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RWJUH’s Emergency Room growing in size, scope – MyCentralJersey.com

RWJUH in New Brunswick is hosting a two year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients. Wochit

A redesigned and revamped Emergency Department with three trauma bays is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

NEWBRUNSWICK Robert Wood Johnson University Hospitalis going through a growth spurt doubling the size and quadrupling the scope of its Emergency Department (ED). Yet, through these major changes, the EDremains open for business, almost oblivious to the goings-on outside.

In the not-so-distant future, the current RWJUHEDwill becomefocused even more on patient needs andaccess, said John Gantner, CEO and president of RWJUH in New Brunswick. He called the project a “bold undertaking.”

“This is no ordinary community hospital ER,” he said. “A lot of thought has been put into this. It is all about access and unique populations such as behavioral health, infectious disease, trauma patients, pediatric patients and it is what you would expect from an academic health center that is catering at a different level to the communities we serve.The important message is the uniqueness of the project and that is really designed about access and will be an extraordinary ER.”

All services will continue to be offered in a non-disruptive fashion, Gantner said.

“The ER is a source for most of the patients who come into the hospital they come in through the ER,” he said. “So when you entertain a project like this, it disrupts the normal access of flow of patients coming into the facility.There’s some dirt being moved around, but Robert Wood is still in business 100 percent.”

As of June 14, the Emergency Department expansion’s Phase II began. This phase is expected to last six weeks. All vehicles and visitors seeking treatment must access RWJUHs Emergency Department via the intersection of Easton Avenue and Little Albany Street during this time. During this time, this area will be used entirely for Emergency Department and patient-related services. Any non-emergency related drop-offs/pick-ups, deliveries or activities will not be permitted as this project continues. The hospital advises that alternate arrangements should be made. Vehicles entering Rutgers Cancer Institute of New Jersey should access Little Albany Street via Easton Avenue.

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The EDexpansion projectis a direct response to an increasing need for emergency medicine and trauma care services in the greater Central New Jersey area, said Michael Valendo, assistant vice president, nursing and patient services at RWJUH.To cater to this need,RWJUH and RWJ Barnabas Healthlaunched theambitious project, which expands RWJUHs current ED50 percent from 40,000 to 60,000 square feet and its patient load capability from 42to 100 individuals.

“We had outgrown that space,” said Lori Colineri, senior vice president and chief nursing officer at RWJUH.

RWJUH sees about 96,000 pediatricand adult visits each year,said Leigh Anne Schmidt, nursing director for the RWJUH Emergency Department.

“We did some modeling and see it going north of six figures in the next decade,” Valendo said.”To the 110 to 115,000 visit rangebased on demographics in the community and population growth.”

“We have grown every year,” Schmidt said. “It was very important to have the capacity and make sure we are not opening in full the first day.”

Composed of seven different projects, the ED expansion in its entirety is expected to cost $60 million.That includes more than constructionand incorporates movement ofvariousdepartments, including the Respiratory Care Department and some patient units, internally,FaithOrsini, administrative director, construction services at RWJUH. Further, the Rutgers University Clinical Research Department formerly housed in the hospital is movingto the nearby East Tower building.That opened up a great deal of space for the project.

The Emergency Department remains openduring the construction period which is expected to be completed in 2019.

“The majority of the clinical parts of the Emergency Department will be done in two years,” Orsini said. “There will be some tail-end pieces, like offices and back-house space that will go into 2020, but the majority will be done within the firstphases about one-and-a-halfto two years.”

Work is being done to regrade and rework Little Albany Street for new ambulance and front entrances as part of Robert Wood Johnson University Hospital in New Brunswick’s Emergency Department expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: Cheryl Makin/Staff Photo)

The project started in March with exterior construction with thedropping down of 28-inches of Little Albany Street in front of the ED entrance and the establishment of new ambulance and front walk-in entrances.

This work also will allow a new ambulance bay better structured to the needs ofEmergency Medical Services (EMS), emergency and ambulance professionals. The current ambulance bay goes under the building and that areawill be recaptured for interior space, Orsini said.

“The new real estate we get is crucial,” she said. “This allows us to do construction without impacting the operations inside. All of our phasing for the project is on the order of not affecting the daily operations.”

READ:Old Bridge mom loses weight thanks to RWJUH

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A new ambulance bay will accommodate eight ambulances at one time. During the planning phase, several local EMSproviders had the opportunity to giveinput on the design.

“This will help our EMS providers too,”Valendo said. “It is much more efficient area for them than what we currently have. There will be an increase in capacity and we have some dedicated space for them not only for their equipment but for their staff as well. That is something we currently don’t have.”

A redesigned and revamped Emergency Department with private rooms is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

Interior construction is expected to begin shortly after a shuffle of departments and offices are complete, Orsini said.

Once complete, the Emergency Department will feature more than 100 private treatment areas for patients with sliding glass doors, as opposed to the current curtained areas. There will be three additional new state-of-the-art trauma bays that can run two traumas at a time if need be.

“That would be six trauma patients at a time,” Orsini said. “And they are being designed pretty close to operating room standard.”

The expanded space also offers patients radiology imaging in the department, adjacentto the trauma area. That detail can potentially reduce wait times for test results, Orsini said.

“The minutes that we can save can potentially save lives,” Valendo said.

A redesigned and revamped Pediatric Emergency Department with sensitivity to special-needs patients is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital New Brunswick)

The Pediatrics ED, already a part of the current facility, will be relocated to near the front door.

“It’s current location is not necessarily ideal,” Orsinisaid. “Your sickest adults come in by way of ambulance, but your sickest pediatric patients come in their parents’ car. So we will be able to peel those patients off almost immediately as they reach the front door.”

The Pediatrics EDalso willberevamped with special consideration given to sensory and visual needs of autistic and special needs patients with different flooring, lighting, furniture and paint. There will be a special room, called a “Snoezelen”room that is a controlled multi-sensory environment.

“A good population of our pediatric patients are special needs and the sensory and the environment is so crucial to keep them in a calm setting and in designing a new pediatrics ED we would miss the opportunity if we didn’t incorporate this into it at this point,” Colineri said. “Environment is key.”

The unit will remain able to see 17 patients at a time but now with private rooms, a play area and a waiting room housed within the Pediatrics ED.

The new ED model will have a dedicatedinfectious disease room that will be able to segregate those patients immediately. It is able to be accessed from outside, Orsini said.RWJUH is designated as the hospital in the state that handlesglobal diseases, such as Ebola, and has specific trained staff to handle such cases.

Another new section is a 12-room dedicatedbehavioral health/mental health suite, which all agreed is a “critical” addition. There are also several internal family support areas that will be situated throughout the ED.

The new ED’s flow model includesa fast-track option for patients who arrive at the department with less emergent diagnoses, Colineri said.

“It will allow patients to get in and out quicker,” she said.

A redesigned and revamped Emergency Department with private rooms is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

Colineri said it is important for RWJUH to take into consideration what patients and families need.

“When we listen to the voice of the customer, we listen to things like privacy and flow gettingin and out quickly,getting to see their doctor or the person who is going to treat them the quickest,” Colineri said. “So those are the things in the design the flow and the redesign of the emergency room to meet the needs of our patients and families. Get them the quickest service of the highest quality and the safest care and package that.”

Though valet parking is being encouraged at this time due to the outside construction, the parking deck will remain the same. Consumers can either valet park at the hospital entrance on Somerset Street or self-park through the Easton Avenue entrance. Valet parking is open 24 hours during this phase. New Brunswick police also are on site to aid with the safety and direct consumers in the construction area.

The project has several professionals working on the project including John Huddy of Huddy Healthcare Solutions of Fort Mill, South Carolina for space planning and strategic planning, architect Francis Huddy of Philadelphia, DCC Design Group of Wilmington, Delaware for interior design, Langan Engineering of Parsippanyfor civil engineering, Highland Associates of Summit, Pennsylvaniafor MEP (mechanical, electrical and plumbing) engineering and O’Donnell & Naccaratowith offices inPhiladelphia, Bethlehem, Pennsylvania and Mountainsidefor structural engineering.

For more information about the the hospital system, visit http://www.rwjuh.edu/rwjuh/home.aspx.

Staff Writer Cheryl Makin:732-565-7256; cmakin@mycentraljersey.com

Work is being done to regrade and rework Little Albany Street for new ambulance and front entrances as part of Robert Wood Johnson University Hospital in New Brunswick’s Emergency Department expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: Cheryl Makin/Staff Photo)

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

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

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

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Blue Cross Blue Shield of Georgia is enacting this policy because it doesn’t want people to use the emergency room as their primary health care.

“The cost of care’s been going up so much faster than people’s earnings. We have got to find a better way to do some of this stuff, taking some of that unnecessary spending out of the system,” JeffFusile, president of Blue Cross Blue Shield of Georgia, said.

Fusile said the insurance provider wants patients to use urgent care, retail health clinics and their LiveHealth app, which are all cheaper than an ER visit.

“What this policy is directed at is regular, run-of-the mill colds, maybe even influenza. But you don’t need to go to the emergency department to get tested for whether or not you have the flu and to get a Tamiflu prescription,” JasonHockenberry, who teaches health policy at Emory University, said.

Hockenberry said, in his research, he’s found many people often use the emergency room inappropriately, for urgent care rather than emergency care.

“This is a real problem. Emergency departments are expensive; they’re there for a different reason. Blue Cross is clearly staking a claim here that we’re going to try to change patient behavior,” he said.

Donald Palmisano, president of the Medical Association of Georgia, paints a different picture when it comes to this policy: Imagine a BCBSGa member has chest pains in the middle of the night. He thinks it might be a heart attack, so he goes to the ER. But it turns out that it was just indigestion. Under BCBSGa’snew policy, he gets charged for using the emergency room inappropriately. So the next time he has chest pains, he thinks, in case it’s just indigestion, he won’t go to the ER. But this time, it’s a heart attack, and he dies.

“Blue Cross is clearly staking a claim here that we’re going to try to change patient behavior.” – Jason Hockenberry

“That’s where our physicians are concerned. Because they’re like, you know, you’re putting the patient, who doesn’t have the clinical background, to determine whether their condition is of an emergency nature,” Palmisano said.

Palmisano said this policy also might disproportionately affect the elderly, those living in rural areas and adolescents over the age of 14.

“I have four children, and if there’s an injury and it’s hard to determine the pain they’re experiencing, it’s hard to determine whether to go to the emergency room or not,” he said. “It puts that added stress because you’re dealing with a loved one and you’re putting parents in a very difficult situation.”

But FusileofBCBSGa said he knows, in medicine, it’s not always black or white.

“There are lots of gray areas where the diagnosis wasn’t so bad after all, but you have to look at the situation the person was in at the time they were in it,” Fusile said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related: Doctors Make Case for Obamacare or Something Like it

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

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

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

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

Anthem defines it in the letter:

“Emergency” or “Emergency Medical Condition” means a medical or behavioral health condition of recent onset and sufficient severity, including but not limited to, severe pain, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that not getting immediate medical care could result in: (a) placing the patient’s health or the health of another person in serious danger or, for a pregnant woman, placing the woman’s health or the health of her unborn child in serious danger; (b) serious impairment to bodily functions; or (c) serious dysfunction of any bodily organ or part. Such conditions include but are not limited to, chest pain, stroke, poisoning, serious breathing problems, unconsciousness, severe burns or cuts, uncontrolled bleeding, or seizures and such other acute conditions as may be determined to be Emergencies by us.

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

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

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

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

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

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

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

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

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

“She had had severe dizziness, vertigo symptoms.”

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

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

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

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

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

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

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

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

Related: ER Visits Hit Record High in 2005

That said, Forman added, ACEP has a point.

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

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

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

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

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

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Blue Cross in Georgia to limit emergency room coverage – MyAJC

The Obamacare exchangemay survive next year in rural Georgia. But patients who depend on its last remaining insurer are now learning theres a catch.

Over the past week letters have arrived at homes throughout the state giving patients a jolt. Blue Cross Blue Shield of Georgia, the only insurer on the exchange for 96 of the states 159 counties, is telling patients with individual policies that if they go to the emergency room and its not an emergency, theyll be stuck with the bill.

I am very concerned, said Dr. Matthew Keadey, who leads an organization of ER doctors. He fears patients who need the ER but arent sure they do will avoid it now. If this is fully implemented, I think were going to have deaths out there because of it.

Blue Cross move could stick Keadey and his colleagues with unpaid bills if non-emergency patients continue to come but cant pay. But patients also are concerned.

Really, like what the (heck)? said Sharon Tarver, a patient in Sumter County who has Blue Cross through the exchange, as she described her reaction when she first read the letter.

It was like, OK, well when you think about people that go when they dont have an emergency, they are taking up time for people who have an emergency, that does make sense, Tarver said. But in her area there are only two urgent care clinics, and they close at 8 p.m. and 9 p.m. She recalled two incidents in the past two years when she went to the emergency room, once with chest pain and once with a cough that reminded her of her mothers lung cancer. They both turned out to be something else.

Would she still go now, after the letter?

It depends. Its a half of one hand and half the other, she said.

Trying to change habits

A spokeswoman for Blue Cross said patients with a legitimate fear of an emergency would still be covered and that the company was forced to act by the rising cost of health care.

The policy defines an emergency as what a prudent layperson would think could pose a serious danger, and it says the insurer will decide what makes that cut. It takes effect July 1. Blue Cross says it wont apply to kids 13 and younger, members who dont have an urgent care clinic within 15 miles, or visits on Sundays and major holidays.

This is not to discourage somebody with an emergency condition who needs to go to an ER to go there, said the spokeswoman, Debbie Diamond. Health care is becoming more and more expensive. Its a way to make sure that people are getting quality and affordable care.

Many pressures may have forced the tipping point. Health care prices are always rising, and Obamacare insurance was more expensive to provide at first than companies thought. This year the Trump administration has especially rattled insurance companies by waffling on whether it would continuesubsidies key to funding Obamacare exchange plans.

Blue Cross parent company, Anthem, was reportedly leaning toward pulling out of many states exchange markets. But two weeks ago itsignaled it may stay in Georgias.

And the fact is that patients who use the emergency room like their personal clinic do waste money, a lot of it.

How much is not really known. Keadey quotes data saying a small percentage of ER patients should be getting their care somewhere else.State Rep. Terry England, a co-chairman of a committee that studied how to stabilize rural hospitals, said its much more. But neither disputes that the letter is at least partly aimed at shaking up those people who know they shouldnt be at the ER.

What Im interpreting is its because theyre trying to change habits and get people to focus on going to their physician and not to the ER, England said.

It kind of comes across as cold and callous maybe, the way that theyre doing it, he said. But at the same time, it may be one of the few ways that you actually are able to maintain hospitals andkeep the doors of hospitals openacross the state.

Keadey acknowledged the existence of problem patients. But his larger concern was patients who belong at the ER and may not go.

Patients are not trained to recognize emergencies, he said. What it really is is a barrier to emergency care. Patients will die because theyre going to think twice about going to the emergency department. One person goes and it turns out they just had reflux or a stomach problem; the next person has the symptoms and its a heart attack.

To me its one more way that were seeing the insurance company trying to take their financial responsibility and place it back on the patient.

Sore throat not enough

Diamond said Blue Cross understood patients had to use their best judgment. If you are having chest pains and it turns out to be indigestion, she said, you still thought you were having chest pains. So you could go to the emergency room.

On the other hand, she said, obvious examples where you should not go to the ER would be if you had cold symptoms; if you have a sore throat.

Blue Cross is steering those patients who dont need emergency care to their personal physicians, urgent care clinics or to Blue Cross 24-hour online medical service, LiveHealth Online. The service requires using an app on a computer or on a phone with internet service. It wont work off a rotary phone, for example.

Most people now have cellphones or computers, said Diamond, the Blue Cross spokeswoman.

Not everyone does. Middle-age policymakers might not understand that because a study by the Pew Research Center found that 95 percent to 99 percent of U.S. adults up to age 50 in 2016 used the internet one way or another. But with older people that number falls off a cliff. And with lower-income people and those in rural areas, it can be harder.

We have so many people that come to the library just to have access to a computer and the internet, said Kirk Lyman-Barner, an insurance agent in Sumter County. And thats closed in the evening of course.

Is it an emergency?

In a May 19, 2017, letter to customers, Blue Cross Blue Shield of Georgia said that starting July 1 it would no longer cover non-emergency visits to emergency rooms. This is the definition it gave for emergencies:

Emergency or Emergency Medical Condition means a medical or behavioral health condition of recent onset and sufficient severity, including but not limited to, severe pain, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness or injury is of such a nature that not getting immediate medical care could result in:

(a) placing the patients health or the health of another person in serious danger or, for a pregnant woman, placing the womans health or the health of her unborn child in serious danger;

(b) serious impairment to bodily functions; or

(c) serious dysfunction of any bodily organ or part.

Such conditions include but are not limited to, chest pain, stroke, poisoning, serious breathing problems, unconsciousness, severe burns or cuts, uncontrolled bleeding, or seizures and such other acute conditions as may be determined to be Emergencies by us.

Exceptions to the rule

According to Blue Cross, the rule will not apply if:

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Against the odds, emergency rooms are getting people into addiction treatment – Philly.com

Gina Marchetti walked into the emergency room to a familiar sight: a patient, just brought back from a heroin overdose by paramedics, sweaty and miserable and hooked up to machines. His mother, on her knees next to her son’s bed at Crozer-Chester Medical Center, crying and begging him to get treatment.

“He had the blank stare on his face, saying, ‘I dont need it, I dont need it’ . . . and what flashed before my eyes was when it was me laying in that bed, it was my mom next to me,” said Marchetti, whose sixth overdose four years ago nearly killed her and launched her on a path to recovery as well as a career.

“Thats what gives me the motivation to do every single thing in my power to help this person.”

The young man has been in residential treatment for several months now.

In the Crozer-Keystone Health System in Delaware County, certified recovery specialists like Marchetti succeed about a third of the time.

But inmuch of the Philadelphia region and across the nation, the notion of using an ER visit to propel someone into addiction treatment remains a dream.

In what some call a “warm handoff,” a patient is transferred directly from the ER into a treatment program without cooling off for days in the old neighborhood, around old using buddies, one fentanyl-tainted bag of heroin away from death.

The emergency room seems an ideal place to intervene. A revived patient has just experienced a potentially life-changing event. Hospitals have resources, including doctors and nurses who are passionate about saving lives.

It turns out not to be that easy. Treatment beds are in short supply almost everywhere, forcing a wait of several days even for those who would jump at the chance to get clean. Many people don’t have insurance. Hard-to-change practices some enshrined in regulations, others history and habit may make a smooth transfer impossible even when everyone involved wants the same thing.

Federal law decrees that if a photo ID is missing as it often is when a homeless personoverdoses admission to methadone maintenance programs be denied. Arranging temporary housing and taxi rides requires giving out a patients name, and health-care providers are not allowed to do that.

“I can do a lot for someone who has diabetes or hypertension,” said Priya Mammen, an emergency medicine physician at Philadelphias Methodist and Thomas Jefferson University Hospitals. But for someone addicted to opioids and at grave risk of another overdose? “Physically being able to make an appointment or referring them happens very rarely,” Mammen said.

Frustration drove her to joinMayor Kenneys opioid task force, which was convened in January and could release its final report this week.

“We’re right on the precipice of the whole system actually changing,” Mammen said. Meanwhile, city emergency departments saw more than 6,400 patients who had overdosed last year, releasing nearly all of them after brief physical examinations.

While drug overdoses killed 907 people in 2016 in Philadelphia 80 percent ofthem related to opioids survivors generally suffer little medical harm and walk out.

Mammen recalled a colleague managing to hold one midnight arrival in the ER until dawn so she would not leave in the dark. She came back in an ambulance several hourslater, but this time could not be resuscitated.

Opioid-relatedoverdose deaths quadrupled between 1999 and 2015 nationwide. But it wasnt until 2014 thatNew Jersey and Pennsylvania joined a handful of other statesin allowing ambulance crews and then the general public to administer the emergency overdose-reversal medication naloxone, resulting in thousands of reported saves. (Philadelphia EMTs have used naloxone for decades, but police started getting it only after the change in state law.)

Being revived is physically painful.Naloxone,sometimes sold as Narcan, blocks opioid receptors in the brain, ending the suppressed breathing response that can lead to death. It also throws the person into withdrawal.

Getting someone in that condition to even consider sobriety requires “language of the heart,” said John Brogan, who set up a recovery specialists-in-the-ER program in Ocean County, N.J., even renting room in a church to house people until they could be admitted for treatment, and cajoling programs to offer scholarships. “We meet them where they’re at. Without judgment.”

Jared Brown is one of his success stories. He was in a coma for 12 days the heroin turned out to be laced with rat poison. “Even as I was pulling the needle out, it felt like acid going into my body, getting closer to my heart. I pulled out my phone, dialed 9-1 . . . didnt get to the last 1,” he said. His mother’s boyfriend “heard me gurgling” hours later and completed the call.

Brogan showed up at the other end and they instantly connected over shared histories of drugs and surfing.

Brown had no insurance, but Brogan got him into a Florida detox center and 114 days of residential treatment in Texas. He was released last July and, at 28, is creating a new life in Austin, going to NA meetings and working for a rainwater harvesting company, which just promoted him to foreman.

Officials in Camden County focused on emergency rooms after seeing overdoses spike several years ago. We just had the objective of getting people into treatment, Freeholder Director Louis Cappelli Jr. said. The county has budgeted $300,000 this year to get people started, avoiding the potentially deadly delay of finding coverage for the uninsured.

Recovery specialists working with the county met about 50 people in emergency rooms last year. Nine entered outpatient treatment. The project just expanded, and four more were admitted to a residential program in just the last two weeks.

Gov. Christie has been increasing funding to make warm handoffs possible, and dozens more Camden residents have made it from ERs to treatment without the countys help. In Pennsylvania, Gov. Wolf has increased spending, too.

Delaware County has among the first programs to get off the ground, a year ago, with a small team of recovery specialists ready to visit ERs when overdose cases came in. Four of the six hospital emergency rooms in the county are part of Crozer-Keystone, and the health system for decades has operated a large outpatient addiction treatment program out of the oldCommunity Hospital. The system took over the recovery specialist team in October.

First Steps Treatment Center a comprehensive, 52-bed residential facility opened within the main Crozer-Chester Medical Center on March 22.Now, handling overdose patients is a lot more seamless, said Sarah Falgowski, chief of adult psychiatry a truly warm handoff, with emergency rooms, assessment, inpatient, outpatient, even transportation part of the same system. The recovery specialists have engaged with 447 patients in the last six months, and 167 of them, or 37 percent, have begun treatment.

The young man that Gina Marchetti remembers so well came in late one weekend night. She did not bring up treatment because that might have scared him. She sent his family out of the room. And then she talked about her own life: nine years using, six overdoses, fears of losing her 10-year-old daughter.

He was going through the same experience that I was with the children and the criminal justice system, she said. Realizing he couldnt be a good father kind of flipped the switch for him. He was admitted overnight.

And if hed said no?

We dont just give up,” Marchetti said. My hope is that one time when I call they will have that moment and just say: I cant live like this anymore. Lets do it.

Ready to get off opioids? How to make recovery stick May 12 – 2:16 PM

Voices of recovery: After opioids, many roads to freedom May 12 – 2:08 PM

Opioids in the workplace May 10 – 3:29 PM

Published: May 14, 2017 3:01 AM EDT

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Against the odds, emergency rooms are getting people into addiction treatment – Philly.com

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Urgent care for cancer patients helps them avoid risky and expensive ER visits – Chicago Tribune

One afternoon a few weeks ago, Faithe Craig noticed that her temperature had spiked to just above 100 degrees. For most people, that 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 the University of Texas Southwestern Medical Center. Her nurse there told her to come in immediately for urgent-care services at the hematology oncology clinic.

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

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

It has been more than a year since the Dallas medical center began providing same-day urgent-care services to cancer patients. It’s an effort to help them avoid the emergency department and admission to the hospital, said Thomas Froehlich, medical director of 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.”

A small but growing number of hospitals and oncology practices are offering cancer patients urgent care in which specialists are available, often for extended hours and sometimes around the clock.

Keeping cancer patients out of the emergency department 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 also 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 [to the hospital as inpatients] 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 immune system instead attacks healthy organs and tissues.

It can be difficult for physicians who are not 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 Barbara McAneny, chief executive of New Mexico Oncology Hematology Consultants, whose three centers around the state provide urgent care for more than a dozen cancer patients daily.

Offering same-day services fits in with a broader shift in oncology toward patient-centered care, said 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, Lichtenfeld said. And starting in 2020, hospitals may be penalized financially if outpatient chemotherapy patients visit the emergency department or are admitted to the hospital, according to a final rule issued in November.

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

Johns Hopkins Hospital opened a six-bed urgent-care center next to its chemotherapy 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 at Johns Hopkins Kimmel Cancer Center. (The patient and the insurer would divvy up that charge based on the patient’s insurance coverage.) Only 20 percent of cancer patients who visit the hospital’s emergency department are discharged home, with 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, Cohen, 68, is receiving immunotherapy. She has been 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, “you sat in the waiting room at the emergency room with people who had the most extraordinary diseases,” Cohen said. “Having Stage 4 lung cancer, the thought of being exposed to pneumonia or bronchitis is more than scary.”

This column is produced by Kaiser Health News, an editorially independent news service that is a program of the Kaiser Family Foundation.

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

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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