All posts tagged study

Only 3% of emergency room visits may truly be avoidable, study … – FierceHealthcare

Though many emergency rooms are overcrowded and some patients may not have urgent needs, just a fraction of visits are truly avoidable, according to a new study.

Researchers examined datafrom the National Hospital Ambulatory Medical Care Survey from 2005 to 2011 that included more than 115,000 records representing 424 million emergency department visits, and found that only 3.3% were avoidable.The study team defined avoidable visits as thosethat did not require diagnostic tests, screenings, procedures or medications.

A number of these avoidable visits were for concerns that the ER is not equipped to treat, like dental or mental health issues, according to the study. Of the avoidable visits, 6.8% were for alcohol- or mood-related disorders, like depression or anxiety, while 3.9% were for dental conditions.

RELATED:4 strategies to reduce ER overcrowding

The findings, published in the International Journal for Quality in Health Care,challenge the commonly held belief that many people visit the ER needlessly, said RebeccaParker, M.D., president of the American College of Emergency Physicians, in an announcement.

Despite a relentless campaign by the insurance industry to mislead policymakers and the public into believing that many ER visits are avoidable, the facts say otherwise, Parker said. Most patients who are in the emergency department belong there and insurers should cover those visits. The myths about unnecessary ER visits are just thatmyths.

RELATED: ER visits offer a teachable moment to reduce drug use

The ER has been a frequent target for initiatives seeking to reduce overuse and the costs associated with emergency care. However, the researchers saidthat their findings point more toward the value in programs to improve patient access to services like mental health and dental care.

The study found that 10.4% of visits from patients with alcohol-related disorders and 16.9% of visits from patients with mood disorders were avoidable, suggesting that policymakers could do more to increase access to the services that would keep those patients out of the ER.

Our findings serve as a start to addressing gaps in the U.S. healthcare system, rather than penalizing patients for lack of access, and may be a better step to decreasing avoidable ED visits, the authors wrote.

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Only 3% of emergency room visits may truly be avoidable, study … – FierceHealthcare


ER bills questioned – Calaveras Enterprise

Dignity Healths Mark Twain Medical Center is one of many hospitals that partner with EmCare.

EmCare, a company responsible for staffing emergency rooms in hospitals across the country, including Mark Twain Medical Center, is linked to a spike in surprise medical bills, according to health policy and economics researchers at Yale University.

The study examined close to 9 million emergency room visits run by a variety of companies between 2011 and 2015. It found that when EmCare partnered with a hospital, not only did out-of-network bills increase, but the number and rate of tests ordered and patient admissions also rose.

EmCare is a subsidiary of Colorado-based Envision Healthcare. Since April 2017, Mark Twain Medical Center in San Andreas has partnered with EmCare to provide emergency room staffing.

In a prepared statement, Mark Twain Medical Center officials said their rates and services offered have remained consistent since partnering with EmCare.

Mark Twain Medical Center and its more than 300 physicians, nurses and support staff are committed to providing, high-quality care to the residents of Calaveras County. In a continually changing health care landscape, were proud that for nearly 30 years we have been able to offer the community 24/7access, 365 days a year, consistent, highly skilled emergency medical services, the medical center said in a statement.

The statement did not provide additional information about billing rates or the number of out-of-network verses in-network bills, as requested.

Television shows paint the emergency room as a place of drama, but for patients, one minor medical emergency can turn into a monetary burden.

A trip through the emergency room doors is followed by a brief talk with the triage nurse and, depending on the status of the emergency, youll wait before seeing an emergency room physician.

Many patients do not know that the physician is an out-of-network doctor until it is too late.

Zack Cooper, assistant professor of public health and economics at Yale University, was one the studys three authors. He said that companies might bank on patients failing to look too closely into their plan and their hospital of choice.

If patients were aware, they may not go to these hospitals, Cooper said. The challenge has been in an emergency, they may not have enough choice.

In 2015, the Consumers Union published a survey that showed that 1 in 4 Californians who underwent surgery or received other treatment at a hospital believed their services were in network but were billed at out-of-network rates.

The New York Times interviewed a woman who received a $500 surprise bill in the mail following a stint at Sutter Coast Hospital in Crescent City. After slipping outside her Crescent City home, she was a taken to Sutter Coast Hospital, where she was treated for a broken ankle. While working on paying off her deductible, she was stunned to receive the bill.

The physician did not identify himself, and only briefly touched her ankle. The physician worked with EmCare.

Network: A network is a group of health care providers, including doctors, specialists, dentists, hospitals and surgical centers.

Out-of-Network Care: Going out of network means youll have to pay a larger chunk of the cost or the total cost of services depending on the plan.

Hospitals typically negotiate rates with major health insurers, but EmCare has traditionally negotiated its rates independent of hospitals. Physicians can bill at higher rates when they are out-of-network providers.

Using insurance claims data, the study found that 22 percent of emergency room visits were treated by out-of-network physicians, with an average surprise bill of $622.55.

Over 1 in 5 visits nationwide to in-network emergency rooms results in bills from out-of-network physicians, according to a previous study. But the most recent study found that 80 percent of those out-of-network bills were issued by about 15 percent of the hospitals studied. Many of those hospital emergency rooms were staffed by EmCare personnel.

That really looked like a light switch had been flipped, said Cooper. It had changed so rapidly.

Gregory J. Duncan is the chief of surgery at Sutter Coast Hospital and sits on his countys health board. He has 25 years of experience dealing with hospital services and billing. He began to notice an issue with billing and coding following an abrupt change from a prior staffing company to EmCare in 2015.

Colleagues working within the hospital began to float horror stories of past experiences with EmCare. He also began to receive complaints from patients who received the surprise bills.

Ive spoken with individuals at two other hospitals and they also had concerns, said Duncan. One doctor worked with a patient and agreed to lower the bill. One of my concerns is if you are someone who understands the billing, you can do that, but most dont have that and to me, that is not fair.

The billing became so bad in Crescent City that on April 25, the Del Norte County Board of Supervisors passed a resolution severing ties between the hospital and EmCare. The resolution specifically mentions EmCare, but was extended to include any out-of-network health care provider.

When the bill arrives, that is when you have your heart attack, Duncan said.

Envision Healthcare provided a prepared statement that dismissed the study as fundamentally flawed. The statement also said that out-of-network billing was not an issue specific to any one company.

The study appropriately identifies out-of-network reimbursement as a source of dissatisfaction for all payers, providers and patients in our current health care system. While the source and methodology of the study is fundamentally flawed and dated, we agree with the implied recommendation which is to advance a shared goal to re-engineer the current system in a positive way.

Cooper agreed that out-of-network billing was not inherently indicative of EmCare, but that firms like EmCare might be taking advantage of the situation.

The research compared EmCare to its top competitor TeamHealth, which took over mostly nonprofit emergency room departments. The research found a smaller increase in out-of-network billing and almost no change in admissions, coding or testing.

When the bill arrives, thats when you have your heart attack.

Its not necessarily that it is good or bad; it just turns out that in this case, EmCare is engaging in behavior that I think we can describe as not being in the patients best interest, Cooper said.

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ER bills questioned – Calaveras Enterprise


Teen ER Visits During Lolla Dropped, But It’s Still Worst Drinking Weekend – DNAinfo

Teenage emergency room visits tied to Lollapalooza have fallen in recent years, but the music festival is still the worst weekend of the year for teen drinking in Chicago, Lurie Children’s Hospital says. View Full Caption

DNAinfo/Justin Barbin

DOWNTOWNLocal hospitals have reporteda huge drop in teenage emergency room visits associated with Lollapalooza, but the multi-day music festival is still considered the worst weekend of the year for underage drinking in Chicago.

Just 65 festival attendeesbetween 13 and 18 years old were sent to an emergency room during last year’s Lollapalooza, down from 121 teenage hospital visits in 2014, according to a study released Tuesday by Lurie Children’s Hospital. The drop is even more significant because the fest was four days last year, compared to three in 2014.

When you add older underage attendees to the total, the number of emergency room visits for Lolla-goers between 13 and 20 still fell, to 128 last year, from 212 in 2014, the hospital said.

The numbers cover binge drinking only, said Julie Pesch, a hospital spokeswoman.

Luriecredits its own underage drinking awareness campaign as well as stricter Lolla policies for the drop, but maintains that binge drinking is still a serious issue for the big annual music festival in Grant Park.

The weekend is still the worst in the city for underage drinking, with a rate nine times higher than average, the hospital said.

Werecommend that parents talk about the risks of underage drinking with their kids, especially before concerts and events where alcohol will be present,” Dr. Nina Alfieri, the lead researcher on the study, said in a statement. “They should have their teenager check in with them throughout the day and make sure their children have safe plans for traveling home.”

RELATED: 10 Ways Lollapalooza Will Ruin Your Weekend, Whether You’re Going Or Not

The hospital said half the teenagers sent to an emergency room during last year’s Lollawere 16 to 18 years old and from outside Chicago. At 53 percent, teenage boys were more likely to go to the hospital than girls.

The hospital said Lollaadded more security to the gates last year to check teenagers’ bags for alcohol and other prohibited items. The festival also added a “Safety Team” of volunteer medical students in light blue shirts who blend into the crowd and can administer aid quickly.

A festival spokeswoman did not immediately return a message seeking comment.

This year’s Lollapalooza kicks off Thursday morning. Headliners include Chance The Rapper, Lorde, Blink-182 and Migos.


More Thunderstorms Expected This Week Including During Lollapalooza

Lolla Weekend The Worst For Teenage Drinking, Lurie Hospital Says (2016)

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Teen ER Visits During Lolla Dropped, But It’s Still Worst Drinking Weekend – DNAinfo


Medicaid expansion didn’t lead to overwhelmed emergency rooms … – Baltimore Sun

After the Affordable Care Act expanded access to Medicaid, some worried that newly insured patients would overwhelm emergency rooms, but those concerns appear unfounded, according to new research from Johns Hopkins Medicine.

The study comes as lawmakers in Washington consider legislation to scale back the federal-state health insurance program for low-income people as part of a larger overhaul of the health care reform known as Obamacare.

Through the Medicaid expansion, there were some people who believed more patients would choose to go to primary care providers instead of the emergency department, because now they have health coverage, and there were some people who believed that the expansion would swamp the emergency department, said Eili Klein, assistant professor of emergency medicine in Hopkins School of Medicine. We wanted to look at what actually happened.

Thirty-two states expanded their Medicaid programs. In a paper published this week in the Annals of Emergency Medicine, Hopkins researchers looked at billing data from Maryland during 18 months before and after enrollment in the health program began in 2014.

Marylands Medicaid rolls swelled by about 20 percent, or 160,000 people. About 800,0000 already were enrolled in the program.

Overall, the study found there was a 1 percent decrease in emergency room use over the study period despite an increase in the number of insured people.

Those new to Medicaid did use the emergency room more about 43 percent more than people without insurance, Klein said. But most people dont visit the emergency room much, and the growth in Medicaid enrollees wasnt enough to have much of an effect.

Among those using the emergency room, there was a six percent increase in those with Medicaid coverage and a corresponding decrease in those with no insurance.

Klein said the financial benefits to patients was positive because they werent stuck with bills they couldnt pay, and the hospitals bottom lines were protected from uncompensated care.

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Medicaid expansion didn’t lead to overwhelmed emergency rooms … – Baltimore Sun