All posts tagged patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


How to Keep Emergency Rooms Focused on True Emergencies – Wall Street Journal (subscription) (blog)

Howard Forman (@thehowie) is a professor of radiology, economics, public health and management at Yale University.

Over the past few decades, hospital emergency rooms have seen a steady increase in visits. This is not surprising since the emergency department (ED) has evolved from a trauma and casualty center to a finely tuned health-care delivery system in its own right. Care that previously would take weeks to deliver can be accomplished there in mere hours. Specially trained emergency medicine physicians (a specialty that is relatively new to medicine) can provide immediate attention for a multitude of traumatic, surgical, medical and mental-health emergencies.

As the availability of ED care has exploded, primary-care and specialty physicians feel more comfortablecurtailing their after-hours clinical availability, allowingunscheduled and poorly documented patients to go to the emergency department. Not surprisingly, a significant amount of nonemergent and less-urgent care is provided in the modern emergency department. This ends up costing more money, distracting highly valued resources with less-critical needs, and disrupting the coordination of care that is better delivered by primary-care physicians.

So what do we do? There are two approaches to solving this problemand only one makes sense.

For decades, insurance companies have tried demand-side strategies to reduce emergency-department visits. ED copays are common; in many cases the copay is waived if the patient was admitted to the hospital (thus signifying, that this was, indeed, a true emergency). Most recently,Blue Cross/Blue Shield of Georgia announced that it will stop paying for ED care deemed to be nonemergent, when assessed after the fact by the insurance plan. To the casual eye, this might make sense: If the encounter is not an emergency, the patient should wait to seek outpatient care, typically at a lower cost. Aligning incentives (lower cost to the patient) with the desired behavior (avoiding the emergency room and obtaining care on a nonemergent basis from your primary-care physician or specialist) would seem logical.

The problem with this scenario is that knowing at home whether you have an emergency is more challenging than it seems. In many instances, patients evaluated in the emergency room and initially judged to have an ailment that could be treated on an outpatient basis were ultimately found to have required emergency management. All too often, for instance, physicians struggle to initially differentiate between gastrointestinal tract discomfort and more serious and even fatal conditions. Financially punishing patients after the fact for not having a heart attack or stroke or appendicitis only encourages other patients to avoid emergent care until it is too late.

In my practice as an ED radiologist, I have seen many cases where an imaging test is ordered almost as an afterthought (such as an abdominal computed tomography scan in an elderly patient), but then surprises the emergency-medicine physician with a consequential result (such as bowel obstruction) that requires surgery or other interventions. If physicians cannot presciently tell who will and who will not ultimately require lifesaving interventions just from their complaint, we should not make such a demand of our patients. A patient with chest pain may just have heartburn or they may also be experiencing a myocardial infarction (a heart attack), and they should not be discouraged by insurance companies from seeking emergency-room assistance.

Fortunately, theres an alternative approach to addressing emergency-room overuse: focusing on supply-side strategies. These include providing telephone consultation services, more accessible primary-care services (including extended and urgent care hours), and integrated delivery of health care, which certain health systems offer. These measures can reduce the demand for emergency care while meeting the immediate needs of the population. Health plans are evolving to recognize this, and integrated delivery systems are reliably lower-cost due to this attention to patient-centered care delivery. For the truly nonemergent patient, the peace of mind alone from knowing that there is an accessible voice or consultant available may be enough. Early evidence suggests that telemedicine (including telephone consultations) can decrease costs by reducing ED visits.

Public and private insurance plans are changing their models of reimbursement to physicians and hospitals to incentivize higher-value care; this, in turn, is changing practice patterns and care delivery strategies. Emergency-medicine physicians and nurses did not go into this field to take care of non-urgent patients, since it distracts from their mission to provide immediate attention to acute emergencies. They, too, would prefer that integrated care delivery models are in place to best care for every patient in a timely, high-quality and accessible way. Demand-side strategies that potentially delay life-saving care will punish patients. Instead, supply-side innovation must lead the charge for better and more responsive care delivery.

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How to Keep Emergency Rooms Focused on True Emergencies – Wall Street Journal (subscription) (blog)


Capital Regional Medical Center to open two freestanding emergency rooms – WCTV

By: Lanetra Bennett June 21, 2017

TALLAHASSEE, Fla. (WCTV) — Capital Regional Medical Center is set to open two full-service emergency departments in Leon County.

Ambrose Kirkland has lived on Tallahassee’s south side for 41 years. He’s glad that one of the two new emergency rooms opening will be on his side of town.

“I think that it’s fabulous.” Kirkland said.

Administrators at Capital Regional Medical Center say they chose Capital Circle at Orange Avenue, and North Monroe near I-10 to give access to care to parts of town that are well established and continuing to grow.

“Most of the people that are over there have to depend on either family or the bus to get them around. With this place being over there, maybe now they can get the help they need.” Kirkland said.

Capital Regional has the E.R. at the main hospital in Northeast Tallahassee and a freestanding E.R. in Quincy.

Administrators say the two saw 101,000 visits in 2016. The C.E.O., Mark Robinson, says E.R. growth is on pace with Tallahassee’s three-percent population growth over the next five years.

“We want to make sure that we’re prepared for that growth and that we provide great quality health care.” Robinson said.

Both one-story facilities will have the same footprint. They will be about 10,800 square feet with 12 rooms and 24 emergency room beds.

Both will provide the same services as any E.R.: offering a full-range of capabilities from pediatric to adult care, full-service lab, C.T., trauma, ultrasound and X-ray.

Robinson said, “It gives folks a chance to do something they might not normally do, and that’s seek care. So, as opposed to debating whether or not they’re going to make the long drive somewhere, they’ve got a place right around that corner that can support them and hopefully treat that injury or illness that they have.”

Construction is scheduled to begin in about three months. The facilities should be open in 2018.

By: Aubrey Brown | WCTV Eyewitness News June 21, 2017

TALLAHASSEE, Fla. (WCTV) — Capital Regional Medical Center is set to open two full-service emergency departments in Leon County in 2018.

One of the emergency rooms will be located on North Monroe Street, just north of I-10. The other will stand at the intersection of Capital Circe SE and Orange Avenue, near Southwood.

There is a need for additional ER services in south and northwest Leon County,” said Mark Robinson, CEO of Capital Regional Medical Center. “Our goal is to provide quality care for our patients with little to no wait time. The new freestanding ERs will allow us to provide critical healthcare services in convenient locations for our patients.

CRMC says both emergency departments will offer 24/7 ER care and are expected to serve more than 25,000 patients per year.

The new ER facilities represent our latest step to expand health care into the community, said Robinson. “The hospitals main campus emergency room and the ER in Gadsden County saw more than 100,000 visits in 2016.

Both facilities will feature 24 emergency room beds and will employ about 62 people full-time.

The project will cost nearly 25-million dollars.

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Capital Regional Medical Center to open two freestanding emergency rooms – WCTV


Choosing the right emergency department can save a life – The-review

Published: June 7, 2017 3:00 AM

Editor’s Note: The following column is an interactive question and answer feature appearing the first Wednesday of each month. Readers are encouraged to send health-related questions that will be answered by a local medical professional to Today’s question is being answered by Karen Abraham, R.N, Clinical Coordinator/Educator, Emergency Department of Alliance Community Hospital.

Q. Last week we called 911 because my mother had a fainting spell. The ambulance arrived promptly and we were asked a question that momentarily stumped us to which hospital do you want to be transported? Since we did not know the extent of her condition, we wanted the emergency room that was closest, which was Alliance Community Hospital. Everything turned out great, and she was treated and released. My question goes back to the choice we made is your ER equipped to handle all emergencies?

A. You made the right choice. When it comes to medical emergencies, time is valuable. Our emergency department at Alliance Community Hospital is staffed with board certified emergency physicians and emergency trained nurses.

We pride ourselves on promptly being ready and able to give care in the instances when time is of the essence. Here in Alliance we have a dedicated team to do whatever necessary to give proper care and ensure the best results to the issue or issues at hand. It is always great to hear from our patients after treatment and in this case, like most, we are delighted to hear how well your experience was for your family.

Within our Emergency Department we deliver a large and diverse spectrum of care. For more complex cardiac cases we utilize the Aultman Heart Center to expedite the most urgent cardiac situations as well as our Telemedicine services that streamline neurologic emergencies. Telemedicine is the use of live video streaming to obtain medical advice from other specialists to provide an extra set of eyes on how to proceed with further treatment. We may not have all specialty services available onsite, but certainly are here to seamlessly arrange for the appropriate treatment for all patients upon discharge.

As a community hospital we are truly making an effort to meet the needs of our patients while getting them prepared for additional care outside the parameters of our hospital if we are unable to continue treatment here. As we all adjust to the current changes in health care we are constantly seeking answers for the patients we care for in our community. From the most minor emergency to the most difficult situation, we are fully trained to accommodate all patients we care for.

Ultimately, we will do what we judge to be in the best interests of the patient. Our staff is trained to be able to identify the magnitude of each emergency situation and apply our expertise accordingly. When time really matters we will use that time in the most efficient ways possible to ensure the best results for our patients.

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Choosing the right emergency department can save a life – The-review


Emergency Room | Bay Medical Sacred Heart, Panama City FL


The Emergency Department at Bay Medical Center provides medical care for approximately 72,000 patients each year, evaluating and treating patients and their families, of all ages, 24 hours a day, seven days a week.

The Emergency Department at Bay Medical Center is comprised of a triage area, a main emergency department, which features three extra-large trauma rooms as well as 28 private treatment rooms, including specialized areas for pediatrics, ENT, obstetrics, orthopedics, and psychiatry. Additionally, we have an eight-bed Rapid Response unit that provides more rapid assessment and treatment for patients with illnesses and injuries that are not serious or life-threatening and a six-bed clinical decision unit.

The Emergency Department nurses are dedicated to providing outstanding quality care to our patients through collaboration with our physicians and other team members. When it comes to making improvements in the Emergency Department, we have a voice. We serve on teams that plan and implement change. Some of our current Performance Improvement activities include, but are not limited to the following:

We are very excited that Bay Medical is currently applying for state designation as a Level II trauma center, which will take us to the next level and is further recognition that Bay Medical is a top-notch hospital where our patients receive Five Star emergency care and treatment.

Visiting Hours General 8:30 a.m. 8:30 p.m. daily Cardiovascular Intensive Care Units (CVICU)

9:00 a.m 11:00 a.m. 2:00 p.m. 6:00 p.m. 8:00 p.m.10:00 p.m. All Other Intensive Care Units

9:00 a.m 5:00 p.m. 8:00 p.m.10:00 p.m.

View Map of Main Facility.

615 North Bonita Avenue, Panama City, FL 32401 | (850) 769-1511 Bay Medical Center All Rights Reserved. Site designed by CYber SYtes, Inc.

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Emergency Room | Bay Medical Sacred Heart, Panama City FL


Urgent Care Services For Cancer Patients Offer A Gentler ER Alternative – NPR

Johns Hopkins Hospital in Baltimore opened a six-bed urgent care center next to its infusion center a couple of years ago. Of the patients who land there, about 80 percent are discharged home afterward, rather than needing admission to the hospital. Courtesy of Johns Hopkins Medicine hide caption

Johns Hopkins Hospital in Baltimore opened a six-bed urgent care center next to its infusion center a couple of years ago. Of the patients who land there, about 80 percent are discharged home afterward, rather than needing admission to the hospital.

On an afternoon a few weeks ago, Faithe Craig noticed that her temperature had spiked to just above 100 degrees F. For most people, the change might not be cause for alarm, but Craig is being treated for stage 3 breast cancer, and any temperature change could signal a serious problem.

She called her nurse at the hospital clinic where she gets care, at the University of Texas Southwestern Medical Center in Dallas, who told her to come in immediately for cancer urgent-care services at the hospital’s hematology oncology clinic.

“I thought I’d be waiting there all night,” said Craig, a 33-year-old teacher and single mother. But the hospital had already lined up a blood draw before she arrived and then sent her directly to get X-rays.

Clinicians had details of her cancer care at their fingertips. “They already knew my story and knew everything about me,” she said. The blood work showed she had severe anemia, requiring a blood transfusion, pronto.

It’s been more than a year since the medical center began providing same-day urgent care services to cancer patients, with the aim of helping them avoid the emergency department and hospital admissions, said Dr. Thomas Froehlich, medical director of the all the center’s cancer clinics.

Cancer treatment “clearly carries a lot of side effects and toxicity, and there are also complications of dealing with the cancer,” Froehlich said. “Many of these things, if you can intervene early, you keep patients at home and out of the hospital.”

UT Southwestern isn’t alone. A small but growing number of hospitals and oncology practices are incorporating urgent care aimed specifically at cancer patients, in which specialists are available for same-day appointments, often with extended hours, sometimes 24/7.

Keeping cancer patients out of the ER makes sense, not only because many of them have compromised immune systems that put them at risk in a waiting room full of sick people, but to provide the most efficient and appropriate care.

“What we hear from cancer physicians and administrators is that in the emergency department not all emergency physicians and nurses feel equally confident in their ability to treat cancer patients,” said Lindsay Conway, managing director of research at the Advisory Board, a health care research and consulting firm. “So they may admit them when it’s not necessary.”

Severe pain, nausea, fever and dehydration are not uncommon side effects of traditional chemotherapy. Newer immunotherapy treatments that activate the immune system to fight cancer can cause serious and sudden reactions if the body instead attacks healthy organs and tissues.

It can be difficult for non-cancer specialists to evaluate what these symptoms mean. “Targeted therapies are wonderful, but if you don’t know the drug, you’re going to have a hard time managing the person,” said Dr. Barbara McAneny, CEO of New Mexico Oncology Hematology Consultants in Albuquerque, which operates three cancer centers in New Mexico that together provide same-day urgent care services to more than a dozen cancer patients daily.

Offering same-day services fits in with a broader shift in oncology toward patient-centered care, said Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society.

“There’s a general sense within the practice of oncology that we need to do a better job of managing pain and side effects, and we need to provide a higher level of care,” Lichtenfeld said.

The federal Centers for Medicare & Medicaid Services is encouraging these efforts through new payment and delivery models designed to reward high quality cancer care, Lichtenfeld said. In addition, starting in 2020, hospitals may be penalized financially if patients who are receiving outpatient chemotherapy visit the emergency department or are admitted to the hospital, according to a final rule issued in November.

Avoiding the emergency department makes financial sense for patients and insurers, too.

Johns Hopkins Hospital opened a six-bed urgent care center next to its infusion center a couple of years ago. Of the patients who land there, about 80 percent are discharged home, at an average total hospital charge of $1,600, said Sharon Krumm, director of nursing administration at Johns Hopkins Kimmel Cancer Center. (The patient and the insurer would divvy up that charge based on the patient’s insurance coverage.)

In contrast, only 20 percent of cancer patients who visit the hospital’s emergency department are discharged home, Krumm says. Those who are have an average total hospital charge of $2,300. The others face the ER charges plus the hefty cost of a hospital admission.

Rebecca Cohen has been a frequent visitor to the Johns Hopkins urgent care center. Diagnosed more than two years ago with stage 4 lung cancer, the Baltimore resident is 68 and receiving immunotherapy. Since her diagnosis, Cohen periodically has needed to be treated or checked for dehydration, electrolyte abnormalities, low hemoglobin, low sodium, blood clots and infection, among other things.

Before she started going to the cancer urgent care center, Cohen said, she used to have to sit “in the waiting room at the emergency room with people who had the most extraordinary diseases. Having stage 4 lung cancer, the thought of being exposed to pneumonia or bronchitis is more than scary.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter @mandrews110.

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Urgent Care Services For Cancer Patients Offer A Gentler ER Alternative – NPR