All posts tagged care

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.


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.


Total visits: 56,395

MediCal: 25,913

Self-pay: 3,792


Total visits: 55,452

MediCal: 25,282

Self-pay: 4,603


Total visits: 52,425

MediCal: 22,159

Self-pay: 6,289


Total visits: 53,547

MediCal: 16,482

Self-pay: 8,042


Total visits: 46,455

MediCal: 14,032

Self-pay: 6,793


Total visits: 44,760

MediCal: 14,217

Self-pay: 6,354


Total visits: 44,751

MediCal: 14,828

Self-pay: 6,434


Total visits: 47,059

MediCal: 15,347

Self-pay: 6,671


Total visits: 47,609

MediCal: 14,109

Self-pay: 7,802


Total visits: 48,604

MediCal: 14,977

Self-pay: 7,865


Total visits: 49,195

MediCal: 15,547

Self-pay: 7,534


Total visits: 49,080

MediCal: 15,539

Self-pay: 7,326

Source: California Office of Statewide Health Planning and Development

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


Emergency Room Telemedicine Consults Help Pediatric Patients –

Source: Thinkstock

June 13, 2017 -The Robert Wood Johnson University Hospital (RWJUH) in Somerset, NJ is the latest hospital to offer emergency room telemedicine consults to improve access to care for high-acuity patients.

The hospital can now connect patients at its Somerset campus with pediatric emergency medicine at the Bristol-Myers Squibb Childrens Hospital (BMSCH).

RWJUH will offer services that leverage real-time video conferencing via a remote telepresence device. This allows physicians to evaluate patients from a remote location without needing extra travel for emergency care.

By providing telemedicine for our emergency pediatric patients, were able to increase access to specialized pediatric care across the region, said Richard Brodsky, MD, Director of Pediatric Telemedicine at The Bristol-Myers Squibb Childrens Hospital at Robert Wood Johnson University Hospital.

Parents can rest assure that their children always have access to the most specialized care, without the added stress of transfers and travel. We expect telemedicine to help expedite the diagnosis process, helping children receive the care they need when they need it, he said.

Along with real-time video, a remote doctor can immediately access a patients records and medical history to facilitate examination through a two-way camera system. A present physician is able to administer specialized videography that integrates with a stethoscope and ophthalmoscope. Through the connected stethoscope, the remote physician can hear the patient’s heart/lung sounds and see a close up of a patients vitals at the same time as the onsite physician.

This is the latest in the continual growth of hospitals utilizing telemedicine services within emergency care. Providers may need to use mobile care delivery platforms such as video conferencing to respond immediately to emergency situations.

Emergency departments also face pressure to keep their doors open 24/7, regardless of patient volume. To address these challenges, hospitals have been increasing their telemedicine capabilities.

Telemedicine came to the rescue of a small hospital on Prince Edward Island, which had shut down its ED overnight to reduce strain on the organization.

In another example, an army hospital in Kentucky pursued telemedicine in order to reduce ER wait times and redirect non-urgent issues to a primary care provider instead of the ED.

Telemedicine is seen by many hospitals as a means of reducing stress on ED staff, hospital resources, and the delivery of specialized care whether its telepsychiatry, pediatric care, chronic care, or any other specific care.

If you or your family member is sick, having access to a doctor right away is a priority, said Master Sgt. Jason Alexander, clinical operations NCO for the Armys Regional Health Command-Atlantic (Provisional). Not only will the care provided be focused to their need but it will also help reduce their wait time and allow ED professionals to take care of more urgent cases.”

Leaders at RWJUH aim to use telemedicine in similar ways to improve access to pediatric care for their patients.

Currently, the RJWUH Telemedicine Program provides RWJUH Somerset pediatric patients access to BMSCH services including board-certified pediatric doctors who specialize in trauma and emergency medicine.

If a pediatric patient who comes to RWJUH Somerset needs a second opinion for an emergency condition, telemedicine can connect them with a doctor to reach a diagnosis before the child would arrive in New Brunswick. Should a patient need a medical procedure following the consultation such as surgery, the child may be transferred to BMSCH for an in-person evaluation.

RWJUH has experienced previous success with pediatric telemedicine, and hopes that increased mobility and care delivery will improve upon an already well-received telemedicine program.

Were bolstering our telemedicine capabilities adding a dedicated remote telepresence device for our pediatric emergency patients, said Marc Milano, Medical Director of RWJUH Somersets Emergency Department.

Weve seen increased patient outcomes since introducing our Teleneurology program for stroke patients in 2014. By expanding our capabilities for pediatric emergency telemedicine our goal is to provide better care more quickly especially in emergency situations where time can be a critical factor for a patients survival and recovery.

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Emergency Room Telemedicine Consults Help Pediatric Patients –


What you should know about freestanding emergency centers – TribTalk

When struck with an illness or injury, sometimes its hard to know where to go for treatment. With so many options for care, including emergency centers and urgent care centers, knowing where to turn during a medical emergency can save precious time, provide the best possible outcome and can ensure you receive the best value for the care provided.

When you need a facility that is open 24/7 and offers a higher level of care to deal with an emergency situation, a hospital-owned and operated emergency center is your best option for a number of reasons. These emergency centers may be freestanding or located within hospitals. While freestanding emergency centers (FECs) are structurally separate from hospitals, they are capable of delivering emergency services 24 hours a day, seven days a week.

According to the Texas Hospital Association, Texas has more FECs than any other state. Out of the 345 FECs in Texas, however, less than 40 percent are hospital owned and operated. That means that more than 60 percent of the FECs in our state are not affiliated with nor owned by hospitals, which often means they are not owned by healthcare operators. These independently owned FECs are not required to comply with the regulatory and accreditation requirements that hospitals are subject to, and therefore, they do not provide outcomes data to state and federal agencies.

At St. Davids HealthCare, each St. Davids Emergency Center serves as an extension of a St. Davids HealthCare hospital, and these centers are staffed by board-certified emergency room physicians and nurses with experience treating emergent injuries and serious medical conditions. St. Davids Emergency Centers are subject to the same licensing and operational requirements as our hospitals because each is licensed as part of a hospital.

With hospital-affiliated freestanding emergency departments like the St. Davids Emergency Centers, there is a seamless continuum of care should a patient need to be transferred to an inpatient hospital setting. As hospital-affiliated freestanding emergency departments, St. Davids Emergency Centers also meet the criteria established by Austin-Travis County EMS to receive patients being transported by ambulance. Each center has a dedicated ambulance bay for the intake of EMS patients.

Within St. David’s HealthCare, our freestanding emergency departments treat the same clinical conditions as emergency departments within hospital facilities. As such, billing is the same for the traditional hospital emergency department as for the hospital-affiliated freestanding emergency department. St. Davids Emergency Centers are considered in-network with most major insurance companies, and they participate in government programs such as Medicaid, Medicare and TRICARE, whereas many independent FECs that are not affiliated with a hospital do not.

As the number of independent, non-hospital-affiliated FECs grows in Texas, its important that patients understand the differences between the various emergency care options. Moreover, it is prudent that patients seek out the appropriate care setting for the acuity, or seriousness, of their needs. In addition to emergency rooms at six St. Davids HealthCare hospitals in Central Texas, you can also find St. Davids Emergency Centers across the region.

For less acute illnesses and injuries that dont require emergency treatment, urgent care centers which are lower-cost alternatives to emergency departments are the better option for patients. Urgent care centers treat non-emergent medical problems that can develop unexpectedly and require immediate attention, filling the gap between primary care physicians and hospital emergency rooms. As healthcare continues to evolve, consumers are looking for quality, convenient and cost-effective options for care and treatment. Urgent care clinics have become a broadly used form of care for many and are seen as convenient and quick solutions for a host of medical needs.

For more information, see the Texas Hospital Associations article Setting the Record Straight on Freestanding Emergency Centers in Texas.

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What you should know about freestanding emergency centers – TribTalk


Spike in opioid visits at ECMC pushes ER doctors to front lines of epidemic – Buffalo News

Opioid-related emergency room visits at Erie County Medical Center more than doubled from 2009 to 2016, a startling rise reflective of the addiction epidemic in Western New York and across the country.

The growth mirrors an increase in opioid deaths and, like the fatalities tied to drug abuse, the patients come from every corner of the region urban, suburban and rural.

An examination of nearly 17,000 opioid-related patient visits at one of Buffalo’s busiest hospitals offers a snapshot of the epidemic, and suggests current estimates of hospital visits connected to opioid use in the region are underestimated.

Data from ECMC also reveal the central role emergency departments have come to play in the wake of the extraordinary expansion in the use of narcotic pain relievers in the United States and the growing abuse of heroin.

Among the results:

In recent years, as the opioid epidemic swept the nation, emergency room doctors have been pressured to reduce their prescribing of addictive painkillers for chronic pain.But now, so many patients arrive in emergency rooms with a history of opioid use that emergency rooms are coming to be seen as a potentially ideal place to start addiction treatment.

This represents a fundamental change for a hospital service focused on stabilizing patients with immediate medical concerns and referring them elsewhere for follow-up care.

“Emergency departments can be a real-time source of information on public health problems like this one. They can also be a foot in the door to getting people addicted to drugs the care they need,” said Dr. Ronald Moscati, an emergency room physician and co-leader of a seven-year study of opioid-related visits at the medical center. “It’s a horrible disease and very difficult to treat.”

More visits from outside the city

The review by Moscati and his colleagues attempted a truer accountingof the ways opioid use ispushing people into hospitals. Most hospitals track opioid-related visitsby looking at counts of addicted patients who arrive in emergency rooms seeking detoxification, suffering from withdrawal symptoms or having overdosed. But in many other cases such as patients who injure themselves or feel ill for other reasons opioids turn out to be a contributing factor.

ECMC sought to track allthe reasons opioid users land in the emergency room.

Of the462,983 patient visits to the ECMC emergency departmentfrom June 2009 through June 2016, 3.6 percent, or16,712,had anopioid connection, particularly patients who overdosed on drugs or requested detoxification treatment.

As the years went on,a greater share of theopioid-related visits came from outside the City of Buffalo, jumping from 42 percent in 2009 to a high of 62 percent in 2014.

Whites represented 59 percent of the patients in 2009 but, otherwise, accounted for about 82 percent of opioid-related cases each year afterward. Most of the patients 63 percent on average were male.The median age grew from 28 to 31.

The statistics include patients who may have visited the emergency room multiple times. But the researchers say the trends at ECMC represent those in the larger community because the emergency department receives a majority of the opioid overdose patients in the region, and is the only emergency department to offer specialized services for trauma, psychiatric emergencies and acute substance abuse detoxification.

Opioid-related emergency room visits at Erie County Medical Center more than doubled from 2009 to 2016. (Derek Gee/Buffalo News file photo)

“There is no mystery to what we found,” Moscati said. “We’ve confirmed in an objective way what was an impression of what is happening, and that gives us better insight for targeting education and treatment.”

The chart review, which was organized by the University at Buffalo emergency medicine department, suggests a way to improve regional surveillance of opioid trends, much like the flu and other communicable diseases are tracked. It also argues for greater involvement in addiction care by emergency medicine doctors.

“We see this as a potential way to see the changes in the overall picture over time,” said Heather Lindstrom, research director of UB Emergency Medicine and a co-author of the study.

Starting addiction treatment in the ER

Addicts looking for help confront a health system with a shortage of treatment options, especially access to buprenorphine, a medication also known as Suboxone that is used to reduce cravings. In 2015, fewer than 20 percent of people in the United States who needed addiction treatment received it, according to the National Survey on Drug Use and Health sponsored by the Department of Health and Human Services.

Emergency room doctors focus on evaluating and stabilizing seriously ill and injured patients. But as physicians, advocates and public health officials grapple with the challenges of how to deal with a mounting number of opioid addictions and overdoses, they are looking at the emergency department as a place to start addiction treatment.

“Historically, in the emergency department, we’ve given people with addiction problems a list of phone numbers for treatment at discharge after their immediate concerns have been taken care of. But too many of them leave, use again and overdose again,” said Dr. Joshua Lynch, an emergency room doctor at ECMC and Kaleida Health involved in an initiative in Erie County to establish medication-assisted addiction treatment in emergency rooms.

Opioids include the illegal drug heroin, as well as powerful pain relievers available by prescription, such as oxycodone, hydrocodone and fentanyl. Experts say an explosion in the use of prescription opioids in the past few decades led to increased use of heroin.

“There is no overnight fix. Policies have to change. The stigma of addiction has to change. Doctors need to be trained,” he said. “But we should be treating addiction like any other medical problem.”

The idea of starting treatment in the emergency room got a big boost from a 2015 Yale University study thatfound that individuals with opioid addiction who were treated with the medication buprenorphine in the emergency room were more likely to stick with treatment beyond the emergency room by a large margin 78 percent compared to 37 percent of patients who were seen in the emergency department and given a referral for care elsewhere.

Dr. Joshua Lynch in the emergency room at Millard Fillmore Suburban Hospital. (Mark Mulville/Buffalo News)

Lynch, who also chairs the hospital group in the Erie County Opiate Epidemic Task Force, said the project here will take that idea a step further with formal links between emergency departments and addiction treatment services, such as Evergreen Health and others in Buffalo. For most opioid-users, the goal is to screen potential candidates, and ensure they leave the hospital with a treatment plan and a definitive link to a place to get treated. A smaller portion who need medication would receive short-term supplies of buprenorphine or other medications, and linkage to addiction services.

None of this will be easy.

Overcoming health system challenges

Doctors must be trained and certified to prescribe buprenorphine, which is also an opioid. Currently, there are only about four emergency doctors in the area with such training, and addiction patients can be difficult to treat in a busy emergency room. To get physician buy-in, referring treatment services must be reliably available at all hours. To truly succeed, more primary care doctors must be certified in buprenorphine prescribing and willing to follow opioid-addicted patients once they have completed addiction treatment.

There are more than 900,000 doctors in the U.S. who can prescribe addictive painkillers, but only 37,000 who can prescribe buprenorphine.

“This is not just an emergency room or addiction doctor issue. The entire medical community needs to step up,” said Lynch, who anticipates starting addiction treatment at ECMC and Millard Fillmore Suburban Hospital later this year once about a dozen emergency doctors receive training to prescribe buprenorphine.

The county is seeking funding to operate the initiative as a study that will involve UBMD emergency medicine doctors affiliated the University at Buffalo and Columbia University, which has experience in designing research on substance abuse and counseling.

“We have the one study from Yale that looks promising. We want to see if the strategy is effective,” said Dr. Gale R. Burstein, county health commissioner. “But you first need to build capacity for medication-assisted treatment. There is no sense in screening people for possible treatment if there is no treatment.”

Meanwhile, the county continues to maintain a 24-hour addiction hotline, and is making slow but steady progress training primary carephysicians, nurse practitioners and physician assistants to use buprenorphine. That effort moves forward against a strong headwind. Primary care physicians have been reluctant to take on patients with drug addiction problems, especially with the need to perform regular drug testing and a common perception, real or not,that they may be held criminally liable if a patient dies of an opioid overdose.

Patient advocates like Debra Smith applaud the effort.

“One of the biggest situations families face is that someone goes to the emergency room to be stabilized, but they are released after the medical emergency is addressed. That’s their job. They save someone and then release them. The problem is it does not meet the needs of the addiction,” said Smith, whose 26-year-old son, Nathaniel, died in 2015 from an opioid overdose.

Smith, who also serves on the county’s opiate task force, said she’s impressed that physicians and public health officials here have taken the concern seriously and are doing something about it.

“They don’t have all the answers, but they’re trying to deal with this,” she said.

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Spike in opioid visits at ECMC pushes ER doctors to front lines of epidemic – Buffalo News


Celebration of excellent care in Beebe Emergency Department –

Part 1 of a 2-Part Series: In these articles, Wes and Michelle Rumble of Lewes share their story about the excellent care they received over the past couple of years in the Emergency Department at Beebe Healthcare.

Wes and Michelle Rumble met 22 years ago in Lewes, while taking lifelong learning classes. Prior to settling in Lewes, each had been busy enjoying life – living and traveling both domestically and abroad. Wes is originally from California, while Michelle is a Beebe Baby (someone born at Beebe) and former Rehoboth Beach summer worker who decided to return to her roots.

Neither had experienced any monumental health issues. Their emergency room visits had been few, peppered over the years, and all relatively minor. That all changed April 18, 2015. That evening, after many hours of serious abdominal discomfort, Wes had his wife call 911. After he arrived at Beebe’s Emergency Department via ambulance, the doctors initially diagnosed Wes with diverticulitis. However, the physician ordered a CT scan to confirm. The results revealed something different, and the doctor promptly switched his opinion to acute appendicitis, informing Wes that a surgeon had already been called.

Wes was taken to surgery immediately, and stayed in the hospital for several days before he was discharged. Wes describes both his ED stay and his inpatient care as top notch; his needs were constantly attended to by staff who were attentive, caring and compassionate.

While Wes was still recovering from appendicitis, Michelle began having episodes of atrial fibrillation that led to a series of ED visits. Then on Oct. 3, 2015, Michelle suffered a stroke. As Wes tells the story, “I was looking over Michelle’s shoulder as we were discussing something on her computer screen. She said something I didn’t understand.”

Wes asked, ‘What did you say?’ And, again, he could not understand – she was speaking gibberish. “Almost immediately I suspected a stroke,” Wes said. Michelle knew something was wrong and got up, talking, but not making any sense. Wes brought her back to a chair to sit down. He then checked her face and arms for stroke signs as he called 911.

“Upon hearing me say ‘stroke,’ the 911 operator immediately transferred me to a medical specialist who guided me through diagnostic tests for the few minutes until the EMTs arrived. All of a sudden, there were three more people in the room with me – one continuing diagnostic tests with Michelle, one observing while preparing to transport her, and the third one asking me questions. Before I knew it, Michelle was on a stretcher and out the door, looking back at me with fear in her eyes,” Wes said.

Wes quickly followed the ambulance to the hospital, but he had to wait to see her after her tests were completed. Wes was worried because he wanted to be with her to help her communicate. He was brought into the ED area and saw Michelle being propelled along the corridor by the EMT crew and then into a room. He soon discovered that the EMTs had taken Michelle to two imaging locations within Beebe. There would have been a long wait at the primary one, and the EMTs were unwilling to leave her, so they had taken her to the secondary location. Their decision not to leave Michelle waiting for imaging was critical. They knew she needed a diagnosis immediately.

While the routine ED tasks were being done, Wes called their children and noticed that Michelle’s fear had subsided a bit.

However, as she struggled to communicate, she became tense and angry, frustrated with her inability to speak. Attempts by the ED doctor, the nurse and others to calm her had little effect. “I remember seeing the doctor and nurse talking briefly off to the side,” Wes says, “then the nurse disappeared. When she returned, she had her arms full of little stuffed animals with Beebe T-shirts on them. She gently handed them to Michelle. Michelle immediately relaxed and a smile appeared on her face.”

By the next morning, after working with her son and other family members, Michelle was able to name the frog and a few others!

“It was a brilliant idea by the ED nurse, Amanda Ragland,” Wes said. “I will forever be thankful to her for thinking to use the stuffed animals, not only to dissipate the anger and frustration, but to help Michelle begin her speech therapy.”

Wes was extremely grateful for the treatment Michelle got at Beebe’s ED. “I cannot say enough about the care my wife received. All matters of consequence were carefully considered. Nothing was done automatically, yet what needed doing was done efficiently.”

After a consultation with a neurologist, Dr. Christopher Kim, a hospital medicine physician who was stationed in the Emergency Department that day, decided that Michelle did not need the clot-buster.

“I remember talking to people afterwards who were surprised that the clot-buster was not prescribed. But I am glad it was not necessary and not used out of habit or blind procedure,” Wes said.

Michelle agreed, saying that it was Dr. Kim’s presence that kept her positive throughout her stay. “He was wonderful. He knew that I was making progress, he was involved but wasn’t in the forefront, and I could tell he was keeping a good eye on me,” Michelle said.

Two days later Michelle was working with therapists in her room when she mentioned some small, fleeting vision problems. Within minutes, she was on a stretcher and on her way to diagnostics because in some cases, vision problems could indicate continued or renewed bleeding. Her tests were negative and soon afterward, she was able to leave the hospital and return home under the care of Beebe Home Care Services. From there she was discharged to begin her outpatient speech therapy. However, more ED visits followed as Michelle’s atrial fibrillation continued to occur.

“It is unusual to be cared for by the same ED personnel on repeated visits,” Wes says, “however, no matter who was on duty, they were indistinguishable in their obvious concern for the patient and for the patient’s well-being.”

Dr. Georges Dahr, cardiologist, was instrumental in Michelle’s treatment; he had treated Michelle for a heart attack in 2010 and now again in 2015 for her stroke.

“He was so patient and spent an extraordinary amount of time with us and with our daughter who is a physical therapist and had at least a million questions,” Wes said. “Dr. Dahr answered them all. He never made us feel like we were bothering him. He makes you feel very special. On several occasions, we had to call him in the evening and there was never a problem with that. He would respond quickly to our calls. He just makes you feel so cared for.”

Eventually, Dr. Dahr recommended that Michelle consider an ablation for the atrial fibrillation. She decided to do that, and following a cryo-ablation in January of 2016, her AFib, and ED visits, stopped.

With numerous visits to the Emergency Department in 2015, and with the resolution of Michelle’s AFib in early 2016, Michelle and Wes thought their serious ED visits were all behind them, however in December 2016, Wes found himself back in the ED three more times.

Continue to follow Wes and Michelle’s story in the May 30 issue of the Cape Gazette.

Each year, the Beebe Medical Foundation hosts the biggest party of the summer, the Beebe Beach Bash! Beebe’s guests will take over a docked Cape May Lewes Ferry to enjoy The Fabulous Greaseband, dancing, dining, auctions and boardwalk games! This year’s Beach Bash will raise funds for Beebe Healthcare’s Emergency Department. If you or your loved ones have been cared for by the Beebe Heroes in the ED, we hope you’ll join us at the BASH! Beebe is committed to providing quality care for patients, and this event will allow the organization to offer the most advanced technology to save and change lives. For more information on how to join in the fun, go to

Originally posted here:
Celebration of excellent care in Beebe Emergency Department –


Home VA Healthcare The Next 72 Hours 3 Things Veterans Must Do During Civilian… –

With the changing landscape at VA concerning emergency civilian care, there are a couple easy steps veterans must take in order to not get stuck with the bill.

This issue recently came up for me. Two months ago, I had symptoms of a heart attack. With ourbaby in tow, my wife proceeded to take me to the local emergency room in the suburbs of the Twin Cities for immediate help. Luckily, I did not die and am now feeling better.

But, had I failed to take a couple key steps, my pocket book would have taken a huge $6,000 hit, and that is what I wanted to write about today.

VA has a great program called fee basis that may cover certain veterans when they seek emergency care if entitled to the coverage. Generally speaking, this coverage is only applicable, however, if you provide notice to VA within 72 hours of admission.

Personally, I provided notice to my local VA medical center about the matter within the 72-hour window, but after two months of hearing nothing from VA, I grew a little concerned.

There is nothing like staring a $6,000 ER bill in the face to make you concerned. Again, luckily, I was covered, but many veterans out there get saddled with an ER bill either because they fail to take the required steps for coverage or because VA makes an adverse decision about the nature of their emergency.

I do not intend to discuss the latter scenario here, but I will address the first.

Here was my experience this week and things you need to know to make sure you do not need to cut a huge check to cover your non-VA emergency visit.

First, if you believe you are experiencing a medical emergency, go to the nearest emergency room you believe can provide the care you need.

Second, once there, be sure to inform the financial counselor that you are a disabled veteran who receives health care from the local VA medical center. Usually, the financial counselor is the person who comes into your emergency room to get your insurance information. Provide the actual name of the facility for their records.

The latter step obviously only applies to veterans who are conscious.

Third, be sure to ask the doctor or family member to contact VA to inform the agency that you are in the emergency room.

Personally, I prefer to make communications like this in writing and keep the record in case the inquiry gets lost.

You can use the IRIS system, fax in a letter to the local VA, or do some combination of both. Your emergency room staff should have the contact information for the local VA if it is in that region.

For me, I contacted VA using the IRIS system immediately after I was discharged to provide notice of the incident to VA since I was within the 72-hour window. I then faxed in the IRIS routing number along with a brief explanation of why, when, and where I was seen to the Minneapolis VA.

The billing process usually takes a few months, and I did not hear back.

Today, I was not sure who to contact locally to find out where my claim was at within the process, so I called (877) 222-VETS (8387). An operator at that number transferred me to the correct fee basis office within the Minneapolis VA system.

The local number for that office is (612) 725-2019. This number will be different for each VA facility.

The fee basis operator there provided the name and number of the contact person responsible for my specific claim.

While on the phone, I also asked about a few details about the claim process for the purpose of reporting any new information back to my readers.

There is a new thing I was previously unaware of.

Whenever a disabled veteran hasone rating of 50% or higher, VA is to be listed as the primary payer on the account. The operator informed me this was a newer change.

This may be important for veterans with at least one rating for one disability that is at least 50% disabling. In that instance, such veterans may have an easier time getting coverage than having to haggle with their own insurance, if they have it, and that insurance has a deductible.

Now, there is case law developing in this area, and VA is in the process of adjusting its policies when it comes to payment of emergency room visits.

In the past, problems have arising where veterans were stuck with the cost of the health care. Hopefully, new changes are on the horizon that will help resolve this kind of problem.

This aside, you need to remember that all veterans cases are unique and different. Not everyone will have the same entitlement or similar experiences. Each situation is different.

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Emergency Room – Highlands Health Systems

In May 2016, Highlands became the first hospital in the state to be recognized as an acute stroke ready facility by DNV Healthcare, one of the leading accrediting agencies in the United States. Acute Stroke Ready Facilities are recognized for establishing evidence based processes that ensure the finest care to patients experiencing an acute stroke.

Highlands underwent a rigorous onsite review where DNV experts evaluated compliance with stroke-related standards and requirements, including program management, the delivery of clinical care, and performance improvement.

At Highlands, we strive for the greatest level of commitment to the care of stroke patients, said Bud Warman, President & CEO, Highlands Health System. We are incredibly proud of this achievement and our ability to better meet the needs of the region.

The certification of Comprehensive Stroke Care ensures that a hospital can provide the services necessary for treatment of stroke patients. Certification involves a rigorous two-day survey, during which the program’s quality and care requirement are reviewed. In some states, including Kentucky, the level of certification determines where EMS providers will transport patients for the most appropriate medical care within state guidelines.

As part of the accreditation process, DNV surveyors will visit Highlands annually to monitor the hospital’s adherence to patient safety criteria established by CMS and to evaluate processes that impact patient care across various departments and facilities of the hospital.

Stroke is the number fourth cause of death and a leading cause of adult disability in the United States, according to the American Heart Association/American Stroke Association. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

About The DNV DNV Healthcare Inc. is based in Cincinnati, Ohio, and is a part of Det Norske Veritas, a global independent foundation dedicated to safeguarding life, property and the environment. For more information about DNV Healthcare and its NIAHO hospital accreditation program, visit

About Highlands Highlands Health System, a community-owned, not-for-profit health system, is the parent company for Highlands Regional Medical Center, the Highlands Center for Autism, Highlands Foundation, and Highlands Home Health.

Highlands serves the Big Sandy region and will develop a healthier community by providing a safe hospital environment, health education, and the promotion of wellness. Highlands provides healthcare services to a number of counties including Floyd, Johnson, Martin and Magoffin with a combined population of over 100,000 residents. The reach extends much farther however, to more than ten surrounding counties whose residents travel to Highlands to receive specialty medical services available at Highlands Regional Medical Center and numerous Highlands clinics.

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Emergency Room – Highlands Health Systems