Industry Payments to Physicians for Opioid Products, 2013–2015 | AJPH

Objectives. To identify payments that involved opioid products from the pharmaceutical industry to physicians.

Methods. We used the Open Payments program database from the Centers for Medicare and Medicaid Services to identify payments involving an opioid to physicians between August 2013 and December 2015. We used medians, interquartile ranges, and ranges as a result of heavily skewed distributions to examine payments according to opioid product, abuse-deterrent formulation, nature of payment, state, and physician specialty.

Results. During the study, 375 266 nonresearch opioid-related payments were made to 68 177 physicians, totaling $46 158 388. The top 1% of physicians received 82.5% of total payments in dollars. Abuse-deterrent formulations constituted 20.3% of total payments, and buprenorphine marketed for addiction treatment constituted 9.9%. Most payments were for speaking fees or honoraria (63.2% of all dollars), whereas food and beverage payments were the most frequent (93.9% of all payments). Physicians specializing in anesthesiology received the most in total annual payments (median = $50; interquartile range = $16–$151).

Conclusions. Approximately 1 in 12 US physicians received a payment involving an opioid during the 29-month study. These findings should prompt an examination of industry influences on opioid prescribing.

Source: Industry Payments to Physicians for Opioid Products, 2013–2015 | AJPH | Vol. 107 Issue 9

Posted in Industry Updates, Opioid Epidemic

Pilot program to reduce opioid deaths launches in Jacksonville, FL in October 

Jacksonville’s first pilot program aimed at reducing the city’s opioid overdose deaths should be operational by October.

Through early intervention and wrap-around services, the program aims to reduce overdoses, deaths and recidivism, according to Raymond Pomm, medical director at Gateway Community Services and River Region Human Services.

It is the only program of its kind in Florida — and those involved in its creation gleaned ideas from working models throughout the country.

St. Vincent’s Riverside partnered with Gateway and River Region to put the plan in place.

“Part of our mission is caring for the poor and the vulnerable, and people who have opioid addiction are definitely part of the vulnerable population,” said Huson Gilberstadt, St. Vincent’s HealthCare’s chief clinical officer and interim president of St. Vincent’s Riverside. “We are there to take care of the people who need us.”

After the program launches, those who overdose within St. Vincent’s coverage area will be offered the opportunity to join the program. Often, opioid-dependent individuals refuse treatment. The new pilot addresses that problem. A peer recovery specialist will contact the addict or the addict’s family to encourage treatment.

“Before this program, we had nothing,” Gilberstadt said. “When we discharge these patients, they are back on the streets within hours. … If we can save one person who would have gone back on the street and overdose and die, then we’ve done our job.”

Hopefully, with the program, returning to the streets won’t be an option.

After the patient is stabilized in the emergency room, the peer recovery specialist will discuss available treatment options: detox and possibly medicine-assisted treatment, residential inpatient treatment and outpatient services.

The specialist will drive them, if needed, to the available facility. The point is to avoid allowing the drug user the chance to relapse, Pomm said.

Right now, the program includes only patients within St. Vincent’s area — those it is capable of helping. Patients who overdose closer to Baptist Medical Center, UF Health or Memorial will still be taken to those hospitals.

After the six-month pilot ends, it can then be implemented across all of Jacksonville’s emergency rooms. According to Pomm, that implementation would not happen all at once.

There won’t be a shortage of patients.

In Florida, heroin deaths escalated to 779 in 2015, a 74 percent increase from the year before and a 2,400 percent increase from 2010. Locally, Jacksonville Fire and Rescue responded to 3,114 overdose victims last year — and is now transferring one overdose victim every two hours.

The need hasn’t gone unnoticed.

The City of Jacksonville voted in July to spend $1.5 million on the opioid pilot program, a decision made at the urging of City Councilman Bill Gulliford.

Gulliford has been responsible for organizing numerous Town Hall-style meetings to discuss the Jacksonville’s opioid epidemic.

“We have a long way to go to catch up with the way this epidemic is quadrupling each year,” Gilberstadt said. “There is not a walk of life that hasn’t been impacted. There’s almost someone in every family that has been impacted by the opioid crisis. … It will be nice to see if we can make an impact on some lives — and move in the right direction.”

Both Pomm and Gilberstadt say the pilot has turned all eyes toward Jacksonville. Other Florida cities want to know if the model works — and other hospitals within the Ascension network are already reaching out to Gilberstadt.

“We are definitely going to have an impact on lives,” he said.

Source: Pilot program to reduce opioid deaths launches in Jacksonville in October | Jacksonville News, Sports and Entertainment |

Posted in Industry Updates, Opioid Epidemic

ERs Can Improve Population Health in Rural Areas

 Emergency physicians in Michigan propose a new health care delivery model for rural populations that depends on a partnership between emergency medicine and primary care and seeks to reverse the trend of failing health in underserved parts of the country.  Their proposal was published online yesterday in Annals of Emergency Medicine (“An Emergency Medicine-Primary Care Partnership to Improve Rural Population Health: Expanding the Role of Emergency Medicine“).

“The traditional urban model of health care has been ineffective at improving rural health,” said the paper’s lead author Margaret Greenwood-Ericksen, MD, MPH of the Department of Emergency Medicine at the University of Michigan in Ann Arbor. “Our emergency medicine-primary care model embraces the role that emergency departments play in providing primary care in rural areas while also connecting patients to other physicians and resources in the community. Rural hospitals can serve as a hub for emergency care, primary and preventive care, and social services for improving rural population health.”

The model proposed by Dr. Greenwood-Ericksen would not replace the existing outpatient rural safety net, comprised of federally qualified health centers and rural health clinics. It would supplement it.

The paper cites Carolinas HealthCare System Anson in Wadesboro, N.C. as an example of a new rural hospital designed to provide both emergency and primary care, calling it “a test of a new model of rural health care delivery.” The final design has no physical walls separating emergency and primary care.

In other communities, similar partnerships could optimize emergency care, meet unscheduled acute care needs, address rural social determinants of health across the care continuum, achieve financial solvency and support public health.

“There is an urgent need for a rural-specific model of care aimed at improving the sharply declining health of rural Americans,” said Dr. Greenwood-Ericksen. “The partnership we propose is novel yet practical and acknowledges that an emergency department might be the closest source of health care for rural patients. Emergency medicine-primary care partnerships can address rural populations’ most pressing social and medical needs.”

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit

Source: ERs Can Improve Population Health in Rural Areas

Posted in Industry Updates, Providers Perspective

A new approach to rural healthcare

In healthcare, conventional wisdom holds that seeking treatment for a non-emergency condition in a hospital emergency room is both expensive and highly inefficient.

But a plan drafted by emergency physicians in Michigan turns that belief upside down, at least as far as rural communities are concerned.

Their study, published in the the “Annals of Emergency Medicine,” proposes a partnership between the ER and primary care providers to meet unique rural healthcare needs.

This partnership, the authors contend, could reverse the trend of failing health in underserved parts of the country.

Urban model ineffective

“The traditional urban model of health care has been ineffective at improving rural health,” said the paper’s lead author Dr. Margaret Greenwood-Ericksen, the paper’s lead author. “Our emergency medicine-primary care model embraces the role that emergency departments play in providing primary care in rural areas while also connecting patients to other physicians and resources in the community.”

Under the proposal, rural hospitals would serve as a hub for a full range of healthcare services, including emergency care, primary and preventive care, and social services for improving rural population health.

The new Carolinas Heathcare facility in Wadesboro, N.C., is cited as an example. The final design has no physical walls separating emergency and primary care. Rather, the two are integrated. The authors say it is a test of their new model of rural healthcare delivery.

Declining health

Greenwood-Ericksen says a different approach is needed because the health of rural Americans is declining.

“The partnership we propose is novel yet practical and acknowledges that an emergency department might be the closest source of health care for rural patients. Emergency medicine-primary care partnerships can address rural populations’ most pressing social and medical needs,” she said.

And with a smaller population surrounding it, a rural hospital ER likely has more capacity to treat non-emergency cases without creating the inefficiencies that could occur in an urban hospital ER.

In an urban ER, Blue Cross Blue Shield of North Carolina estimates a non-emergency patient waits an average of four hours to see a doctor, and the visit could cost an average of $1,200. It says a better alternative is an urgent care facility, which are common in cities and suburbs but are rare in rural areas.

Source: A new approach to rural healthcare

Posted in Industry Updates, Providers Perspective

Medical emergency: ER costs skyrocket, leaving patients in shock

  • Americans are being overcharged by more than $3 billion a year for ER services, according to data from Johns Hopkins School of Medicine.
  • Bills can be nearly 13 times the rates paid by Medicare for the same services.
  • Americans in the Southeast and Midwest, and poor and minority patients, are the most exploited by emergency-room billing practices, especially at for-profit hospitals.
No matter how advanced medical technology gets, for many patients modern health care begins in a hospital emergency room and ends with an unexpectedly huge bill.

On average, emergency-room bills for out-of-network care is 4.4 times higher than what Medicare allows for the same services, costing consumers more than $3 billion a year, according to a nationwide study by the Johns Hopkins School of Medicine, recently published in the Journal of the American Medical Association Internal Medicine.

Put another way, emergency medicine physician charges came to about $4 billion versus $898 million in Medicare allowable amounts. Overall, the study found that emergency departments are charging anywhere from 1.0–12.6 times ($100–$12,600) more than what Medicare pays for services.

The greatest disparities were for those who lack insurance or have to go to a facility that’s not in their health plan’s network. The biggest overcharges were made to poor and minority patients, and the biggest gaps between charges for Medicare and uninsured patients were at for-profit hospitals, mostly in the Southeast and Midwest, the study said.

The service with the highest median markup ratio? Wound closures, at 7.0, while interpreting head CT scans had the greatest within-hospital pricing variation, with markup ratios ranging between 1.6 and 27.

General internal medicine physicians had a markup rate, compared to Medicare pricing, less than half what is billed by ER physicians. For a physician review of an electrocardiogram, the median Medicare allowable rate is $16, but emergency departments charged anywhere from $18 to $317, with a median charge of $95 (or a markup ratio of 6.0), the Johns Hopkins study found. General internal medicine doctors in hospitals charged an average of $62 for the same service.

A problem that’s not going away

For the study, researchers analyzed the Medicare billing records for 12,337 emergency medicine physicians practicing in almost 300 hospitals in all 50 states in 2013 to determine how much emergency departments billed for services compared to the Medicare allowable amount (the sum of what Medicare pays, the deductible and coinsurance that patients pay, and the amount any third party such as the patient pays).

ER care may be the one place in the health system where consumers ask the fewest questions and get exploited on price the most, says Martin Makary, a Hopkins surgeon and professor of public health policy who was the lead investigator for the study.

“This is consistent with outlier stories we’ve always heard about seeking care out of network,” Makary said. “Generally, these patients feeling like they’re being treated as if they did something wrong. We can’t expect people to live within a local network bubble and never leave.”

“This is a huge problem. Consumers are being overcharged, sometimes exorbitantly.”-Jenifer Bosco, staff attorney at the National Consumer Law Center in Boston

The Johns Hopkins’ data tracks a troubling pattern when it comes to ER billing. Health policy journal Health Affairs found in a 2016 study that 1 in 5 inpatient emergency-room cases result in surprise bills. A Kaiser Family Foundation survey last year found that among insured, non-elderly adults struggling to pay medical bills, charges from out-of-network providers were a contributing factor one-third of the time. And 7 in 10 individuals with unaffordable out-of-network medical bills did found that the provider wasn’t in their plan’s network when they received care.

The surprise bills are not going away. One reason: An investigation last month by the New York Times, including work done by Yale University researchers, found that some hospitals are outsourcing emergency-room services to out-of-network doctors groups and for-profit companies that aggressively hike prices.

“This is a huge problem,” said Jenifer Bosco, staff attorney at the National Consumer Law Center in Boston. “Consumers are being overcharged, sometimes exorbitantly.”

How to prevent huge ER bills

The real questions for consumers are: What can they do to prevent overcharges? How can they fight back? What rights do they have that they may not know about?

The advice is slightly different for insured and uninsured patients, Bosco said. Families with incomes low enough to qualify for the Medicaid expansion or for Obamacare subsidies have rights that don’t always apply to wealthier patients.

Here are some key steps to protect yourself.

1. Get to a nonprofit hospital, if at all possible.

Depending on the emergency, this may not be practical, experts concede. But a provision of the Affordable Care Act, which wasn’t yet in force in 2013, requires nonprofit hospitals to have written financial assistance policies and to limit charges for those who qualify for financial assistance to no more than the rates generally paid by other insurers, usually the Medicare rate, said Marie Watteau, a spokeswoman for the American Hospital Association.

“Hospital payments will vary because they reflect each individual hospital and the unique care needs of the patient population it serves,” Watteau said in a statement. “One community may have sicker patients with more chronic illness, while another may care for more uninsured patients. Drawing information that is meaningful from a uniform set of charges is challenging because hospital care is individually tailored to each patient’s needs.”

For single Americans making $48,284 or less, or families with incomes below $92,000, this provision can limit the amount emergency rooms can charge, making a painful accident or illness hurt your wallet less. But for-profit hospitals aren’t covered by the provision, Bosco said.

2. Ask for financial counseling at the ER.

Hospitals routinely have this service available, and it can be the key to learning your rights. On top of the Obamacare provision covering nonprofit hospitals, Medicaid-eligible patients are able to apply for coverage up to 10 days retroactively, Bosco said. That can cover nearly all of the unexpected bills for patients who make less than Medicaid cutoffs, about $33,900 for a family of four. (The cap varies by state.)

In addition, a counselor can explain that the ACA requires that Obamacare plans cover out-of-network ER care without co-pays over and above what in-network ERs charge — it’s one of the essential health benefits the law requires subsidy-eligible plans to have. Most employer-provided plans have a similar provision.

3. After you get the bill, go back to the hospital or doctor and negotiate.

It’s well known that providers give insurers, both private and public, big breaks on quoted rates. Uninsured or out-of-network patients initially get billed at so-called chargemaster rates. But Makary and Bosco agree that hospitals will rarely dig in to get the full price when challenged. If they do, they risk getting nothing for their services, so they are likely to cut the price and negotiate a payment plan. In addition, hospitals are getting better about prominently posting their financial-assistance policies in ERs, Bosco said.

“It’s not a great solution,” Bosco said. “But patients with a low income can ask for the Medicare or Medicaid rate.”

— By Tim Mullaney, special to

Source: Medical emergency: ER costs skyrocket, leaving patients in shock

Posted in ER Billing, Industry Updates

80 Rural Hospital Closures: January 2010 – Present 

Rural Hospital Closures 2010-Current

Map ID
Medicare Payment
Closure Year
Number of Beds
80 East Texas Medical Center- Trinity Texas 7.2 Micro MDH 2017 45 None
79 Campbellton-Graceville Hospital Florida 7.1 Neither CAH 2017 25 None
78 Timberlands Hospital Texas 8.0 Neither SCH 2017 49 Outpatient/Primary Care/Rural Health Clinic
77 Copper Basin Medical Center Tennessee 10.1 Metro CAH 2017 21 Urgent or Emergency Care
76 Davie Medical Center- Mocksville North Carolina 7.1 Metro PPS 2017 10 None
75 Gulf Coast Medical Center Texas 7.1 Micro PPS 2016 94 None
74 Nix Community General Hospital Texas 7.0 Neither PPS 2016 18 None
73 Quitman County Hospital Mississippi 10.1 Neither CAH 2016 25 None
72 North Georgia Medical Center Georgia 7.0 Neither PPS 2016 40 Urgent or Emergency Care
71 Epic Medical Center Oklahoma 10.2 Neither MDH 2016 33 Urgent or Emergency Care
70 Tennova Healthcare- McNairy Regional Tennessee 7.0 Neither MDH 2016 26 None
69 Colusa Regional Medical Center California 7.1 Neither SCH 2016 42 None
68 Memorial Hospital & Physician Group Oklahoma 7.1 Neither SCH 2016 37 Outpatient/Primary Care/Rural Health Clinic
67 SoutheastHEALTH Center of Reynolds County Missouri 2.0 Neither CAH 2016 21 None
66 New Horizons Medical Center Kentucky 10.2 Neither CAH 2016 25 Outpatient/Primary Care/Rural Health Clinic
65 Westlake Regional Hospital Kentucky 7.0 Neither MDH 2016 49 Urgent or Emergency Care
64 Southern Palmetto Hospital South Carolina 7.1 Neither SCH 2016 30 None
63 St. Mary’s Hospital Illinois 4.0 Micro PPS 2016 94 Urgent or Emergency Care
62 Albany Area Hospital Minnesota 2.0 Metro CAH 2015 17 None
61 Pioneer Community Hospital of Newton Mississippi 7.0 Neither CAH 2015 21 None
60 Merit Health Natchez-Community Campus Mississippi 4.0 Micro PPS 2015 101 None
59 Southern Maine Health Care- Sanford Medical Center Maine 4.1 Metro PPS 2015 46 Urgent or Emergency Care
58 Mercy Hospital Independence Kansas 7.2 Micro PPS 2015 41 None
57 Nye Regional Medical Center Nevada 5.0 Micro SCH 2015 10 None
56 Parkland Health Center- Weber Rd Missouri 4.1 Micro RRC 2015 98 None
55 Cochise Regional Hospital Arizona 4.0 Metro CAH 2015 25 None
54 United Regional Medical Center Tennessee 4.0 Micro PPS 2015 53 None
53 Parkview Adventist Medical Center Maine 4.1 Metro PPS 2015 55 Urgent or Emergency Care
52 Hunt Regional Community Hospital of Commerce Texas 7.2 Metro CAH 2015 24 None
51 Yadkin Valley Community Hospital North Carolina 2.0 Metro CAH 2015 15 None
50 Marlboro Park Hospital South Carolina 4.0 Micro PPS 2015 94 None
49 Parkridge West Hospital Tennessee 7.1 Metro PPS 2015 50 Urgent or Emergency Care
48 Parkway Regional Hospital Kentucky 7.2 Micro PPS 2015 48 None
47 Kilmichael Hospital Mississippi 8 Neither MDH 2015 19 Outpatient/Primary Care/Rural Health Clinic
46 East Texas Medical Center- Mount Vernon Texas 9 Neither MDH 2014 49 Outpatient/Primary Care/Rural Health Clinic
45 East Texas Medical Center- Clarksville Texas 7.2 Neither MDH 2014 30 None
44 East Texas Medical Center- Gilmer Texas 7.1 Metro PPS 2014 37 Outpatient/Primary Care/Rural Health Clinic
43 Doctors Hospital of Nelsonville Ohio 7.2 Micro CAH 2014 25 Urgent or Emergency Care
42 Sac-Osage Hospital Missouri 9 Neither SCH 2014 47 None
41 Haywood Park Community Hospital Tennessee 7.1 Neither DSH 2014 36 None
40 Lower Oconee Community Hospital Georgia 10.2 Neither CAH 2014 25 None
39 Tilden Community Hospital Nebraska 10.2 Neither CAH 2014 20 Outpatient/Primary Care/Rural Health Clinic
38 Vidant Pungo Hospital North Carolina 10.2 Micro CAH 2014 25 None
37 Mid-Valley Hospital Pennsylvania 1 Metro CAH 2014 25 Urgent or Emergency Care
36 Nicholas County Hospital Kentucky 10.2 Neither CAH 2014 16 None
35 Good Shepherd Medical Center Texas 10.1 Neither CAH 2014 25 None
34 North Adams Regional Hospital Massachusetts 4.1 Metro MDH 2014 98 Urgent or Emergency Care
33 Lake Whitney Medical Center Texas 10.1 Neither MDH 2014 49 None
32 Gibson General Hospital Tennessee 7 Neither MDH 2014 41 Urgent or Emergency Care
31 Humboldt General Hospital Tennessee 7.1 Neither PPS 2014 42 Urgent or Emergency Care
30 Florala Memorial Hospital Alabama 3 Neither PPS 2013 22 Outpatient/Primary Care/Rural Health Clinic
29 Starr Regional Medical Center-Etowah Tennessee 7.2 Micro MDH 2013 60 Urgent or Emergency Care
28 Wise Regional Health System-Bridgeport Texas 7.0 Metro PPS 2013 35 Urgent or Emergency Care
27 St. Andrews Hospital Maine 10 Neither CAH 2013 25 Urgent or Emergency Care
26 Blowing Rock Hospital North Carolina 10.1 Micro CAH 2013 25 Nursing or Rehabilitation Facility
25 Lee Regional Medical Center Virginia 10.1 Neither MDH 2013 70 None
24 Charlton Memorial Hospital Georgia 2 Neither CAH 2013 15 None
23 Patient’s Choice Medical Center of Humphreys County Mississippi 7.2 Neither CAH 2013 25 None
22 Shelby Regional Medical Center Texas 7.2 Neither PPS 2013 54 None
22 Corcoran District Hospital California 4.1 Metro PPS 2013 32 Outpatient/Primary Care/Rural Health Clinic
20 Calhoun Mem Hospital Georgia 2 Neither CAH 2013 25 None
19 Stewart-Webster Hospital Georgia 10.1 Neither CAH 2013 25 None
18 Elba General Hospital Alabama 10.2 Micro MDH 2013 20 Nursing or Rehabilitation Facility
17 Renaissance Hospital Terrell Texas 4.1 Metro PPS 2013 106 None
16 Chilton Medical Center Alabama 7.1 Metro PPS 2012 27 None
15 Muskogee Community Hospital Oklahoma 4 Micro PPS 2012 45 Outpatient/Primary Care/Rural Health Clinic
14 Florence Community Healthcare Arizona 4.1 Metro CAH 2012 25 None
13 Hart County Hospital Georgia 7 Neither MDH 2012 82 None
12 Cheboygan Memorial Hospital Mchigan 7 Neither CAH 2012 25 Urgent or Emergency Care
11 Saint Catherine Medical Center Fountain Springs Pennsylvania 7.2 Micro PPS 2012 53 None
10 Bamberg County Memorial Hospital South Carolina 7.2 Neither PPS 2012 59 None
9 Physicians Choice Hospital-Fremont Ohio 4 Micro PPS 2012 8 None
8 Hualapai Mountain Medical Center Arizona 4 Metro PPS 2011 70 Nursing or Rehabilitation Facility
7 SouthWest Alabama Medical Center Alabama 7.1 Neither PPS 2011 27 None
6 Central Kansas Medical Center Kansas 4 Micro Re-based SCH 2011 41 Outpatient/Primary Care/Rural Health Clinic
5 Randolph Medical Center Alabama 7.2 Neither CAH 2011 12 None
4 Franciscan Skemp Medical Center Wisconsin 7 Neither CAH 2011 25 Outpatient/Primary Care/Rural Health Clinic
3 Lakeside Medical Center Minnesota 7.1 Neither PPS 2010 10 Nursing or Rehabilitation Facility
2 Holy Infant Hospital South Dakota 10 Neither Re-based SCH 2010 22 Outpatient/Primary Care/Rural Health Clinic

Source: 80 Rural Hospital Closures: January 2010 – Present – Sheps Center

Posted in Industry Updates, TX Hospitals

As rural hospitals close, millions of Americas live nowhere near an emergency room

As a nurse practitioner, Wanda Liddell knew it was a medical emergency when she saw one of her patients struggling to breathe last month. But in her backcountry town of Cross City, Florida, the ambulance took 30 minutes to arrive. Even worse, it was another 45 miles to the nearest hospital.

Liddell faces this situation often and always wonders, what if?
She is one of many medical providers working in towns 30 miles or more from a hospital, a distance that can make the difference between life or death.
 The recent debates over the Affordable Health Care Act raised concerns that millions of Americans could lose access to health care. But already, there are many Americans who live in areas where critical-care services are lacking.
A recent study estimates that nearly 30 million Americans don’t live within an hour of trauma care. And a CNN analysis found that residents living in 16% of the mainland United States are 30 miles or more away from the nearest hospital.
Dr. Jeremy Brown, director of the National Institute of Health’s Office of Emergency Care Research, said treatments for heart attacks and strokes are most effective when done quickly.
“Every minute that you can get the patient into treatment sooner will represent some brain cells that are saved,” he said.
In fact, the rate of accidental deaths — adjusted for age — was nearly 50% higher in rural versus urban areas from 1999 to 2015, according to data from the Centers for Disease Control and Prevention. The CDC says distance to emergency rooms was a key factor.
The problem has been exacerbated as rural hospitals struggle to stay open. Since 2010, 81 rural hospitals have closed in the United States, according to a rural health research program at the University of North Carolina. Another 673 rural hospitals are vulnerable to shutting down.
Areas without hospitals are called “hospital deserts.” The deserts are biggest in Western states. In Nevada, for instance, there are only 13 hospitals providing critical-care services to rural areas.
The 2,400 residents of Tonopah, Nevada, who live halfway between Las Vegas and Reno, must travel more than 100 miles to get to a hospital. It was one of the most extreme examples that CNN found outside of Alaska.
Jessica Thompson, a registered nurse there, has family roots in the community dating back more than a century.
“I’ve been told multiple times that’s what I get for (choosing) to live in rural Nevada and that really upsets me, because that isn’t the choice I made. I was born in a hospital and I had a hospital my entire life up until two years ago,” she said.
Thompson worked at the hospital before it closed. She said the loss of the hospital was devastating, evoking lots of emotion.
“People angry, people sad, people scared,” she said. “You know the fear of, ‘Will I make it to another facility if something bad happens?’ “
Irene Carlyle said she and her husband moved from Los Angeles in 2005, hoping to stay in Tonopah. But now she doesn’t know if that will happen.
“We’re both on Medicare,” she said. “I said (to my husband), ‘You know, at some point, we’re going to have to move.’ It’s going to come. I mean at some point you get sick.”
Last year, the nonprofit Renown Medical Group began leasing space to provide primary care services, but for now, there are no immediate urgent care options.
Other parts of the country are dealing with similar problems, including pockets of Florida, Texas and New York.
The closed Nye Regional Medical Center is seen on Friday, Nov. 18, 2016, in Tonopah, Nevada.

A report last year by the Henry J. Kaiser Family Foundation predicts that the problem will worsen as more rural hospitals are likely to shut down. This is in part because rural towns are losing population and becoming poorer.
Republican hopes to repeal and replace Obamacare could make the problem much worse, experts say, if millions of American lose their health insurance. That would put even more pressure on rural hospitals.
Some in Congress have proposed efforts to try to save rural hospitals. A bipartisan group of senators led by Iowa Republican Charles Grassley introduced a bill that would change Medicare rules to allow rural hospitals to have an emergency room and outpatient care, without the need for hospital beds.
“A car accident or a heart attack is dangerous under the best of circumstances, but it’s a lot more dangerous for someone who’s far away from an emergency room,” Grassley said. “When a rural hospital closes, its emergency room closes with it.”
Join the conversation

Thompson, the nurse in Tonopah, believes something needs to be done.

“There’s a lot of people out in the rural community who feel like they’ve been forgotten,” she said.

Source: As rural hospitals close, millions of Americas live nowhere near an emergency room. – CNN

Posted in Industry Updates, TX Hospitals

ER imposes limits, guidelines in battle against opioid addiction 

Starting Tuesday, the Emergency Room at Advocate Sherman Hospital in Elgin and its satellite emergency care facilities throughout the area will begin enforcing strict guidelines for use of various opioid painkillers, hospital officials said Monday.

With the guidelines in place, staff will not be prescribing long-acting opioid painkillers, won’t be giving more than a short dose of opioid painkillers and won’t be refilling lost, stolen or destroyed prescriptions. Emergency room caregivers will not be using the powerful painkiller Dilaudid, except for cases involving cancer patients or bad traumas.

The effort is in part based upon what already is taking place at Advocate Good Samaritan Hospital in Downers Grove, Advocate Sherman Public Affairs and Marketing Manager Jennifer Benson said.

“What led to this is concern with the nation’s opioid epidemic,” Emergency Medicine Dr. Christopher Frantz said.

Advocate Sherman Pharmacy Clinical Manager Paul Drahos said that Dilaudid is up to ten times more potent than morphine and provides a mild euphoria to those taking it.

Signs ER staff members have been noticing can be clues someone is coming to the emergency room specifically to feed an opioid habit, Sherman emergency room officials said.

For instance, when a patient specifically asks to push the Dilaudid into their system by injection, undiluted and asks for Benadryl, that’s a red flag, Drahos said. Another concern is when a patient claims to be allergic to other painkillers.

Emergency Department Manager and nurse Kristy Sheehan said such patients are told to fill out police reports and referred to their primary care physician for a copy of the original prescription for refilling.

Emergency room workers also are seeing a rise in recent years in the number of people who claim to be new to the area or who present false credentials in the hopes of getting painkillers. Ortega and the others also noted a rise in the number of phone calls to the ER related to painkillers and asking who is on duty, presumably in the hopes of getting a doctor who hasn’t seen them before. Others with painkiller addiction issues have been periodically peering into the ER windows to see who is on duty, Ortega said.

Sheehan noted that when alternatives to Dilaudid or opioids are discussed with people who may have addiction issues they tend to leave the ER instead of saying, sure let’s try that.

“We’re seeing people with opioid addiction issues from all walks of life,” Ortega said.

Sheehan said Advocate Sherman also is working with area physicians on a Complex Patient Program, looking for ways to assist with patients who make multiple visits to the ER instead of visiting their primary care doctor. Most of these patients are dealing with chronic pain issues, Sheehan said.

Ortega noted a June report from the Illinois Department of Health that points to how widespread the opioid abuse problem is.

The Department’s data shows 2,278 drug-related overdose deaths during 2016, which is a 44.3 percent increase over the 1,579 drug-related overdose deaths that were reported by the Department for 2013.

Of the statewide drug overdose deaths during 2016, more than 80 percent (1,826) were opioid-related. The opioid-related overdose deaths in 2016 represented an increase of more than 70 percent compared to 2013 numbers, and a 32.1 percent increase over the 1,382 opioid-related overdose deaths that were reported in 2015.

Sherman hospital officials have not yet determined whether signs alerting patients to the new guidelines will be posted. Hospital officials in some other states said they are required to take an approach that avoids discouraging people from getting care, said Emergency Room Physician Dr. Ryan Stanton in Lexington, Kentucky.

Stanton said interpretation of the federal Emergency Medical Treatment and Labor Act by regional offices of the Centers for Medicare and Medicaid Services in Kentucky and some other states prohibits some signage. That’s why Kentucky hospitals post guidelines inside cabinets and show them to patients after a consultation, he said.

Emergency rooms in Kentucky also are not allowed to treat chronic pain, and can only prescribe a 3-day supply of painkillers for injuries such as sprained ankles, he said. They also cannot use any long-acting painkillers, he said.

Emergency Medicine Doctor Jennifer Stankus of Olympia, Wash., said guidelines also are posted inside cabinets, similar to Kentucky.

“We also have strict monitoring of prescriptions in Washington,” Stankus said.

In Lubbock, Texas, Emergency Medicine Doctor Juan Fitz said many hospitals in that area work together and are not providing Dilaudid or Demerol.

Locally, Northwestern Medicine Senior Media Relations Specialist Kim Waterman said that that Delnor Hospital in Geneva and other hospitals with Northwestern have no strict protocols in place similar to Sherman’s guidelines but look at use of pain medication on a case-by-case basis, with a focus on reducing the use of narcotics.

Officials from Presence Saint Joseph Hospital in Elgin could not be reached for comment Monday.

Posted in Industry Updates, Opioid Epidemic

Cuero hospital’s emergency department to move for renovations

Beginning Monday, Cuero Regional Hospital will temporarily relocate its emergency department to the front of the hospital so the current emergency department can undergo renovations.

This temporary emergency department area will be where the day surgery unit is now. To get there, turn left at the switchboard and go down the hall. Directional signs will be in place, and the switchboard will be staffed 24 hours a day to help patients locate the department or any other hospital department, according to a news release from the hospital.

All emergency patients will use the hospital’s front parking lot and enter through the main, front entrance.

When completed the emergency department will have six private patient rooms, an enlarged waiting room space, more private patient registration areas, and an upgraded nurse’s station to improve patient flow, according to the news release.

The day surgery unit has been temporarily moved to the second floor.

The day surgery unit, where the emergency department will be housed, features five private patient rooms and a waiting area.

When the emergency department renovation is complete, the day surgery department will move back to the first floor.

Source: Cuero hospital’s emergency department to move for renovations – Victoria Advocate – Victoria, TX

Posted in Industry Updates, TX Hospitals

In Ontario, Paramedics linking with ER docs could mean treatment at home

When Simcoe County Paramedic Services director Andrew Robert looks at your living room, he can see a virtual emergency room.

And under the advice from the Sunnybrook Centre for Prehospital Medicine’s Dr. Paul Hoogeveen, the county’s head paramedic is asking for $1.2 million in start-up funding for a new, alternate pathway program, along with ongoing funds of $263,557 per year.

Thanks to technology, paramedics can connect with emergency room physicians to assess, and sometimes treat, patients right where they are, he said, which will save time, enable paramedics to go to other calls and reduce demand in hospital emergency rooms.

“The Ontario Telemedicine Network is like FaceTime on steroids. You can use a device to link up to a digital stethoscope,” said Robert.

“You’re dizzy and not feeling well and you call 911. We’d do an assessment. Maybe you’d fit the protocol to be assessed at home. The doctor in emerg would hear your breath sounds and heart sounds. We even have an audioscope (to look in your ears).”

Those devices enable the doctor to determine you have an ear infection, so the paramedic creates a script for medicine, as determined by the doctor, and sends it directly to the pharmacy, he said as he described a scenario that could become more and more common as the baby boom generation ages.

“It all takes half the time of taking you to the hospital. It’s a more efficient way of dealing with 911 calls,” said Robert.

“We’re hoping for funding. It’s in alignment with the (province’s) Patients First plan for Ontario, the right care for the right patient at the right time.”

Robert said some people call 911 for help because they don’t have a family doctor or struggle with transportation challenges. This program would not only get them the help they need quicker, it would be less disruptive and avoid them to have to get home after a time-consuming hospital visit.

“It’s not being done in Ontario right now, so we’d like to do a pilot program,” he added, with the $1.2 million being invested in staff training and additional equipment, such as that for blood testing.

Should it receive Ministry of Health and Long-term Care financial support, the pilot program would train 20 front-line paramedics, who would work in five, as-yet unidentified communities in the county.

“We’re looking at more opportunities to be efficient with resources by helping and managing people in their homes. We call it the ‘silver tsunami’. People age 65 and older use us more than those who are younger,” said Robert.

“As the baby boomers (age), it’s impacting health care.”


Source: Paramedics linking with ER docs could mean treatment at home –

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