, Inc.

She said patients are inappropriately showing up to emergency departments with itchy eyes and other non-emergency symptoms.

Dr. Becky Parker, president of the American College of Emergency Physicians (ACEP), said it’s about money.

“The insurance company is not on the same plane. They are not here to take care of people. They are here to make money. It’s clear that the insurance companies are looking to make money. It is about the dollar. It is not about high quality care,” Parker said.

“Our concern is that the insurance industry is trying to push this nationally.”

Related: Doctors Make Case for Obamacare or Something Like it

The 2010 Affordable Care Act lays down strict rules for covering emergency room visits. ACEP said the insurance industry is taking advantage of the Trump administration’s disregard for the ACA to push the boundaries.

“Health plans have a long history of not paying for emergency care,” Parker said.

“For years, they have denied claims based on final diagnoses instead of symptoms. Emergency physicians successfully fought back against these policies, which are now part of federal law. Now, as health care reforms are being debated again, insurance companies are trying to reintroduce this practice.”

Davis denies this. “It is reinforcing language that has been in the contract that has not necessarily been enforced before,” she said. She said policies still apply what is known as the “prudent layperson” standard.

Anthem defines it in the letter:

“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 patient’s health or the health of another person in serious danger or, for a pregnant woman, placing the woman’s 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.

But Parker said the letters and the new policies have a chilling effect on patients and could leave some with bills in the thousands of tens of thousands of dollars.

Related: You Thought it Was an Urgent Care Center Until you Got the Bill

“The ‘prudent layperson’ standard requires that insurance coverage is based on a patient’s symptoms, not their final diagnosis,” ACEP said.

“If patients think they have the symptoms of a medical emergency, they should seek emergency care immediately and have confidence that the visit will be covered by their insurance.”

Blue Cross and Blue Shield may potentially deny a claim from someone who shows up with chest pain, ACEP said. Davis said a sharp pain with a deep breath could be a symptom of the common cold, and is not an emergency.

Parker said it’s not reasonable to expect a patient to know the difference. “I don’t know and you don’t know if that is a heart attack, a blood clot, or a collapsed lung unless I see you in the emergency room,” she said.

The last thing a doctor wants is for a potentially dying patient to hesitate, worried about a bill.

“It’s really dangerous for our patients,” Parker said.

“I had a woman the other day who was in her early 40s who came in for having a stroke,” added Parker, an emergency physician at West Suburban hospital in Oak Park, Illinois.

“She had had severe dizziness, vertigo symptoms.”

The patient had waited until office hours to come in because the co-pay on her health insurance plan to see a primary physician was $50 but it was $250 for an ER visit. The patient missed an important early window for treating her stroke, Parker said. “She told me, ‘I can’t believe I risked my life for $200.'”

Dr. Howard Forman, an expert in health policy and medical imaging at Yale, said both sides are right.

“To me, this is a problem of the system,” Forman said. “This is not about bad actors.”

Related: People Get Surprise Medical Bills in 22 Percent of ER Visits

Doctors want to work 9 to 5 and patients have few other choices outside of those hours, he said.

“There are a lot of people who go to emergency rooms for things that are not true emergencies,” Forman said.

Many may simply go because they are anxious. “That incurs a significant cost to the healthcare system,” he added.

“I don’t believe insurance companies hold down costs so they can make more profit,” Forman said. Many insurance companies simply manage programs for employers who are self-insured, meaning they pay their employee health costs themselves.

Related: ER Visits Hit Record High in 2005

That said, Forman added, ACEP has a point.

“It is really difficult to know in advance which patient is really having an emergency,” he said. “Doctors aren’t even great at predicting which patients have something terrible.”

And you cannot blame patients for using ERs. “The emergency room has become the multi-specialty clinic of the 21st century,” Forman said. “You can go to the emergency room with blood in your stool, which for most people is not an emergency, and four hours later not only be diagnosed with colon cancer but you could have already met with the oncologist,” he added.

“We provide a level of service in the ER now that is extraordinary.”

And that drives up costs. What the insurance companies say they want to do is direct people to less expensive and more appropriate options.

“If a member can’t get an appointment with their primary care doctor, most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics or 24/7 telehealth services such as LiveHealth Online,” the Anthem letter advises.

See the original post here:
Major Insurance Company’s Payment Decision Angers ER Doctors – NBCNews.com

Read More...

From The ER To Nowhere: GOP’s Health Care Bill Threatens Opioid … – WBUR

wbur Commentary On the front line of the opioid crisis, emergency physicians Alister Martin and Nathan Kunzler implore: less lip service, more drug rehabilitation services. Pictured: A doctor delivers a numbing drug to nerves responsible for a patients arm pain, in an effort to help the patient avoid or reduce use of potentially addictive painkillers after surgery. (Patrick Semansky/AP)

Like what you read here? Sign up for our twice-weekly newsletter.

Imagineyou get a frantic call from a loved one. He has chest painthat feels like the last time he had a heart attack and he is en route to the emergency room.

After weaving through traffic on I-93, negotiating the maze of hospital parking, you arrive at his bedside in the ER an hour later.

You find him struggling to pack his bags, his right hand still clutching at his chest, beads of sweat trickling down his forehead, his face wincing from the tiny jolts of pain running through his chest like electricity.

Confused, you asked what happened.

Between strained breaths he’s able to hand you the discharge paperwork he was just given.

The cover of the discharge packet is a page titled “Information On Heart Attacks.” The next page shows a summary sheet of his laboratory resultsdiagnosing him with a heart attack. If he does not receive a procedure called a percutaneous coronary intervention soon, he’ll likely die from this.

The doctor returns and hands him a list of nearby centers that provide the treatment.She states, Unfortunately, most centers dont accept new patients at this hour,but perhaps if he calls first thing on Monday, he couldget treatment in a week or so, insurance permitting.

You protest, knowing he may die if he doesn’t get immediate help. The doctor replies, “I am so sorry,there is nothing more we can do tonight.”

Sound absurd?

Thankfully, this is not the way we treat heart attacks.

Unfortunately, this is the way most emergency departments treat patients looking for help overcoming their opioid addiction.

Today, if your loved one presentedthemselvesto almost any emergency room solely looking to get treatment for his addiction, he’s likely to get what amounts to a routine physical exam, a discharge packet with a list of phone numbers to detox facilities and a pat on the back.

In the midst of what is the biggest public health crisis since the AIDS epidemicin the mid-1990s,we also have an enormous treatment gap that is exposed nightly in our state’s emergency rooms.

Consider: A recent federal survey found that Massachusetts had by far the highest rate of opioid-related ER visits at 450 for every 100,000residents, a number10times higher than the lowest rate in Iowa at 45visits. Maryland was a distant second at300 visits.And yet, the data show us that about80 percentof patients with substance use disorder do not get the treatment they need. This status quo is unacceptable.

Fortunately, some emergency departments are quickly adopting innovative strategies to providebetter care for this population. The treatment that holds the most promise is medication-assisted therapy (MAT) in which doctors administerbuprenorphine in the ER, a partial narcotic that is less addictive and easier to taper off than methadone.

For instance, emergency physiciansat Yale New Haven Hospital recently tested how administering Suboxone, a brand of buprenorphine,and then referring patients to outpatient providers to continue themedicationtherapy would impact the rate of persistence with addiction treatment. The result: After 30 days, 78 percent of patients who were given Suboxone and a brief interview remained in treatment while only37 percent of patients who merely received a referral to an outpatient drug rehab provider remained intreatment.

The authors leveraged alittle-known exemptionto a federal law that allows emergency providers to administer Suboxone in the ER to treat withdrawal symptoms for 72 hourswhile permanent treatment is being arranged. That exemption allows doctors to provide this valuable treatmentwithout going through theunpopularDrug Enforcement Administrationwaiver processthat currently prevents 97 percent of all physicians from being able to prescribe the drug.

Another studyfrom Medstar Union Memorial Hospital foundthat starting Suboxone before hospital dischargedecreases return hospital and ER visits and improves patients perception ofquality of life.

These studies point topotentially life-changingsolutions for these vulnerable patients.

The House’s passage of the Republican health care bill,however,threatens the use of this solution in emergency rooms nationwide. This is because starting Suboxone in the ER is only effective if patients can continue treatment with outpatient providers that can prescribe the medication. This relies on insurance payers covering the medication.

For emergency physicians like us, this means … there may be no outpatient physicians able to continue the treatment, effectively creating a bridge to nowhere.

Today, Obamacareensures this coverage byrequiring that all patients covered under Medicaid expansion receive essential health benefits, including substance use disorder services like Suboxone.

Frighteningly, the recent Congressional Budget Office reportreveals thatthecurrent version of theRepublican health care billeliminates the requirement for essential health benefits and threatens this solution. If insurers do not cover Suboxone, outpatient providers will be unable to continue prescribing this medication to discharged patients.

For emergency physicians like us, this means that while we may be able to start patients on these lifesaving medications, there may be no outpatient physicians able to continue the treatment, effectively creating a bridge to nowhere.

As Senate Republicans produce their version of the Republican health care bill, emergency physicians on the front line, desperate for solutions, implore:less lip service, more drug rehabilitation services. Turning the tide on the opioid epidemic starts with protecting the essential health benefits that combat opiate addiction.

Follow Cognoscenti on Facebook and Twitter, and sign up for our twice-weekly newsletter.

Read more from the original source:
From The ER To Nowhere: GOP’s Health Care Bill Threatens Opioid … – WBUR

Read More...

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.

Like us on Facebook

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.

Follow this link:
Blue Cross Blue Shield To Launch Emergency Room Policy – WABE 90.1 FM

Read More...

Wisconsin proposal would help keep chronically ill out of emergency rooms – Milwaukee Journal Sentinel

The emergency room entrance at Columbia St. Mary’s Hospital’s emergency department at 2301 N. Lake Drive in Milwaukee.(Photo: Mike De Sisti / Milwaukee Journal Sentinel)Buy Photo

MADISON – Last year in Wisconsin, thousands of people visited an emergency room more than seven times eacha stream of bad outcomes for taxpayers, the health care industry and the patients themselves.

To respond, lawmakers voted last week to givehospitals a powerful financial incentive to reduce emergency room costs within the state’s Medicaid health programs for the needy.

The pilot proposal: Work with diabetics and patients with asthmaandheart disease to control the health conditions that are landing them in the emergency room. If successful, the proposal could mitigate millions of dollars in unnecessary costs for taxpayers and give patients better lives to boot.

“It’s really creative,” said Eric Borgerding, the CEO of the Wisconsin Hospital Association and a supporter of the proposal. “I’m confident it will result in a reduction of emergency department utilization.”

The approach: Payhealth care providers to prevent bad outcomes and emergency room visits for patients rather than paying them even more to provide emergency room care after a patient has had a bout with asthma, or worse yet, a heart attack.

The caveat: Gov. Scott Walker’s administration wasn’t closely involved in the proposal and is still reviewing it, with one top official asking whether the state needs a completely new initiative to accomplish what its existing programs couldbe doing already.

Pointing to numbers from the state hospital association, Borgerding and Rep. Joe Sanfelippo (R-New Berlin) said that last year 10,000 Medicaid recipients in Wisconsin used an emergency room more than seven times at a total cost of $52 million.

Sanfelippo worked on the Medicaidpilot after seeing the success that Aurora Health Care and St. Joseph Hospitals were having with a similar initiative.

“I thought, ‘Hey, maybe this is a trend and something we can build on,’ ” Sanfelippo said of the hospitals’ efforts.

By working with a core group of frequent ER visitors, the hospitals worked to ensure that patients regularly saw a primary care doctor, dealing with challenges ranging from child care and transportation to mental illness. Aurora cut per patient costs by an average of $55,000 within the target groupat its St. Luke’s hospital and nearly $34,000 a patient at its Sinai location. St. Luke’s saw a startling 68% decrease in ER visits and an 80% cut in ER costs among the targeted patients.

“We think there’s a lot of room for expanding this,” said Mark Huber, Aurora’s senior vice president for social responsibility.

Anne Johnson, an emergency room physician for Aurora, gives the example of a patient in her 60s with emphysema and anxiety issues who used to showup at the ER five times a month.

A team at Aurora that included a social worker looked into the woman’s case, working to ensure she got the medicine needed to manage her condition and contacting the woman’s niece about her aunt’s challenges.

“Her family member had no idea,” Johnson said.

Today, the woman is coping with her condition much better and only needs the emergency room every six months, Johnson said.

Sanfelippo’s proposal, which was approved by the Joint Finance Committee Thursday, would set aside $2.3 million over the next two years to encourage hospitals and health systems to take similar steps. The provision in the state budget still needs to be approved by both houses of the Legislature and Walker.

Under the program, hospitals and health systems would get up to $1,000 a year for each frequent emergency room patient enrolled and try to lower his or her ER use and costs. If the health systems prevented ER visits and saved money for taxpayers, the state Department of Health Services would pay half of the savings to the health care provider.

Sen. Jon Erpenbach (D-Middleton) didn’t rule out Sanfelippo’s proposal but noted there were other approaches to prevent emergency room use, including expanding the state’s Medicaid program to more people.

“There’s a lot of ways to work on over-utilization of the ER,” he said.

State Medicaid director Michael Heifetz was also cautious.

Heifetz acknowledged the need to actively manage Medicaid patients’ cases. But he also pointed out that the great majority of patients in Medicaid are already in HMOs, which should be doing at least some of this work already.

The proposal also lays out in some detail how to add more case management into the state’s system, reducing the flexibility for state officials, he said.

“It’s very prescriptive and needs further review,” Heifetz said of the provisions.

Read or Share this story: http://jsonl.in/2s208Cw

Read the original post:
Wisconsin proposal would help keep chronically ill out of emergency rooms – Milwaukee Journal Sentinel

Read More...

GOP Rep. Kevin Cramer claims emergency rooms are universal health care – Shareblue Media

Rep. Kevin Cramer (R-ND) has repeatedly and falsely claimed that a law mandating hospital emergency rooms provide care to anyone who needs it is the same thing as universal health care a cruel interpretation of the law that has become an article of faith for Republicans.

Cramer, who may run against Democratic Senator Heidi Heitkamp in 2018, made his statement in at least four appearances over the last two weeks.

At a town hall meeting, he told constituents, We have universal health care access because we require by law and by tradition and by compassion that any person that walks into an emergency room receives care.

In another appearance, Cramer said, In the early 80s or mid-80s wepassed a law requiring health care for everybody in the United States of America. That was 30 plus years ago. So that means no one can be turned down for care.

He also made the claimin tworadio interviews, and at another town hall meeting, as repeated justification for his vote in favor of the Republicans health care repeal plan, which would strip health insurance from at least 24 million Americans.

CRAMER: Back in the 1980s, actually, when Ronald Reagan was President we the country passed universal healthcare by, you know, guaranteeing that no one would be denied health care. So, weve had it since the 1980s, this mandate. Its just that how you pay for it has always been the sticking point. So, most people, for a long time it was through the emergency room, and thats very expensive care. And that burden is then passed on to other people who have insurance and drives up costs.

Cramer is citing a 1986 law which mandates emergency room treatment for anyone who needs it, but the law does not cover care before or after an emergency room visit.

And no matter how many times Republicans say it, emergency room care is not health care.

Laws like the Affordable Care Act understand this, and provide for health care access so doctors and other health care professionals can catch illnesses before they become so severe that an emergency room visit is needed.

The goal of preventative medicine is to save money in the long run, but more importantly to prevent pain and long-term suffering. Catching someone before they have a heart attack is obviously preferable to an emergency room visit for cardiac arrest, for instance.

Furthermore, the emergency room is useless for diseases that need ongoing treatment, like cancer, diabetes, and end-stage renal disease. The emergency room cannot provide chemotherapy or ongoing dialysis that hundreds of thousands of Americans need to survive.

Universal health care is a system that provides health care to all citizens, regardless of income. That means in all phases of care, not just when things are so critical or life-threatening that emergency services are needed.

An actual universal system of care does not yet exist in the United States, and Cramer is lying to his constituents when he says otherwise.

Here is the original post:
GOP Rep. Kevin Cramer claims emergency rooms are universal health care – Shareblue Media

Read More...

How to navigate a bustling emergency room – The Seattle Times

A visit to the emergency room is a stressful experience, especially as wait times can easily exceed several hours. Heres how to make sure you and your loved ones have appropriate care.

Complaints about emergency room care are legion, with stories of distress frequently voiced both by patients and by the relatives and friends who accompany them to the ER. Sometimes these complaints are warranted, as when patients with abdominal pain wait unattended in the ER for hours until their appendix bursts. But more often than not, they stem from a misunderstanding of how emergency rooms operate and how patients themselves can be helpful.

Among the laments Ive heard: I was there four hours before I saw a doctor. Nurses, doctors and orderlies kept scurrying past my cubicle, but no one paid any attention to me. I couldnt get anyone to bring me a drink of water. I was observed for hours, but no one would tell me if or when I might be admitted to the hospital.

And if you do need to be admitted, expect to wait some more in the emergency room until a bed is available in the appropriate unit.

Each year some 120 million Americans go to an emergency room, a number that increases annually even as more hospitals close their ERs (there are now 22 percent fewer than 20 years ago). According to the Centers for Disease Control and Prevention, the average wait time before seeing a physician is 55 minutes, but the wait could easily exceed several hours on a busy night or weekend.

The most important fact every ER visitor should know is that true medical emergencies patients with a potentially life-threatening problem like a heart attack, stroke, respiratory distress or uncontrolled bleeding take precedence over a broken bone, headache or stomach pain.

A triage nurse will evaluate the severity of your problem and assign you a priority number. Expect to wait if your life is not hanging in the balance, and dont complain if someone who came in hours after you is seen first. As one nurse put it, Waiting is good. It means youre not going to die.

However, if you are waiting to be seen and your symptoms get worse or new ones develop, let the admitting desk know. ERs do not want people vomiting or passing out in the waiting room. But there is little to gain from exaggerating your symptoms youll confuse the diagnosis and may be subjected to needless tests in order to be seen sooner.

Also important to know: If faced with a true emergency, call 911. The responding ambulance will take you to the nearest hospital equipped to deal with your problem. Dont follow the example of two friends of mine who walked themselves to the hospital while in the throes of a heart attack. And dont drive or have someone drive you. If you come by ambulance, you will be evaluated and given emergency treatment immediately, even before reaching the hospital. But if your problem turns out to be less than urgent, once there youll be sent to the back of the line.

If a doctor sends you to the emergency room, ask the office to call ahead and provide important background information.

But think twice before heading to the ER for less-than-urgent problems. If your doctor is not accessible, minor ailments like a bad cold, sore throat, earache, eye infection, back pain or a cut needing stitches are best treated in an urgent care facility, now common in most cities. These days many chain drugstores have clinics staffed by medically trained personnel who can treat many minor problems, although not a bad cut or wound, and suggest more specialized care or follow-up when needed. (Do ask first about cost and insurance coverage.)

In addition, some hospitals, including most hospitals in Connecticut, have a fast-track emergency room for treating patients with less serious problems and getting them out quickly.

Assuming that an emergency room is your best option, there are many things you can do to make the visit more efficient and less anxiety-provoking. Along with your insurance card, keep a card in your wallet or a list on your phone with all the medications and supplements you take and any allergies or chronic health problems you have. If available, also take copies of recent laboratory or diagnostic test results.

Try to have someone come with you or meet you at the ER who can serve as your advocate and helpmate. A friend who recently spent many hours in the ER with an elderly woman who had fallen and broken her nose was able to get her a needed drink, refill her ice pack, find out when she might be admitted and offer moral support.

Once assigned an ER cubicle, learn the names of the nurse and doctor in charge of your case since they are the best ones to ask for help, including pain relief, and may be the only ones who know if its safe for you to eat or drink something.

Although it is normal to be stressed and anxious when seeking emergency care, try to practice self-calming measures like deep breathing or meditation. This can help to minimize your symptoms and counter a tendency to become hostile, which would not endear you to the ER staff and may even result in less, rather than more, attention paid to your case.

When you are ready to be discharged, make sure you understand the instructions for the continuing or follow-up care you may need and request a number to call if your condition worsens later.

Link:
How to navigate a bustling emergency room – The Seattle Times

Read More...

Mount Sinai St. Lukes | Emergency Services NYC

Get emergency care phone numbers

Psychiatry Emergency Outreach

Our comprehensive emergency services provide rapid evaluation and treatment of psychiatric disturbances, as well as planning for follow-up care. The four emergency service components of our program include: psychiatric emergency rooms, extended observation beds, mobile crisis outreach, and the crisis residence program.

Our Emergency DepartmentDr. Dan Wiener, Chairman of Emergency Medicine at Mount Sinai St. Lukes, talks about the St. Lukes Emergency Department

Rapid Triage and Care Patients who come to the St. Lukes Emergency Department are seen immediately by a nurse who evaluates their medical condition. Once evaluated, youll be immediately brought into a treatment room, and promptly treated by our expert and caring clinical team. We can even register you at your bedside, so you dont lose time doing paperwork.

Diagnostic Services in the ER If you need an X-ray or an ultrasound, we can usually do it very quickly in the Emergency Department. The doctor treating your emergency will be nearby, and if your condition changes suddenly, he or she can respond immediately.

In addition, CT and MRI scanners are readily available in the hospital, if necessary.

Separate Treatment Space for OB/GYN The Emergency Department at St. Lukes has separate, specially-designed rooms for women with obstetric and gynecologic emergencies. This more private environment offers all of the necessary equipment and diagnostic services for OB and GYN care including ultrasound in one room so patients dont need to be moved from space to space.

Fast Track Service for Non-Critical Care For injuries and illnesses that are not life threatening, the St. Lukes Emergency Department provides Fast Track service treatment in a separate space thats overseen by Board-certified Emergency Medicine Physicians. In Fast Track, patients with immediate, but less critical, needs are treated quickly in a comfortable, more appropriate environment than the main Emergency Room. Fast Track is available from 8 a.m. to 11 p.m.

Follow-Up Care After your emergency medical condition has been treated, our staff will help you to get the follow-up care you need. Our Physician Referral Service can give you the name of a doctor who can provide you with follow-up care and who participates in your insurance plan. If appropriate, we can also make an appointment for you in one of our many specialty clinics.

Some test results (such as throat cultures) will not be available until after you leave the department. In such cases, our physician assistants will call you if the results are positive.

Specialized Services for Victims of Violent Crime and Sexual Assault The Crime Victims Treatment Center at St. Lukes is one of the largest and most comprehensive hospital-based victim treatment centers in New York. As the first hospital in New York to establish a specialized, highly acclaimed treatment service for victims of sexual assault, we have SAFE (Sexual Assault Forensic Examiner) examiners available 24 hours a day. SAFE examiners devote their full attention to the victims needs, and only with the victims consent, collect evidence that can be used to prosecute the crime.

Stroke Team Our rapidly deployed stroke team is capable of administering thrombolytic (clot-dissolving) medication to eligible patients within three hours from the onset of symptoms, which is the time period recommended by the American Heart Association.

For information on the symptoms and treatment of stroke, click on the link below to go to the website of the National Institutes of Health.

http://www.ninds.nih.gov/disorders/stroke/knowstroke.htm

Heart Attack Care Patients arriving at our Emergency Department with chest pain will receive an EKG shortly after arrival. We have 24-hour cardiac catheterization capabilities for patients with symptoms of a sudden heart attack. In the catheterization lab, a small wire is threaded up the femoral artery in the groin to the heart, and a balloon on the tip of the wire is used to open the artery and expand a chicken wire-like stent to hold the artery open. The blood can then flow freely to supply the heart muscle with oxygen and other nutrients.

Learn More on the NHLBI WebsiteLearn more about heart attacks on the official website of the National Heart Lung and Blood Institute (NHLBI).

What are the signs and symptoms of a heart attack?What is a heart attack?How is a heart attack treated?

Read the rest here:
Mount Sinai St. Lukes | Emergency Services NYC

Read More...

Page 112