Idea #277 for November 22nd, 2009: The Long Wait or The Problem With Emergency Care Wait Times

Our emergency rooms need fixing. New data show that patients that need care the quickest are least likely to receive it. Less than half of patients who needed emergency care within 15 minutes actually received it within that time frame. More troublesome is that those numbers have been getting worse in recent years.

The researchers studied data from 540 million emergency department visits spanning from 1997 to 2006. In 1997, 59% of the patients requiring care within 15 minutes received it, yet in 2006, that number was down to 48%. Whether patients were insured did not seem to matter in this case. However, Hispanic and African American patients faced even longer wait times on average than whites. There’s no simple fix for this mess, but effective healthcare reform legislation must address this before the trend worsens.

Read about this study here.

Idea #264 for November 9th, 2009: The Waiting Game or Are The Uninsured To Blame For Long ER Waits?

Uninsured patients are often thought to be responsible for the long waits at many emergency rooms in the US. The thinking goes: patients with no insurance cannot see a primary care provider so instead they are forced to visit the emergency room for non-emergency problems. However, statistics seem to dispute that notion. A study looked at median wait times at emergency rooms over a decade and found that while waiting times have been increasing over the years, the percentage of uninsured patients has remained relatively constant. Something besides uninsured patients must be responsible for the growing wait times.

Researchers found that all patients, whether insured or uninsured, have been visiting emergency rooms more frequently in recent years with non-urgent problems. Further, the patients that have seen the largest increase in wait times are the ones who are in most need of care. The researchers say that the problem is likely due to inadequate access to primary care for both insured and uninsured patients, as well an aging population and the increased amount of care associated with them. The study’s authors also place part of the blame on hospitals’ inefficiencies in the processing of patients and of running diagnostic tests. Solutions to this will have to include allowing greater access to primary care and streamlining the emergency intake process. Increasing access to health insurance apparently will not solve this problem, if this study’s findings are accurate.

Read more about the study here.

 

Idea #263 for November 8th, 2009: Beating The Clock or Time Is Crucial For Stroke Victims

For people exhibiting symptoms of stroke, getting emergency care as fast as possible could mean the difference between life and death. Yet 40% of stroke patients use private transportation to get to ERs instead of dialing 911, says a new CDC report. Timing is crucial because the drug used to treat a stroke, tissue plasminogen activator, has to be given within three hours of the first symptoms. Patients cannot afford to wait for travel arrangements.

The important thing here is that people have to be well aware of the typical symptoms of stroke so that they can identify their condition rapidly and seek emergency help. A vital part of that process is making sure people who are at high risk of stroke — smokers, people with hypertension or obesity, etc. — know what the beginning of a stroke feels like. The symptoms include: vision problems, weakness on one side of the body, and rapid onset of dizziness or headache. It’s in the best interest of elderly patients and other people in a high risk category to memorize the symptoms of a stroke so that if the worst happens, they can react promptly.

Read more about this issue here.

 

Idea #231 for October 7th, 2009: Scaling Up or Adjusting Antibiotics Dosages for Obese ER Patients

In an ER environment, patients are often given standard doses of antibiotics regardless of their weight and other factors, a study has found. As a result, many obese patients are not receiving high enough doses of antibiotics, which means their infections are not being sufficiently treated. That in turn can lead to antibiotic resistance, a major problem in the realm of healthcare.

The study specifically looked at how doctors at Washington University Medical School treated emergency room patients with BMIs over 40. For the three antibiotics they focused on, researchers found that proper dosing guidelines were followed less than 10% of the time among obese patients. If those numbers of indicative of how emergency departments across the nation are functioning, then we really need to implement stronger guidelines for this. Considering how many Americans are obese, this poses a real danger, both to the patients themselves and to the public, who will have to deal with more resistant strains of bacteria in existence.

To read more about this study, read this article from ABC News.

Idea #193 for August 30th, 2009: A Low-Cost Option or Assessing The Effectiveness of Retail Clinics

Retail clinics, like those found in CVS or Walmart, are a popular way to receive prompt, inexpensive treatment for non-urgent health ailments. Not only are they convenient, but they are also quite effective, a new study says. The clinics were assessed in their treatment of ear infection, sore throat, and urinary tract infection (which combined, make up 40% of their cases) in an article to be published in Annals of Internal Medicine. Researchers found that the clinics followed accepted guidelines in lab tests performed and medications prescribed, and that frequency of misdiagnosis was not outside of acceptable ranges.

Retail clinics are usually staffed with nurse practitioners and can diagnose and treat minor sicknesses and provide routine wellness services like vaccinations. A third of Americans live within ten minutes of clinics like these, and another 6,000 clinics will open in the next few years. Visit costs usually range between $30 and $110, and patients don’t need appointments and can expect to spend only 15 minutes on a visit. The costs are generally 80% less than those associated with emergency rooms.

It makes sense to treat common illnesses in a low-cost, high-turnaround environment like this, instead of clogging emergency rooms with people who aren’t all that ill. There’s the potential of lowering healthcare costs overall as more of these facilities are rolled out. It’s encouraging to hear that the standard of care in retail clinics is commensurate with other, conventional healthcare facilities.

Read more about the study in US News.

Idea #130 for June 28th, 2009: More Budget Woes or Funding Poison Control

California is dealing with such a major budget crisis that it seems no program is safe from the chopping block. One such program is poison control, which may soon be eliminated entirely in California. They would be the only state without such a service, but some worry that other states would follow California’s lead and cut out their own poison control services amid economic crises. Washington, Oregon, Tennessee and Michigan have all begun efforts to at least downsize their poison control centers.

People generally call into poison control with problems related to taking wrong medications, food poisonings, and ingesting potentially harmful substances. Beyond those immediate concerns, there is another important aspect to the service, and that is reporting. Data from poison control are reported to the CDC, which it then uses to find trends and track down sources of contaminated products or foodborne illnesses.

National surveillance will suffer when California ceases its poison control program. Additionally, one group estimates that California will face $80 million in extra costs associated with people using ERs more often in cases of suspected poisonings. Also, 911 centers will probably be placed under heavier burden. Closing poison control programs will have a greater effect than the obvious immediate outcomes, and states should weigh them carefully before cutting their funding.

Read more from the AP and from this Washington news site.

Idea #56 for April 15th, 2009: You Can’t Afford to Neglect Diabetes or The Economy and Diabetes Care

The ripples from the global economic crisis are reaching many areas outside the world of finance, including healthcare. People are losing their jobs, and consequently, their benefit packages. In fact, 3.7 million Americans have lost their insurance since the crisis began. Even in cases where employees were not insured in the first place, the recession has now made it more difficult for them to pay for healthcare out of pocket. Because of this, patients have been cutting back on health spending.

The Associated Press reports that the recession has led to diabetes sufferers increasingly neglecting their illness since the economy faltered last fall. Close to 2 million new cases of diabetes are diagnosed each year, yet sales of diabetes drugs and devices for monitoring the disease have dropped recently. Meanwhile, the average co-pay of an office visit has risen in the past decade, making seeing a doctor more pricey even for the insured. Emergency rooms are now seeing more patients experiencing complications from untreated diabetes.

While ignoring or delaying treatment for diabetes might save money in the short term, the effects of the disease will be costly down the road. Diabetes can lead to blindness, neuropathy and amputations, and even death, if not monitored and treated correctly. The recession doesn’t have to mean you are stuck without treatment options. For those who can afford it, enrolling in the federal COBRA program allows the recently unemployed to continue their employee health insurance for up to three years. Also, low-income patients can qualify for discounted clinic visits and prescription assistance programs.

Read more stories about the economy and its effect on diabetes from: the LA Times, Associated Press, and a Wisconsin local news site.

Idea #8 For February 26th, 2009: Hello, 911 This Is The Border Patrol or Making Border Patrol Pay Their Share

This post touches on some immigration issues that I don’t think are an appropriate forum for this blog and I am not making any comment on immigration and illegal immigration here. My point put simply is that un-reimbursed costs relating to the complex situation on the border are putting border hospitals out of business. This would be kind of funny if it weren’t true…

The US Border Patrol in many cases lets caught persons go free so as not to be on the hook for their healthcare, this is bad policy all around. If the Border Patrol (a federal agency) brings an injured person under their custody to a hospital, the federal government is on the hook for the cost of care. If, on the other hand, Border Patrol calls 911 or “patient dumps” them instead, the hospital and local government have to incur the costs, as long as the person was is not in custody. Unfortunately for border-state hospitals, the latter scenario is often the case and its costs are crippling. The Border Patrol has budget realities just like everyone else but this seems a clear case that takes advantage of local resources to avoid paying for a problem that is literally their mission statement. While there has been reduced “patient dumping” as of late, it still goes on and with budget tightening on the horizon it isn’t a big leap to say that it will soon be more prevalent again.

Here’s a real-life example that illustrates some more absurdity of the border situation:  many people with HIV illegally come into the US for healthcare because most of the time they have absolutely no alternative. They receive it in many cases at no cost. Because of the strict drug regimens, they need to be consistently on the drugs, otherwise very expensive steps are needed to reinstate the protocol. So when a person in this situation is caught, we spend about $5,000 to deport them and then when they re-enter we need to spend another $12,000 to restore their drug protocol. So by not deporting them we would save $17,000, which is more than a year of their free care if we had just kept them on the drug consistently to begin with. Clearly, this is not a good system.

Examples like these are leaving border hospitals in financial ruin, forcing many of them to close their doors for good. A provision in the Medicare prescription drug bill of 2003 included $1 billion for reimbursing hospitals for unpaid illegal immigrant bills. Not surprisingly, hospitals have not received much of the federal funds they were promised. Without getting into the larger debate on immigration, steps need to be taken to alleviate some of the financial burden hospitals are experiencing under the system. For one, the loophole that allows Border Patrol to call 911 and absolve themselves of any financial responsibility must be closed. If the Border Patrol had to use their agency’s funds to pay for immigrant healthcare, they will have more incentive to do their job well. Federal money should be dispensed more freely and effectively in the event a hospital is left footing the bill. There’s no reason private hospitals should have to pay for the federal government’s inability to secure our border.

See this in the media: http://www.studentnewsdaily.com/news-issue/counting_the_costs/ , http://www.thefreelibrary.com/NEW+BORDER+THREAT+-+%60PATIENT+DUMPING%27.-a083966589 , http://www.tucsonweekly.com/gbase/Currents/Content?oid=oid:69346