ER Doctor Says We Can’t ‘Band-Aid Over’ Opioid Crisis

A typical scenario looks like this: A 911 call comes in, then emergency services arrive on the scene, determine it’s an overdose, and administer the opioid-blocker Narcan. The patient is then transported to the emergency room.

Once in the hospital, it’s common for emergency physicians to keep an eye on the patient while busy taking care of other emergencies like heart attacks, traumas, and strokes.

The patient might get some literature on addiction and treatment options before being discharged. This patient is now at an extremely high risk of dying within one month, according to a study carried out by Scott Weiner, an assistant professor at Harvard Medical School.

“The opioid overdose patient, who sobers in the hallway, is offered a detox list, and then is discharged, has a 1 in 10 chance of being dead within one year. And their highest risk is within the first month,” Weiner said at an opioid panel discussion at the annual American College of Emergency Physicians (ACEP) conference on Oct. 30.

Emergency room physician Dr. Krista Brucker wants the health system to react to overdoses in the same way they do heart attacks.

“The team would be different, but the idea is, you send out a page and activate everybody and they have to be there within 15 minutes—and then the patient is immediately linked with ongoing care,” she said on Nov. 1. “And hospitals [should] get measured on how quickly they can get a patient from their overdose into treatment.”

Brucker said the Sidney & Lois Eskenazi Hospital in Indianapolis, Indiana, where she works, is already measured on such things as how quickly a patient with a suspected broken bone gets opiate pain medication, or how quickly a patient is taken to the pathology lab.

“If we were all ranked and sorted based on it [getting overdose patients to treatment], and reimbursed, it would incentivize hospitals to take this more seriously,” she said.

Bridging the Gap

As Brucker saw overdoses pile up in Indianapolis, she responded by helping launch Project Point, an initiative set up in 2016 to help bridge the gap between the emergency department and treatment.

“I landed in this by accident. I love emergency medicine and I fell into this because I really couldn’t believe that this was the best we could do for patients,” she said. Patients surveyed by Project Point have overdosed seven times each, on average, she said.

A Project Point staff member gives an overdose kit to a patient at the Sidney & Lois Eskenazi Hospital in Indianapolis, Indiana. (Courtesy of Project Point)

Brucker and the Project Point staff meet with overdose patients while they’re still in the emergency department. Last year, after the project launched, they talked to 84 people. This year, so far, it has been 323 people.

“It’s both sad and very good,” said Brucker. She finds out their stories, including any childhood trauma they suffered, educates them on naloxone (commonly known as Narcan), and tests them for HIV and hepatitis C.

“We then try and link people into ongoing treatment after that intervention in the emergency department is complete,” she said.

Forty-five percent of those patients go on to visit some type of treatment center.

“And if we can get them to their first visit, half of them make it to three visits,” she said.

Brucker also discovered that about 55 percent of the Project Point patients have a mental health illness, or have been treated for one in the past. She advocates for a whole build-out of the behavioral health system.

“For me, the opiate, the whole epidemic, the whole problem, is a symptom or several symptoms of some underlying pathology that if we ignore and band-aid over, we do so at our own peril, because it will come back again,” she said.

“Even if you put every single person who uses heroin today into the best treatment for them, even if the system were perfect, you’ve still ignored a huge part of what fueled it, and so it will come up again, in some other way.”

Medication-Assisted Treatment

“I wish I could tell you that opening up a bunch of Suboxone clinics would fix the problem—which is what I think a lot of people are hoping,” Brucker said.

Suboxone is a medication commonly used to treat opioid addiction. It is a combination of buprenorphine (an opioid) and naloxone (which blocks the effects of opioids). Suboxone has been used in opioid addiction treatment since 2002. Methadone, the other main medication-assisted treatment, has been around for decades, while naltrexone (commonly known as Vivitrol) is fairly new.

Some hospitals are administering Suboxone in the emergency department, but most don’t—even if patients want it.

“My experience in Indiana … is that patients really want it and we’re trying very hard to open the door to treat them, but we’re still really limited [in the number of] providers who can and will prescribe it,” Brucker said.

Very few doctors have the required X-waiver from the Drug Enforcement Administration to prescribe buprenorphine.

“It would be easy to get more ER doctors waivered (lots of people are working on this), but in most places there is nowhere for these patients to follow up (not enough treatment capacity),” Brucker said. “So even if I write a three- or seven-day supply, you need someone to pick that person up and continue their care—and most health systems across the country don’t have that capacity right now.”

She said it is very difficult to quickly get a patient onto either methadone or buprenorphine, or long-acting naltrexone. And addicts who are faced with the choice of coping with the immediate onset of a cold turkey withdrawal or shooting some heroin, will most often choose the latter.

“That’s why I think the health system really has to adapt because we have to lead with medicine, and we have to be there when the patient is ready,” she said.

But, she said, some profit-driven providers have given medication-assisted treatment a bad reputation, which creates more barriers to overcome. And each individual provider has limits to how many patients they can have on medication-assisted treatment (30 patients in their first year).

Behavioral Health

In a recent survey of emergency physicians nationwide, 57 percent said there are an inadequate amount of detox and treatment centers, and 87 percent said the problem with opioids was either increasing or remaining steady in their location.

In Indiana, for example, there are six or seven addiction psychiatrists for the entire state, Brucker said.

“And they’re all maxed out in terms of capacity,” she said. “So even if the health system wants to start, let’s say, a really high-quality opioid treatment program, finding the staff—from physicians to nurses to social workers—it really is hard.”

Dr. Krista Brucker (R) and Project Point members meet at the Sidney & Lois Eskenazi Hospital in Indianapolis, Indiana. (Courtesy of Project Point)

When President Donald Trump declared the opioid crisis as a nationwide public health emergency on Oct. 26, he pledged to broaden access to treatment, including overturning an old federal rule that prevented states from accessing Medicaid funding for residential treatment facilities that have more than 16 beds.

The declaration also allows for expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.

The declaration will expire on Jan. 24, 2018, unless the president reauthorizes it.

But, Brucker says, the system has to take it a step further than just preventing deaths. “It’s an emergency and people are dying, and our first job is stop people from dying. But to not ask the next questions seems particularly sad,” she said.

“If you’re talking about helping people address all of their other co-morbid mental health issues … then that requires a much larger build-out of behavioral health infrastructure.”

And not just for opioid addiction.

“I think we should treat diabetes more like a behavioral health disease,” she said. “A lot of people are saying you have to treat addiction like you treat diabetes—you have to be on insulin the rest of your life. Well, a lot of diabetes is behavioral, so I think we should go the other way.”

Source: ER Doctor Says We Can’t ‘Band-Aid Over’ Opioid Crisis | opioids | The Epoch Times

Aggressive testing provides no benefit to patients in ER with chest pain | Washington University School of Medicine in St. Louis

Patients who go to the emergency room (ER) with chest pain often receive unnecessary tests to evaluate whether they are having a heart attack, a practice that provides no clinical benefit and adds hundreds of dollars in health-care costs, according to a new study from researchers at Washington University School of Medicine in St. Louis.

Specifically, computed tomography (CT) scans and cardiac stress tests are overused in the ER for patients with chest pain and provide no information to determine whether a patient is in the midst of a heart attack, the researchers found.

The study appears Nov. 14 in JAMA Internal Medicine, which coincides with a presentation of the study at the American Heart Association’s Scientific Sessions in Anaheim, Calif.

A typical clinical evaluation includes a medical history, physical exam, electrocardiogram and blood test for a protein that becomes elevated after the heart is damaged. In addition, many patients also are given a CT scan of the arteries that deliver blood to the heart or a cardiac stress test. A stress test measures heart function during exercise.

“Our study suggests that in the emergency room, stress testing and CT scans are unnecessary for evaluating chest pain in possible heart attack patients,” said cardiologist and senior author David L. Brown, MD, a professor of medicine. “Patients don’t do any better when given these additional tests. Our study is not a definitive randomized clinical trial, but it does suggest that we are over-testing and over-treating these patients.”

In recent years, Brown said doctors can more accurately diagnose heart attacks largely because of advances in the blood test that measures levels of a protein called troponin. High troponin levels signal injury to the heart.

“This troponin test is super-sensitive,” Brown said. “But earlier blood tests were much less accurate. A patient could be having a heart attack and these older tests often would come back normal. Doctors didn’t trust the tests, so they looked for other ways to evaluate the patient. CT scans and stress tests were among the methods used. But now that the blood testing method is so much better, there is less reason to continue doing these screening tests in the emergency room.”

The investigators evaluated data from 1,000 patients treated at nine medical centers across the country, including Washington University School of Medicine, that were a part of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) clinical trial. The current study revisited data from that trial, looking for any differences in outcomes for patients who received a clinical evaluation alone (118 patients) compared with those who received a clinical evaluation plus either a CT scan or a stress test (882 patients). In the study, 88 percent of patients received the extra testing. Nationwide, the overwhelming majority of patients evaluated for chest pain in the ER get such extra tests, Brown said.

During the nearly month-long follow-up period, there were no differences between the two groups in the percentages of patients that had a stent placed to open an artery, underwent coronary artery bypass surgery, returned to the emergency room or experienced a major cardiac event, such as heart attack.

While providing no clear health benefit to emergency room patients, the extra tests also led patients to stay in the hospital longer than may have been necessary and exposed them to radiation from testing that was not required to diagnose a heart attack. Length-of-stay for patients who received less testing was, on average, 20 hours compared with 28 hours for those who did receive either of the two additional tests.

The analysis also showed that, on average, a patient receiving more testing accrued $500 more in health-care costs during the ER visit. Patients who received more testing during the initial ER visit also received more follow-up tests, leading to $300 more in health-care costs for this group during the 28-day follow-up period. With 10 million patients coming to the ER for chest pain each year in the United States, these extra costs add up, according to the investigators.

“It’s important to keep in mind that CT scans and stress tests are used to diagnose coronary disease — whether someone has plaque in the arteries,” Brown said. “Many people have coronary plaque but are not having a heart attack.

“The goal of evaluating patients with chest pain in the ER is not to screen for coronary artery disease,” he said. “Anyone who goes to the ER for chest pain and gets sent home should make an appointment to see their primary care doctor to talk about their recent hospital visit. It’s important to follow up to see if additional testing is warranted because screening tests are not appropriate in this specific emergency situation.”

Source: Aggressive testing provides no benefit to patients in ER with chest pain | Washington University School of Medicine in St. Louis

Mark Zuckerberg says extent of opioid crisis was biggest surprise of US tour 

The “biggest surprise by far” from Mark Zuckerberg’s listening tour of America is the extent of the opioid crisis, the Facebook CEO said on Friday.

“It’s really saddening to see,” he said, referencing the 64,000 people who died from drug overdoses last year.

“That’s more people than died from Aids at the peak of the Aids epidemic. That’s more Americans that died in the whole of the Vietnam War. It’s more people than die of car accidents and gun violence I think combined, and it’s growing quickly,” he added.

Zuckerberg’s eyes welled up as he talked about his encounters with communities affected by the crisis. He described sitting down with a group of recovering heroin addicts in Dayton, Ohio, and hearing a woman say how when she was an addict her objective with shooting up was to get as close to death as she could without dying. He mentioned another man whose thought upon seeing his friend overdose was “I wonder who that guy’s dealer is because that must be really good stuff”.

“So this is like … just intense,” said Zuckerberg, speaking in a 50-minute Q&A at the University of Kansas.

Zuckerberg made his comments about opioid addiction the day after former Facebook president Sean Parker used the language of addiction to criticize the social network, stating that features such as the “like” button were designed to give users “a little dopamine hit”.

The Facebook CEO also highlighted the impact of opioid addiction on the broader community, including the strain on police resources and the employable workforce, referencing an Alabama shrimp fisherman who couldn’t find people to work on his boat because so many people were hooked on opioids.

The “good news”, he added, is that there is a roadmap for dealing with these kinds of crises – as demonstrated by France, which had its own opioid crisis in the 1990s and 2000s.

Zuckerberg and his wife Priscilla Chan have pledged billions to tackling disease through their philanthropic organization the Chan Zuckerberg Initiative. The Guardian contacted the organization to find out if it would be allocating any funds to tackling the opioid crisis, but received no response.

The tech CEO’s photogenic trip around 30 states in America to meet people in communities outside of his Silicon Valley bubble has led many to speculate that he plans to run for president – something the CEO and the company have repeatedly denied.


Source: Mark Zuckerberg says extent of opioid crisis was biggest surprise of US tour | Technology | The Guardian

Emergency action needed to protect ER patients- New Hampshire

We are extremely grateful to Dr. David Heller, medical director of the Emergency Department at Portsmouth Regional Hospital, for sounding the alarm about dangerous changes to health insurance coverage of emergency room services.

Effective Jan. 1, if you are insured by Anthem Blue Cross Blue Shield, the insurance company says it will deny coverage of services received in an emergency room if it turns out you didn’t need emergency care.

In a policy directive to all local hospitals, Anthem wrote: “Effective Jan. 1, 2018, if a member chooses to receive non-emergency care in a hospital emergency department when a more appropriate setting is available, the claim may be reviewed by an Anthem medical director and potentially denied. The member will be responsible for all charges incurred.”

So when you are feeling chest pains, you, as a non-medical professional, will need to decide whether you are really having a heart attack and therefore need to go to the ER, or whether it might be a muscle pull and therefore you’ll wait a bit because you can’t risk getting stuck with an expensive ER bill your insurance company refuses to cover.

“This sets us back many years when this was a standard insurance practice,” Heller told Seacoast Sunday. “A federal law was passed years ago called the ‘Prudent Layperson’ law that says if a prudent layperson feels that their medical condition is an emergency, they cannot be second-guessed by the insurance companies after the fact. This is a dangerous move on the part of insurance companies.”

While “Prudent Layperson” is a federal law, 47 states around the country have also implemented their own state laws to protect citizens from dangerous insurance billing practices. Unfortunately, New Hampshire is one of the three states without a prudent layperson law. We urge state lawmakers to correct this dangerous oversight as soon as possible.

Heller’s concerns are shared by ER doctors around the country.

“Health insurance companies are scaring people away from emergency departments, saying they will decide after the fact what is a real emergency,” said Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians (ACEP). “If your insurer disagrees with your decision to visit the ER, they may now refuse to pay. These new actions violate federal law and are dangerous, because people with identical symptoms — such as abdominal pain or chest pain — may either have a deadly medical condition or a non-urgent issue. Health insurers can’t expect patients to know the difference between a heart attack and something that is not life threatening.”

Heller notes that often symptoms that are not definitive emergencies, give warning about serious underlying medical conditions.

“People cannot be afraid to go to the hospital,” he said. “I am mortified by this. If a person has a rash, it could be less serious, but it could be indicative of Stevens-Johnson syndrome, meningococcemia, Kawasaki’s disease, toxic shock syndrome. I could go on. These are all rashes that are indicative of conditions that can kill you if not properly identified and treated quickly. This is a very bad move on the part of Anthem.”

Dr. Parker of the national emergency physicians organization voiced similar concerns.

“Nearly 2,000 diagnoses on the list, which Anthem BCBS considers to be ‘non-urgent,’ would not be covered if the patient goes to the emergency department. Some of these diagnoses are symptoms of medical emergencies. For example:

• ‘Chest pain on breathing’ can be a life-threatening pulmonary embolism.

• ‘Acute conjunctivitis,’ if caused by gonorrhea, can cause blindness.

• ‘Influenza,’ which has killed hundreds of thousands of people over the past century, can be an emergency. Thousands of people die from the flu each year.”

“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,” Parker said. “The vast majority of emergency patients seek care appropriately, according to the CDC and often times should have come to the ER sooner.”

Anthem is attempting to reduce costs and maximize profit by putting local lives in danger. New Hampshire needs to pass a prudent layperson law as soon as possible and the federal government needs to stop Anthem and other insurance companies from implementing billing practices that help their bottom line at the expense of public health.

Source: Emergency action needed to protect ER patients

St. Louis County releases first prescription drug monitoring report

Doctors write the equivalent of more than 1.5 prescriptions for controlled substances for every person in St. Louis County, according to the first report from the county’s new prescription drug monitoring program.

The report reflects data from the first three months of the program, which tracks prescriptions of opioid painkillers, muscle relaxants, stimulants and other legal drugs with a potential for abuse. There are 14 geographic areas from across Missouri in the report, which also includes St. Louis, St. Charles County, Lincoln County, Cole County and Kansas City.

Of the areas included, Lincoln County residents have the highest rates of controlled substance use, with a ratio of more than two prescriptions for every resident. St. Louis is on the lower end, with 1.2 prescriptions per resident. The report covers controlled substance prescriptions and refills that were filled from April through June 2017 at about 90 percent of pharmacies in the participating areas.

There isn’t enough data yet to make conclusions about Missourians’ use of controlled substances, but the program is working as intended to identify people who are at risk of prescription drug overdose, said Faisal Khan, director of the St. Louis County Department of Public Health.

“We want to continue to empower as many doctors and pharmacists as possible to use the system,” Khan said. “It’s time that Missouri caught up.”

Missouri was the last state to start a prescription drug monitoring program to target the national epidemic of painkiller abuse and overdoses. After the Legislature failed for years to pass bills that would create such a program, two separate drug monitoring efforts were announced this year.

The county health department established its program in April and invited other jurisdictions to participate. Doctors and pharmacists can access the database to check a patient’s prescribing history and watch for potential abuses. Now about 76 percent of the state’s population is covered by the 54 participating cities and counties, Khan said.

Meanwhile Gov. Eric Greitens signed an executive action in July to create a statewide prescription drug monitoring program. Unlike the typical format that tracks patient behaviors, the governor’s system would be primarily used by law enforcement and professional boards to identify doctors and clinics that overprescribe painkillers. The program has not started.

The county program gives pharmacists a new tool to identify people who may need the overdose-reversing treatment naloxone, said Amy Tiemeier, an associate professor at St. Louis College of Pharmacy who serves as an adviser to the program. There were more than 700 opioid overdose deaths — including prescription painkillers and heroin — in the St. Louis region in 2016, with the number expected to increase this year.

A study released Tuesday out of West Virginia raises questions about the effectiveness of prescription drug monitoring programs in reducing total opioid deaths. After the state’s monitoring program started in 2012, there was a marked decrease in prescriptions for painkillers, but more than a 200 percent increase in heroin overdoses. The added attention to prescriptions could be encouraging people to switch to illegal heroin use, although more research is needed, the study’s authors said.

Through the St. Louis County prescription database, pharmacists and doctors can look up a patient’s history to check for the drugs they have been prescribed, by which provider and in what amounts over a certain time period. Doctors can also check their own records to look for any fraudulent prescribing under their names.

Red flags could include multiple doctors, multiple pharmacies and high quantities of opioid painkillers that the patient is refilling at a quick pace. While there could be legitimate reasons for the prescribing behaviors, patients should be aware if they are at risk of overdose, Tiemeier said.

One potential problem identified in the report is the nearly three prescriptions for every woman older than 65 in St. Louis County. It is not uncommon for patients with arthritis or cancer to be prescribed a fast-acting painkiller, a longer-lasting painkiller and an anti-anxiety medication, which could explain the figures.

Still, Tiemeier said the numbers are concerning.

“We need to do some deeper digging to see where that’s coming from,” Tiemeier said. “Pharmacies have a huge opportunity to really impact mortality around the use of opioids.”

Source: St. Louis County releases first prescription drug monitoring report | Health |

Two Texas ERs got bad reviews online. Now they want Google to help them find out who did it

Two North Texas free-standing emergency room operators want tech giant Google to give up the identities of nearly two dozen reviewers who rated them poorly online.

Highland Park Emergency Center on Lemmon Avenue and Preston Hollow Emergency Room on Walnut Hill Lane filed a joint petition Tuesday in Dallas County District Court.

The 30-page pre-suit deposition lists the screen names used by 22 individuals, who the facilities claim never were treated in their emergency centers.

They want Google to share the users’ identities and the review site’s metadata in order to help with the investigation. Google could not immediately be reached for comment.

The petition was filed by Scott Yackey, a Dallas-based associate in the intellectual property group of the law firm Dykema Cox Smith. The firm has been contacted for more information.

Like other businesses, health care providers across the U.S. have been struggling to figure out how to manage online reviews.

It’s a particular challenge for the medical industry, as consumers often have little detail about costs or quality of care beforehand. Moreover, patients tend to enter the system under high-stress situations.

With more consumers turning to the web to seek out information about their doctors and medical facilities, health care businesses are more frequently having to address negative reviews posted on sites such as Facebook, RateMD, Healthgrades and Yelp.

Some have proactively set up their own websites to solicit patient feedback, while others respond to claims posted on existing sites. Some use the information to improve the patient experience.

And there are health care organizations that encourage as many patients as possible to share comments. It’s sort of a numbers game, said Alicia Daugherty,  who leads a team that researches market innovation, patient engagement and transparency for the Advisory Board.

“If they can make it easy for more patients to leave reviews, then their overall average tends to go up and the impact of negative reviews is less,” she explained.

Very few have turned to lawsuits. But they are starting to appear.

For example, in September, an Ohio plastic surgeon filed a defamation lawsuit against a Chicago woman who posted anonymous reviews on websites used by patients to swap information about doctors.

The woman claimed her problems got worse after surgery, but the surgeon claimed the reviews were “rife with false information,” reported The Wall Street Journal.

Generally speaking,  health care consultants say there are pros and cons to going the legal route.

One benefit is that it could deter fraudulent activity. The risks are that exposure might make it more widely known that an organization has negative reviews, or make patients uncomfortable.

“It’s difficult for businesses to actually know what happened if they don’t have a real name,” Daugherty said. “But in health care, people don’t want everyone to know what kinds of services they are receiving. There are patient privacy issues.”

In the petition filed Tuesday in the Dallas County court, Highland Park Emergency Center and Preston Hollow Emergency Room argued that Google reviewers who were never patients, or the guardians of patients, gave them one-star ratings and posted angry comments.

The reviews were probably posted by a third party “to defame and disparage” their businesses, they said.

In one example, a person wrote that although the care they received was timely and cordial, they were left with an $8,000 bill. In another, a reviewer referred to the business model as “extremely deceiving” and said patients get charged “an exorbitant amount of money” for simple procedures.  “Scam, scam, scam,” wrote another.

The emergency rooms said that their review of internal medical records did not identify patients with the names listed online. According to the petition, the facilities believe the reviewers were contracted or hired by a competitor in order to intentionally and fraudulently post  false  reviews to damage their reputations.

The ER operators said they often responded back, acknowledging the complaint, providing contact for billing, or asking the reviewer to confirm they have the correct facility.

That tends to be a good approach, said executives at the Binary Fountain, a Virginia-based group that helps health care organizations with patient experience and reputation management.

However, when it comes to negative reviews, the group has a “take it for what it is” philosophy, said executive vice president of strategy and corporate development Andrew Rainey.

Tracking down anonymous online identities is time-consuming and difficult, and the opposite direction of where health care is trending.

“I understand where they’re coming from. Online reviews do impact volume and perception,” added senior vice president of marketing, Aaron Clifford. The challenge health care facilities have is getting more happy consumers to speak up.

“It’s incumbent on the system to provide a good enough experience to the patient to that they’ll want to.”

While it remains to be seen how the request will play out, the concerns with free-standing emergency rooms has been in the public spotlight for some time.

It’s a relatively new health care model, one that has been growing rapidly in Texas. But the facilities’ out-of-network status with health insurers quickly led to consumer complaints.

And not just online.

For example, in January, a Colorado man filed a lawsuit against the largestoperator of free-standing emergency rooms, Lewisville-based Adeptus Health. The lawsuit claimed the company misled patients who could have been treated in lower-cost urgent care centers.

Source: Two Texas ERs got bad reviews online. Now they want Google to help them find out who did it | Health Care | Dallas News

HCA announces revenue increase, agreements to buy five Texas hospitals | Healthcare Dive

  • On its earnings call this week, HCA announced its revenues increased by 3.5% to $10.623 billion in the first quarter of 2017, which is up from $10.26 billion in the first quarter of last year.
  • HCA also announced recent acquisitions, including definitive agreements to purchase three Houston area hospitals from Tenet Healthcare and two Texas hospitals from Community Health System.
  • The health system said its 2017 guidance remains the same, including between $43 and $44 billion in revenues expected this year.

HCA Healthcare not only has a new name starting May 8, but it continues to add more hospitals.

During the earnings call, HCA officials said the health system is adding another five hospitals, including four in the Houston market: the 423-bed Houston Northwest Medical Center, the 171-bed Cypress Fairbanks Medical Center Hospital, the 444-bed Park Plaza Hospital and the 65-bed long-term acute care Plaza Specialty Hospital; and one in the San Antonio area: South Texas Regional Medical Center, a 67-bed hospital.

Those aren’t the only acquisitions for HCA. They are also buying a Georgia acute care hospital and hope to buy Memorial Hospital in Savannah, according to R. Milton Johnson, chairman and CEO of HCA Healthcare.

Johnson said the seven hospitals would add 2,000 beds and about $1.5 million in new annualized revenues to HCA Healthcare. HCA currently has 171 hospitals and 118 freestanding surgery centers in 20 states in the U.S and U.K.

Hospital M&A activity has continued to be on the increase with multiple transactions being announced amidst first quarter earnings reports.

Source: HCA announces revenue increase, agreements to buy five Texas hospitals | Healthcare Dive

Tenet sells 3 hospitals to HCA as it beats Q1 earnings expectations 

  • Tenet Healthcare said Monday it is selling three acute care hospitals in Texas to HCA Holdings in a $725 million deal expected to close in the third quarter of this year.
  • Tenet has also reached an agreement with Humana whereby all Tenet’s physicians will be phased back into Humana’s network by October. And it is increasing its ownership in ambulatory surgery center operator United Surgical Partners International to 80% by July 3.
  • The company also reported a smaller than expected $52 million net loss in continuing operations for the first quarter of 2017. This compares to a $55 million loss in the first quarter of 2016.

The hospital sales aren’t a surprise as Tenet, one of the largest for-profit hospital operators in the country, has been among many for-profit health systems looking to improve financials by offloading assets and easing debt burdens. CHS also announced divestures Monday, including the completion of nine hospital sales.

Tenet CEO Trevor Fetter said in an earnings call Tuesday the company’s focus is on reducing both complexity and leverage in order to “improve long-term economics of the company.” Hospital divestitures beyond the sales just announced can be expected, but will be smaller and cannot yet be announced, he said.

The new contract with Humana runs through May 2020. Tenet noted in a press release that the hospitals being added to Humana’s network “represent the majority of the revenue that Tenet previously generated from Human under its prior contractual relationship.”

Fetter said the greater share of USPI ownership lowers the amount of future capital that is pre-committed to the buy-up, which is expected to complete in July 2019 with Tenet owning 95% and a subsidiary of Baylor Scott & White Health with the remainder.

The buyer for the Texas hospitals, HCA, recently announced 2017 first quarter revenues of $10.6 billion and net income for the quarter at $659 million. The preliminary results were worse than Wall Street analysts had predicted, and HCA blamed that primarily on changes in the payer mix.

Source: Tenet sells 3 hospitals to HCA as it beats Q1 earnings expectations | Healthcare Dive

Columbia County sues drugmakers, distributors over opioid epidemic |

WILLIAMSPORT – Columbia County has joined other municipalities and states that have or are considering suing drug manufacturers contending they have been a contributing factor to the opioid crisis.

Its suit filed Thursday in U.S. Middle District Court comes one day after Luzerne County did the same thing. A number of counties are considering suits, according to the County Commissioners Association of Pennsylvania.

The 17 manufacturers and wholesale distributors named as defendants in the Columbia County suit are accused of engaging in false, deceptive and unfair marketing and/or the unlawful diversion of prescription opiate drugs.

The county claims the opioid epidemic is directly related to the misuse of pain medications.

The 210-page complaint states opiate drugs have been prescribed at a higher rate in Columbia County over the past five years than the national or Pennsylvania averages.

It cites documentation that in 2016 the prescription rate in the county was 80.7 per 100 people compared with the national and state averages of 66.5 and 69.5, respectively.

The result, according to the county, has been a high rate of hospitalization for drug overdoses and a rising death toll. There were eight drug-related deaths in 2014, 16 in 2015 and 18 in 2016, the suit states.

The county accuses the defendants of conducting a market scheme designed to persuade doctors and patients that opioids can and should be used for chronic pain.

That results in a broader group of patients who are more likely to become addicted, it claims.

The manufacturers have falsely touted the benefits of long-term opioid use even though there is no scientific reliable evidence to support those claims, the county charges.

Its suit seeks unspecified punitive damages and the following:

  • An injunction preventing the companies from engaging in the unlawful sales of prescription opioid pills.
  • Compensation for past and future costs to abate the public nuisance caused by opioid epidemic.
  • An order requiring the defendants to fund an “abatement fund.”
  • The cost of providing medical care and treatment for those suffering from opioid addiction and for infants born with opioid-related medical conditions.
  • Expenses incurred by law enforcement and public safety related to the opioid epidemic.

Source: Columbia County sues drugmakers, distributors over opioid epidemic |

Anthem makes patients question ER visits – INDIANAPOLIS

INDIANAPOLIS — Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room.

Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn’t an emergency and stuck her with a $4,110 bill.

 “How are you supposed to know that?” said the 34-year-old from Lexington, Kentucky. “I’m not a doctor … that’s what the emergency room is for.”

In an effort to curb unnecessary and costly ER visits, the Blue Cross-Blue Shield insurer has told customers in a few U.S. states to go to the hospital only in a real emergency such as a heart attack, stroke and major bleeding — or they could wind up footing the bill.

Anthem, the nation’s second-largest insurer, wants patients to consider alternatives like drugstore clinics, nurse advice hotlines or telemedicine. Insurers for years have been raising ER co-payments to try to deter unnecessary — and expensive — visits, and Anthem’s policy marks another round in this long-standing fight.

But some also worry that Anthem’s clampdown will scare patients away from the ER in an actual emergency, especially in cases where major problems may not seem serious at first.

“I think it’s completely unfair to patients,” said Dr. Jesse Pines, who teaches emergency medicine at George Washington University. “It runs the risk of really hurting some people.”

Customers in Missouri and Georgia received letters earlier this year from Anthem warning them that minor complaints should be checked out at places like clinics or urgent care centers, where visits can cost $85 and $190, respectively. By comparison, Anthem says a typical ER visit costs around $1,200.

The ER should be used “as it was designed — to treat life-threatening illness,” said Dr. Craig Samitt, Anthem’s chief clinical officer. “This is in no way meant to compromise a member’s determination of whether they’ve got an emergency.”

The push began in 2015 in Kentucky and will expand to Indiana next year and possibly other states that have seen a rise in unnecessary visits. Those involve “common medical ailments” that the average person knows should not be seen in an emergency room, according to Samitt.

There are many exceptions to the ER rule: Patients won’t get dinged when there isn’t an urgent care center nearby, if they need help on a Sunday or major holiday, if a doctor recommends going to the ER or if someone is under age 14.

Samitt also said Anthem isn’t simply rejecting every non-urgent ER claim it receives. The insurer has a physician review a case before issuing a denial, and will consider a patient’s circumstances. Anthem said it may cover a patient who arrives with chest pains that turn out to be indigestion instead of a heart attack.

However, hospital officials in Missouri say many of Anthem’s reviews haven’t been this thorough. The insurer has rejected some claims in only a couple days and hasn’t requested patient records before making a decision, said Daniel Landon, a senior vice president with the Missouri Hospital Association.

U.S. emergency department visits are expected to climb to around 150 million this year, up from 141.4 million in 2014. The rise is due partly to coverage expansions under the Affordable Care Act, an aging population and an increase in opioid overdoses, according to the American College of Emergency Physicians.

Other insurers also review ER use but not as aggressively as Anthem, said Laura Wooster of the emergency doctor group. The group has asked Anthem to stop immediately.

Anthem spokeswoman Joyzelle Davis said the insurer has met with representatives of the doctor group, but it has no plans to stop its program.

Anthem said it has seen a drop in unnecessary ER visits in Kentucky since it started its review there and has rejected only around 1 percent of all claims as avoidable.

In Wrenne’s case, the letter from Anthem said: “We do not believe that a person with an average knowledge of health and medicine would think that this needed care right away” to avoid a serious problem. The insurer said she could have been treated safely in a doctor’s office or clinic.

The hospital whittled Wrenne’s bill down to several hundred dollars. But now she’s nervous about using the ER again.

“It’s just frustrating to be a reasonable person and have to weigh the cost of … going to the ER or not because you have no idea what the bill would be,” she said.

Judy Kurtz also is worried about future emergency care. The 62-year-old Maysville, Kentucky, resident was hit with a $1,600 bill a couple years ago after the insurer rejected an ER visit.

A doctor had told her to seek emergency help after an antibiotic reaction made her throat and face swell. She said Anthem eventually paid the claim. But it took about a dozen phone calls and six months to get the insurer to change its mind.

The retired school teacher doesn’t want to go through that again and has set a high bar for going to the ER.

“It would have to be terribly life-threatening if I were to go,” Kurtz said. “I would probably have to be (unconscious) and someone would have to carry me out.”

Source: Is it an emergency? Insurer Anthem makes patients question ER visits | Star Tribune