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What you should know about freestanding emergency centers – TribTalk

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

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

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

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

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

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

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

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

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

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Would You Take Uber to the Emergency Room? – Healthline

In a segment on Jimmy Kimmel Live earlier this month, people on the street voiced their opinions about the new healthcare bills various provisions.

However, the segment, called Lie Witness News, was really a sketch made up by shows producers.

Those interviewed approved of proposals like deploying veterinarians to perform surgeries on patients who lacked insurance, and paying people to stitch up their own wounds using YouTube tutorials.

But one suggestion, which elicited peals of laughter from the studio audience, was not actually so far-fetched.

Lets talk about the bills provision replacing ambulances with Uber EMT, the interviewer said. A lot more drivers on the road obviously and time is of the essence. It doesnt really matter who drives.

Yeah, as long as you get to the hospital quick, reliable. I think that could be provided by regular people, said the young man on camera.

You support Uber EMT? asked the interviewer.

Id be in for that, he said.

Read more: The challenge of taking someone with dementia to the emergency room

While the government is not actually proposing that Uber replace ambulances, more and more people do seem to agree that regular people are capable of bringing someone to the hospital in the event of an emergency.

According to Stat News, and other outlets, hard data isnt available to quantify the trend, but Uber and Lyft drivers are encountering riders who need more than a ride home from the bar.

When I got there, to my dismay, I see him literally dragging himself toward my car, hand on his chest, stating he was having chest pains and was getting dizzy, wrote a driver on an online message board.

I offered to call 911, as the hospital he wanted to go to was over 15 minutes away, but he insisted for me to take him, the driver continued. Fortunately, I was able to get him to the hospital and he was admitted, but it made me wonder why someone in that situation would prefer an Uber over an ambulance the only rationale I can come up with is money.

Uber, Lyft, and medical experts would all agree that the mans situation was one that required an ambulance, not a rideshare.

In an ambulance, EMTs can administer treatment en route. Plus, their knowledge of the areas emergency rooms enables them to bring the patient to the hospital best equipped to handle the situation.

But there are occasions when ridesharing services are appropriate, and may even serve to fill a void in access to healthcare.

Last year, Uber partnered with Circulation, a company that arranges rides for people getting medical care.

And Lyft is entering the healthcare market in multiple ways, forging direct partnerships with providers like Blue Cross Blue Shield, and with traditional medical transportation companies like American Medical Response.

For us as an organization, healthcare aligns very, very well with our mission, with our values, Dan Trigub, head of healthcare and elder mobility solutions at Lyft, told Healthline.

People who get insurance through a company that has partnered with Lyft dont request a ride themselves. Their providers schedule a pickup through the companys stand-alone website, Concierge.

So whether they know it or not, a patient covered by one of these services may be taking an Uber or a Lyft to their next doctors appointment.

Read more: Hospitals open emergency rooms specifically for senior citizens

A 2005 report from the National Academies of Sciences estimated that 3.6 million Americans miss or delay healthcare due to lack of transportation.

Minorities, people with low incomes, and those with chronic illnesses are affected disproportionately.

The same report found that paying for transportation to make sure people get to their appointments would cut down on healthcare costs in the long run.

That reasoning fuels the federal requirement that Medicaid pay for its beneficiaries to take a cab, van, public transportation, or other mode of transport to the doctors office if the patient has no other way of getting there.

The Centers for Medicare and Medicaid Services (CMS) spent $2.7 billion on nonemergency medical transportation (NEMT) in 2013, according to the U.S. Government Accountability Office (GAO).

Most companies providing Medicaid services partner with transportation brokers, who in turn contract with cabs or other livery services to arrange rides. They then bill CMS for reimbursements.

But this system has come under scrutiny for being opaque, expensive, and ineffective. GAO officials identified NEMT as an area of high risk for fraud and abuse. Last year, New Jerseys Medicaid program failed an audit of its NEMT services for improper oversight and reporting.

There was clearly a need for something better, Robin Heffernan, chief executive officer of Circulation, told Healthline.

With the traditional service, you had to call several days in advance of the ride and then the broker would go take several hours to figure out whether they could accept your ride, and come back and give you a four-hour window for your patient to be ready, she said.

Its huge to be able to have one platform which can, in a more structured manner, deliver these rides, track them, and account for them, she said.

According to CareMore, a company that serves Medicare beneficiaries, its partnership with Lyft has cut both wait times and per-ride costs by about a third.

People no longer have to wait an hour or more to be picked up after their appointment ends, Dr. Sachin Jain, CareMores president and chief executive officer, told Healthline.

With Lyft, youre working with a driver who is proximate, theyre relatively close to where you are, so that wait time on the pickup ride is shorter, Jain said.

Jain said that CareMore provided senior sensitivity training to Lyft drivers to prepare for picking up a customer base that is not widely associated with using ridesharing services.

Read more: Rural hospitals closing at an alarming rate

But these services are not, however, replacing ambulances. At least not yet.

Unnecessary ambulance rides rose from about 13 percent to 17 percent between 1997 and 2007, according to a study from the University of Pittsburgh.

James Langabeer, a professor of health informatics at the University of Texas, said that people call an ambulance when they dont really need one for all sorts of reasons.

I think the emergency department is a place where you can go and you know youre going to get care, whereas if you call a provider and they say tell me about your insurance, its a barrier, he told Healthline.

Even people with insurance may not have a primary care doctor or medical home they feel comfortable visiting, he added.

Langabeer studied a pilot program run by the Houston Fire Department, called Emergency Telehealth and Navigation (ETHAN).

ETHAN allows EMTs to offer alternatives to patients who call 911 but do not require emergency services.

One solution is to offer cab vouchers for office visits, which the EMT can help schedule. Langabeer said he can imagine ridesharing filling a similar role.

But despite his interest in easing the burden on ambulances, Langabeer stressed that 911 is still the best option for anyone in medical distress.

Were not always as patients the best people to diagnose, or the right people to diagnose our own conditions, he said. On the other hand, we do know our body, and we know whats abnormal. And if you do know this isnt normal, and youre completely convinced, now how do you get there?

In those cases I say, Yeah, call any type of special transportation that can get you to those places and get you in.

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Would You Take Uber to the Emergency Room? – Healthline

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Fidget spinner sends child to emergency room – WSAV-TV


WSAV-TV
Fidget spinner sends child to emergency room
WSAV-TV
After rushing to the emergency room, x-rays revealed that part of a fidget spinner was stuck in the girl's esophagus. Doctors were able to surgically remove it and the 10-year old will be fine. However, Joniec posted the photos on Facebook to warn
Are Fidget Spinners Bad for You? Texas Girl Has Surgery After Swallowing Metal Toy PartNewsweek
Fidget spinners: Mom warns about choking hazard – TODAY.comToday.com
Fidget spinner sent Texas girl to operating room, mom warns other parentsDallas News

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Providence opens pediatric emergency room – KWTX

WACO, Texas (KWTX) Waco children can get lifesaving health care much closer to home now that Providence Health Center opened its new pediatric emergency room.

The kid friendly staff is trained to educate young patients on their healthcare needs. More accessible to McLennan County families. Waco native Voa Himstedt hasnt had a stay in the hospital in over a year.

“The team kind of helps me feel better you know,” Himstedt said.

The 6-year-old is diagnosed with hydrocephalus, a condition where brain fluid pools and pushes the brain out towards the skull. She spent many of her early days under the care of doctors at Austins Dell Pediatric Hospital.

“I was probably holding my breath for two years, her mother Laura said.

It was extremely stressful but as a parent you just do what you have to do and you think about it later.”

But the Himstedts can breathe a sigh of relief knowing her daughter can now get that same care from doctors close to home at Providence Hospital.

“It’s a huge comfort knowing that it’s going to be here at Providence and knowing that they’ll be able to communicate with doctors who know her condition and her entire history,” Himstedt said.

After three years of planning Dr. Nicholas Steinour, emergency department medical director, said the new Pediatric Emergency Center offers Waco families a kid friendly place to heal.

The new emergency room is not a trauma center but up to 11 children can be treated at any time.

Realizing that they’re not just little humans but have their own nuances and thats something Dell is really providing training and education for all levels of the staff, Steinour said.

“I remember one time there was a bunch of shots and I wasn’t even scared,” Voa said.

“There was a nurse that was doing the IV and she said you might want to look away and then I didn’t”

Steinour said more resources are focused on pediatric patients. The staff is trained to keep patients informed and active in their healthcare. The environment is improved to make kids, which makes up 20 percent of emergency room patients, comfortable.

Voa likes the changes but still said the best medicine is moms love.

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Free-standing emergency rooms offer costly convenience – Stillwater News Press

HOUSTON – Not far from neighborhood streets lined with million-dollar homes here lies an open-air mall where people go to eat, shop and – when needed – get emergency medical treatment. People pull up to the front door, park next to a gleaming antique ambulance and enter a waiting room that feels more like a graceful hotel lobby than a holding area for sick people.

It isn’t a clinic or an urgent care – it’s an emergency room, without the hospital.

When lawyer Richard Yount opened the facility, called Elite Care Emergency Center, in 2009, the idea was simple: Emergency rooms were crowded, with miserable waits and rushed doctors. He could fix that – and make a lot of money – by carving the department out of the hospital, putting it in a neighborhood where people without insurance were unlikely to show up and charging hospital-level prices.

There was just one problem: People assumed it would be cheap, especially at first. “No matter how many times you tell people you’re an emergency room, they have a tendency to think: If you’re in that kind of an environment, you’re an urgent care,” said Yount, who now operates four free-standing ERs.

Free-standing emergency rooms, standalone facilities where people can receive acute care any time of day, have increased in Texas in recent years as a result of a 2009 law that permitted the establishment of emergency rooms independent of hospitals. They join a host of other on-demand facilities – including hospital ERs, hospital-owned satellite ERs, “microhospitals” and urgent-care facilities – where people can receive care, especially if they have robust health insurance.

Texas’s wild west of competition, with lit-up signs advertising “SHORT WAIT TIME FOR LACERATIONS” and highways punctuated by warring billboards, is a leading example of how an emerging wave of convenient medical-care options for Americans can also create confusion and lead people to seek expensive treatment for conditions that might not merit it, pushing up costs across the health-care system.

Across 32 states, more than 400 free-standing ERs provide quick and easy access to care. But they also are prompting complaints from a growing number of people who feel burned by hospital-size bills, like $6,856 for a cut that didn’t require a stitch or $4,025 for an antibiotic for a sinus infection.

Emergency care requires costly imaging and laboratory equipment and facilities that are open 24 hours a day and staffed round the clock by a physician – and the costs reflect that. Prices for an average free-standing ER visit have grown and are now similar to hospital ERs, but patients with the same diagnosis rack up bills 10 times higher than at an urgent care, according to an analysis of one insurer’s Texas data by Rice University economist Vivian Ho. She found use of the facilities in Texas more than tripled between 2012 and 2015.

The high cost raises the question of whether people are seeking out more expensive care only because it’s convenient, not because it’s necessary.

“If there had not been a close, convenient emergency department, would that person have gone to an emergency department, or sought care somewhere else?” said Jeremiah Schuur, an emergency medicine physician at Boston’s Brigham and Women’s Hospital who studies the industry.

Texas’s flowering of freestanding ERs leads a debate about whether convenience makes people healthier or needlessly drives costs up – a central dilemma in health=care innovation. Health-care specialists want people to seek care that’s necessary. But with U.S. health-care spending surpassing $3 trillion this year, new attention is focused on how making health care a better consumer product might simply increase its use. Research shows, for example, that walk-in retail health clinics and telephone medicine, which might seem to replace more expensive options, actually tend to slightly drive up health-care spending.

“The vast majority of people who get sick on a monthly basis don’t go get care, don’t even think about getting care – and among those who do think, ‘I should go get care,’ only two-thirds of them end up getting a visit of some type,” said Ateev Mehrotra, a physician and researcher at Harvard Medical School who did that research. “There is an enormous market of people out there who . . . choose to get care when it’s convenient.”

Texas’s crowded landscape of ERs and clinics may seem like a consumer paradise, in which people are able to shop around. But it lays bare a simple truth: It’s hard to shop when no one knows what anything costs.

Bryan Piccola of Frisco, Texas, sliced his left pointer finger on July 4 when his knife slipped cutting tightly wound zip ties off a toy for his year-old daughter. He debated cleaning the wound up and sticking a bandage on it, but he went to a free-standing First Choice Emergency Room a few miles from his house. He asked beforehand how much it would cost, since he is a veteran and didn’t have separate insurance, and says he was assured it wouldn’t be too bad. He received five stitches and, later on, the bill: more than $5,000. The company discounted it to $2,888.

“You drive by them all the time. There’s a bunch of these little pop-up clinics,” Piccola said. “If they would have told me [how much it would cost], I wouldn’t have gone – I’d have gone home and wrapped it up and waited for the scar.”

Adeptus Health, the company that owns First Choice Emergency Room, declared bankruptcy in April. It declined a request for an interview.

Richard Yount embarked on his career as an emergency room entrepreneur as Texas’s access to emergency care was hitting rock bottom, given a failing grade by the American College of Emergency Physicians. He had watched other hospital services, such as imaging centers, being spun into separate, lucrative businesses.

“You had not a lot of competitors and you had all the patients you’d ever want, and they paid a lot. Money just fell in your lap,” Yount said. “I watched this train go by for 30 different services, and I only caught onto the caboose.”

Yount’s insight was simple: In addition to the physician’s bill, hospitals were paid a “facility fee” to cover X-rays, CT scanners, laboratories and round-the-clock staffing by physicians and nurses. Freestanding emergency rooms shared many of these costs, since they strive to deliver the same care available in a hospital ER, and the facility fee made the business viable.

By situating in well-off neighborhoods, they could largely avoid patients who couldn’t pay. Without a hospital affiliation, they cannot bill Medicare or Medicaid for emergency care, and many carry warnings on the front door that they do not accept those less-lucrative plans. And as a start-up, the free-standing ERs weren’t encumbered with the high administrative costs of a hospital.

Complicated cases, such as surgeries or trauma, could be sent by ambulance to a hospital, but stand-alone emergency room operators argue they can see people faster, keep them out of the hospital altogether and save money.

Yount, 68, is a jumble of contradictions. He is an unapologetic capitalist who operates four free-standing emergency rooms in Texas and is in the process of finding a site in Las Vegas to build a “microhospital” – an ER with some inpatient beds.

He is also a Bernie Sanders supporter and a strong believer in universal health care whose office is still decorated with light-blue signs from the Vermont senator’s presidential campaign.

“I can believe in one thing on a macro level, as to what this country needs to do. But if I want to operate, I’m operating within the current system that we have. So I make the economic decisions based on the current system we have,” Yount said. “Doesn’t mean I have to like the current system – and I don’t.”

Yount says the start-up costs are about $5 million. In the early days, the business could break even with just seven or eight patients a day. The break-even point today is up to eight or nine, and Yount expects the number to rise as pressure from insurers increase.

The model appeals to many physicians and nurses.

“The mind-set is totally different here,” said Aaron Schwartz, an emergency physician at Elite Care. “In the hospital, it’s driven by surveys and scores, efficiency and throughput times and volume. … We can spend as long as the patients want us to spend with them.”

Some patients appreciate the convenience. Miguel Balli, 24, of Houston had spent a miserable night, vomiting and ill, when he showed up at Elite Care one Monday morning. Within an hour, he was getting an IV drip and beginning to feel better.

“These setups are a lot more beneficial for the patient as far as time concern and quickness and availability,” Balli said. “If you’re not the most serious person at the ER, if you’re not the one bleeding out or having a heart attack, you’re probably going to get last on the totem pole.”

The problem is the flip side of the success: People who would have thought twice before navigating down to Houston’s crowded medical hub, the world’s largest medical center, have a surfeit of options right in the neighborhood.

In Sugar Land, an affluent suburban city south of Houston, there is St. Michael’s Emergency Center, right next to Emerus 24HR Emergency Hospital, a former free-standing ER that’s been converted into a small hospital. In the driveway, two identical signs look like mirror images, each directing people with an “EMERGENCY” in a different direction. A mile away, in both directions, are two hospitals.

The ease of access is a good thing if it is moving people to seek care for symptoms that would be dangerous to ignore.

Many free-standing emergency room operators say they do their utmost to stress to people that they are in an emergency room, with emergency room prices, and they refer patients with minor conditions to urgent-care facilities. The buildings have “emergency” signs on them and are required by state law to carry written warnings that they will charge a facility fee – although the amount is not disclosed.

But Ho of Rice University has found a big overlap in the types of conditions for which people seek care: three-quarters of the 20 most common diagnoses at free-standing emergency rooms were the same as at urgent-care centers. A slightly smaller overlap existed for hospital-based emergency rooms.

“It’s fine if it generates the value of the price that is paid, but if it’s not generating that value, then all it does is raise costs for everybody,” Ho said. “There needs to be more transparency in terms of the cost. Why should it be comparable to what a hospital ER is charging?”

But even as free-standing emergency rooms defend themselves, the model appears to be evolving, in part in response to the confusion. Yount provided a tour of what he says is the future: a large free-standing ER that stands apart from shopping malls and wouldn’t easily be mistaken for an urgent-care clinic.One of his competitors, Emerus, switched to building “microhospitals.”

Free-standing emergency rooms blame insurers for big bills, arguing they deny claims or underpay them. Insurers, in turn, blame the facilities for charging high prices.

“There’s this misleading factor, or I’d go so far as to say deception,” said Shara McClure, a vice president at Blue Cross Blue Shield of Texas. “A member who’s having an incident, having an acute condition, they go into these free-standing ERs thinking they’re a cost-effective solution.”

The Texas legislature is considering bills that would help protect consumers from surprise bills and regulate the industry.

That points to the biggest lesson emerging from Texas’s experiment.

“We need to do more to make prices extremely visible to patients,” said Schuur, of Brigham and Women’s Hospital. “But it also calls into question the ability of patients to be smart consumers, particularly in the time when they have what they perceive as an acute health-care need.”

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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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Lawmakers hit freestanding emergency rooms with mediation and disclosure requirements – Chron.com

Sky Canaves, Houston Chronicle

An emergency room entrance is seen in a file photo.

An emergency room entrance is seen in a file photo.

Lawmakers hit freestanding emergency rooms with mediation and disclosure requirements

AUSTIN — The House voted 129-11 on Wednesday in favor of the Senate’s version of a bill that will force freestanding emergency rooms and other out-of-network providers into mediation with customers who dispute surprise bills under a state program launched in 2009.

Senate Bill 507 also requires that bills sent to patients include a prominent explanation of the mediation process. The legislation was passed in the Senate in late March and approved by the House Insurance Committee on Tuesday.

Surprise medical bills, also known as balance bills, typically arise when patients seek care at an in-network facility, such as a hospital, but are treated by an out-of-network provider. A recent study by the Center for Public Policy Priorities found that more than 300 hospital emergency rooms in Texas do not have a single ER doctor covered by the state’s three largest insurance plans.

Beyond the standard hospital emergency rooms, over the past five years Texas has seen a boom in freestanding emergency care centers, with more than 200 currently in operation. These account for nearly 70 percent of out-of-network emergency claims, according to Texans for Affordable Healthcare, a coalition of insurance companies, hospitals, and underwriters that supports legislation to rein in costs.

Recent research has found that Texans are more likely to receive surprise medical bills than residents of most other states. State residents have a 34 percent chance of receiving an unexpected bill as a result of being admitted to a hospital through the emergency room, compared to 20 percent nationwide, according to a report published in Health Affairs in February.

In 2009, the state adopted a mediation process for surprise bills arising from hospital ER visits, but it appears that few of those eligible have taken advantage of the option. Only 3,800 patients have sought mediation since the program’s introduction, while the Center for Public Policy estimates 250,000 people covered under eligible health plans will receive surprise bills for out-of-network services within a two-year period.

The House also voted on Wednesday for final passage of a bill requiring freestanding emergency rooms to provide notice of whether they participate in any health plan networks, since many do not. House Bill 3276, sponsored by State Rep. Tom Oliverson, R-Cypress, aims to clarity the status of these facilities in order to help patients avoid surprise bills later on.

Another pair of bills that would limit how much freestanding emergency care facilities can charge for services have been left pending in their respective Senate and House committees.

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Lawmakers hit freestanding emergency rooms with mediation and disclosure requirements – Chron.com

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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

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