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

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

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


Who pays when someone without insurance shows up in the ER? – USA TODAY

Right now, GOP senators are trying to gather enough votes to pass their Obamacare replacement plan, but even fellow Republicans are having a time a hard time accepting the health care bill. USA TODAY

An ambulance arrives at a hospital emergency room.(Photo: PhotoDisc)

WASHINGTON If an uninsured patient shows up in the emergency room, who pays? The hospital? Taxpayers? The patient? Other patients?

The question is important as Republicans debate health care legislation that could result in more than 20 million fewer Americans having health insurance in ten years.If that happens, some people will go without care. Others will show up at hospitals, but wont be able to pay their bills.

The year the Affordable Care Act passed, hospitals provided about $40 billion in “uncompensated care” that is, care they were not paid for.That was nearly 6% of their total 2010 expenses.

A 1985 federal law requires emergency departments to stabilize and treat anyone entering their doors, regardless of their ability to pay.

But that doesnt mean the uninsured can get treated for any ailment.

Theres lots of medical care we want to consume thats not an emergency, said health care economist Craig Garthwaite, an associate professor and director of the health care program at Northwestern University’s Kellogg School of Management.

It also doesnt mean that hospitals wont try to bill someone without insurance. And the bill they send will be higher than for an insured patient because theres no carrier to negotiate lower prices.

As a result, the uninsured are more likely to be contacted by collection agencies, as they face problems paying both medical and non-medical bills. One study, published in 2016 by the National Bureau of Economic Research, found that someone who goes into the hospital without insurance doubles her chances of filing for bankruptcy over the next four years.

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For the bills that go unpaid, hospitals can try to compensate by charging other patients more. But that doesnt happen as much as many people including policymakers — think.

The authors of the ACA believed thatincreasing insurance coverage through Medicaid and subsidies for private insurance would lessen the cost-shifting that leads to higher insurance premiums. Supreme Court Justice John Roberts also mentioned that benefit in the 2011 decision he authored upholding the laws constitutionality. But researchers havent been ableto document much of a cost shift.

Studying the effects of expanding Medicaid in Michigan where more than 600,000 gained coverage researchers at the University of Michigan havefound no evidence that the expansion affected insurance premiums. They did, however, document that hospitals uncompensated care costs dropped dramatically by nearly 50%.

Conversely, when Tennessee and Missouri had large-scale Medicaid cuts in 2005, the amount of care hospitals provided for free suddenly increased. In a 2015 study published by the National Bureau of Economic Research, Garthwaite and his co-authors estimated every uninsured person costs local hospitals $900 in uncompensated care costs each year.

This is not a trivial thing for a hospital to deal with, Garthwaite said. While hospitals average 7% profit margins, uncompensated care costs can be more than 5% of revenue.

Hospitals do get help with the unpaid bills from taxpayers.

The majority of hospitals are non-profits and are exempt from federal, state and local taxes if they provide a community benefit, such as charitable care. Hospitals also receive federal funding to offset some of the costs of treating the poor.

The ACA scaled back those payments in anticipation that hospitals’ uncompensated care costs would go down. The GOP proposals to overhaul the ACA would reinstate the payments, while making changes to Medicaid and private insurance subsidies that the nonpartisan Congressional Budget Office estimates would result in more than 20 million fewer people having insurance by 2026.


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The return of extra federal payments to hospitals for uncompensatedcare wouldnt be enough to offset the unpaid bills, according to an analysis by the Commonwealth Fund. The study examined the Medicaid changes included in the bill that passed the House in May, and co-author Melinda Abrams said the effects of the Senates pending proposal would be at least as great.

Hospitals operating margins in all states would decline. And hospitals in most of the 31 states which expanded Medicaid under the ACA would have negative operating margins by 2026, according to the analysis.

Ultimately, you have to cut services, fire people, or both, Abrams said. It is shifting the burden of the cost. What is currently shared between the federal government and state governments will be shifted largely to the states. And the burden will be felt by the providers, the patients, the community and the taxpayer.

Pressure from hospitals was often a factor in states decisions to expand Medicaid under the ACA. In some states, such as Indiana, hospitals even agreed to a pay new taxes in exchange for the additional federal revenue from Medicaid patients. Most of the recent decline in hospitals uncompensated care costs has been in states which expanded Medicaid.

And hospitals are among those fighting hard against GOP efforts to phase out the expansion and cap overall Medicaid payments to states.

If these proposed cuts take place, devastation would occur for local rural economies due to hospitals closing and patients incurring huge amounts of debt, Trampas Hutches, CEO of Melissa Memorial Hospital in Holyoke, Colo., said at one of the many events organized by the American Hospital Association and other health care providers in opposition to the GOP bills.

One reason Medicaid has been harder to cut than other safety-net programs such as welfare cash payments is that a large part of the spending is a transfer to health care providers, Garthwaite argues. Thats particularly true for hospitals which are essentially insurers of last resort when there are large coverage gaps.

When policymakers decide not to provide health insurance for a portion of the population that otherwise could not afford insurance,” Garthwaite and his colleagues wrote in their 2015 analysis, “hospitals ultimately bear the cost of that decision,

As President Donald Trump continues to push his agenda of repealing and replacing Obamacare, Americans are not on his side about this. Susana Victoria Perez (@susana_vp) has more. Buzz60

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Who pays when someone without insurance shows up in the ER? – USA TODAY


Black widow spider bite sends 5-year-old girl to emergency room – CBS News

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Kailyn Donovan, 5, is recovering from a black widow spider bite in Mendon, Massachusetts.

CBS Boston

At first, Kristine Donovan thought the dark mark on the back of her 5-year-old daughter’s leg looked like a bruise.

CBS Boston

It wouldn’t have been unusual, given that her energetic daughter, Kailyn, frequently plays outside their Mendon, Massachusetts, home for hours.

But when the “bruise” started turning black a few days later, Donovan knew something wasn’t right.

On Friday, the concerned mom rushed her daughter to a nearby hospital, where she was told the wound was caused by a black widow spider bite.

Thebite of a female black widowcan be very painful. The venom is thought to be 15 times more potent than that of a rattlesnake, and can cause severe muscle pain and spasms, as well as abdominal cramps, for up to a week.

“She never felt it bite her,” a surprised Donovan told CBS Boston. “It could have been in her jeans in the location where it bit her, we just don’t know.”

Kailyn is now being treated with antibiotics and frequent dressing changes.

Dr. William Durbin, the pediatric infectious diseases specialist who has been treating Kailyn at UMass Memorial Medical Center since Saturday, told The Boston Globe the dark purple and black colors on the wound was a byproduct of necrosis, or cell death.

“She had a very distinctive bite, which was very scary for her parents and of course the doctors, too,” Durbin said.

More than 2,000 people in the U.S. report black widow spider bites yearly, but deaths are rare these days. According to the National Institutes of Health, fatalities from black widow bites typically occur among young children, the elderly and those who are extremely ill.

Luckily, Donovan says the bite was treated in time and already appears to be healing.

“She’s happier now that we’re not in the hospital,” Donovan said. “It doesn’t seem to bother her. She looks at it, she doesn’t think it’s gross, so I try not to make a big deal out of it, to make her nervous or anything.”

Though black widows are mostly found in the southern and western regions of the United States, Donovan says her daughter’s story should serve as a warning — there’s a possibility of a black widow spider bite no matter where you live.

As a precaution, Donovan plans to spray around her house, hoping to kill any venomous spiders that may remain.

“We’re going to be spraying, and they’re going to come in the house and do some spraying in here too,” Donovan told CBS Boston. “But the doctor said it definitely was outside — they don’t chase people. It probably was bothered. We’ve been doing a lot of yard work, it probably upset one of them and she was just in the wrong place at the wrong time.”

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Black widow spider bite sends 5-year-old girl to emergency room – CBS News


Docs, Dems warn Boston emergency room lines will grow if GOP health bill passes – Boston Herald

Bay State lawmakers and doctors warn that the GOPs health care bill threatens to worsen the emergency room overcrowding crisis, which the Herald reported yesterday has led to wait times in the city that are double the national average.

It is a very serious concern, because that has important health care consequences, but its also a question about resources, said Bay State U.S. Sen. Elizabeth Warren. Thats why I am fighting so hard against the Republican plan to tear up our health care system, because they would actually leave us with fewer health care resources, which means longer waits in all of our hospitals.

According to a Herald special report on emergency rooms, the departments at Boston Medical Center and Brigham and Womens Hospital have wait times of nearly an hour twice as long as the national average.

Massachusetts General Hospital takes two times longer than hospitals nationwide to get ER patients into inpatient treatment.

The American Health Care Act, which cleared the House earlier this month, would scale back the Medicaid coverage that saw a massive expansion under Obamacare.

This has spurred concern that fewer people would have access to primary care physicians, forcing more patients to use emergency services as their only alternative.

The language of the bill could change as it moves through Congress, but the Chief of Emergency Medicine at Massachusetts General Hospital, Dr. David Brown, said as currently written, the health care bill would, among other things, severely cut federal support for Medicaid programs and leave millions without any health insurance at all.

He added, The nations emergency departments, which already serve as a major safety net in health care, will become even more overcrowded than they currently are. This will no doubt impact the quality of care and patient experience.

But Bay State U.S. Rep. Stephen Lynch said Obamacare has caused its own set of problems, one being that hospitals have been forced to operate at full capacity because of the increasing number of Medicaid patients.

Lynch said he plans to reach out to local hospitals to get a sense of what can be done to fix the issue.

Im not surprised its gotten worse, Lynch added, but that doesnt absolve us of the responsibility of fixing the problem, you want to make sure people have access to good doctors and good hospitals in a timely fashion.

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Docs, Dems warn Boston emergency room lines will grow if GOP health bill passes – Boston Herald


Here’s How Many People End Up in the ER Due to Cotton Swabs –

They may look harmless, but cotton-tip applicators send an estimated 34 kids to the ER every day, according to a new study in The Journal of Pediatrics. The authors say theirfindings debunk the myth that we need to clean our ears regularlyand serve as a reminder that doing so may cause more harm than good.

The Q-tip, the original cotton-tip applicator, was invented in 1923 after the companys founder watched his wife clean their babys ears with cotton wads and a toothpick. The ready-made swabs may have been a more convenient alternative at the timebut since the 1970s, doctors have cautioned against using them for the purpose of ear cleaning, noting that they can push wax deeper into the canal (causing impaction) and increase injury risk to the eardrum.

Today, research shows that the use of cotton-tip applicators is the most common cause of accidental penetrating ear injury in children. But despite doctors and manufactures warnings not to use the bathroom staple for ear hygiene, many people still do, says Kris Jatana, MD, an otolaryngologist at Nationwide Children’s Hospital and associate professor at The Ohio State University Wexner Medical Center.

For the new study, Dr. Jatana and his colleagues looked at reports of cotton swab-related ear injuries at hospitals across the country between 1990 and 2010. (Because the National Electronic Injury Surveillance System stopped coding hospital reports for these specific injuries after 2010, more recent info was not available.)

In that 21-year period, an estimated 263,000 patients under age 18 were treated in emergency departments for complaints like ear blockage, pain, and bleedingmore than 1,000 a month, or about 34 a day. Most of these injuries77%occurred while children used cotton-tip applicators themselves. Parental and sibling use accounted for 16% and 6% of injuries, respectively. Overall, 73% of the injuries occurred during ear cleaning; other causes included children playing with the swabs or falling down while a swab was in their ear.

RELATED: 8 Things ER Doctors Refuse to Have in Their Homes

The most common injuries were foreign body sensation (the feeling that something is stuck in the ear), perforated eardrum, and soft-tissue injury. (While cotton swabs have also been associated with ear infections and earwax impaction, these conditions were excluded from the study because it wasnt possible to know if they developed before or after a swab was used.)

Two-thirds of patients were under 8 years of age, and 40% were younger than 3. Fortunately, 99% of patients were treated and releasedbut the authors note that some of these injuries still could have been serious. Damage to the eardrum or inner ear can lead to dizziness, problems with balance, facial nerve paralysis, and permanent hearing loss, they write.

Injury rates did decline over the course of the study, but more than 12,000 children were still treated in 2010a number that Dr. Jatana says is unacceptably high.

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So how are people supposed to clean their ears?

In short, theyre notat least not on a regular basis. The ear is actually self-cleaning, says Dr. Jatana. Wax serves a function, to trap dirt and debris and bring it toward the outside of the ear. It also humidifies the ear canal, he adds, and has antimicrobial properties.

When visible wax is seen in the outer part of the ear, that can be wiped away with a small wet towel or baby wipe, he continues. But sticking any object into the canal itself is completely unnecessary and very dangerous.

In January, the American Academy of OtolaryngologyHead and Neck Surgery Foundation released updated guidelines on this topic, including a new list of dos and donts for patients. They include Do know that ear wax is normal, Dont over-clean your ears, and Dont put cotton swabs, hair pins, car keys, toothpicks or other things in your ear.

RELATED: 5 Mistakes You’re Making Cleaning Your Ears

There are effective ways to treat bothersome earwax impaction, including irrigation devices, wax-softeningdrops, or in-office procedures. But the Academy recommends that people speak with their doctors before trying any treatments at home, since they arent safe for everyone.

You should also see a doctor if you experience drainage or bleeding from the ears, hearing loss, or feelings of pain or fullness in the ears, the guidelines state.

The study authors recommend that cotton-tip applicators be stored out of reach of children, that stronger warning labels be added to their boxes, and that parents be advisedas soon as babies are bornnever to use them for ear cleaning. And just as importantly, they recommend more public education about the myths and facts of ear hygiene.

I think some parents instill in their children that cleaning out the ear canal is similar to brushing their teeth, says Dr. Jatana. That misconception needs to be dispelled in order to help prevent these injuries from occurring.

Here’s How Many People End Up in the ER Due to Cotton Swabs –


Mount Sinai St. Lukes | Emergency Services NYC

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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.

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?

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Mount Sinai St. Lukes | Emergency Services NYC