Cheap, fast test for Zika and dengue could cost just $1

A new blood test can cheaply and quickly distinguish between the mosquito-borne Zika and dengue viruses, researchers reported Wednesday, giving public health officials a valuable tool to track the spread of outbreaks and prepare for the possible consequences of the different infections.

The test, which was described in the journal Science Translational Medicine, relies on a simple paper strip, and researchers hope it can eventually be purchased for less than $1. The scientists who developed the test are at work to commercialize it and production would need to be scaled up before it could be deployed widely.

Knowing which disease is spreading in an area is crucial for public health responses and research. But the Zika-dengue distinction is all the more important because Zika, unlike dengue, can cause severe birth defects and can be transmitted through sex, meaning it is vital for pregnant women to know which virus they have and for their sexual partners to identify their infections as well.

The problem is that Zika and dengue are similar; with some tests, the viruses “cross-react,” meaning that a dengue sample might produce a positive Zika test. They also trigger similar symptoms, including fever, headaches, and body pain. Samples often need to be sent to state labs to confirm the infection, which is expensive, time-consuming, and not realistic on a mass scale. That made it challenging to accurately track the recent Zika outbreak as it swept through South and Central America.

A 15-minute test 

The new test exploits a quirk in how the viruses affect the body. Zika and the four strains of dengue each cause infected cells to release a slightly different version of a protein called NS1.

For the test, antibodies that can uniquely identify those specific Zika or dengue NS1 proteins are embedded onto a paper strip, along with gold nanoparticles. The end result is that if the virus is present in the sample, a red dot will appear on the strip.

The test works best when analyzing serum — a component of blood that can be easily separated out in health clinics — but the researchers said it should also work on blood samples.

“All you do is mix the serum with a solution and you dunk a paper strip into it,” said Kimberly Hamad-Schifferli, an engineer at the University of Massachusetts, Boston, and visiting scientist at the Massachusetts Institute of Technology, who helped lead the research. “You wait 15 minutes and you look for the appearance of a colored dot.”

The Zika test accurately identified infections in 81 percent of positive samples and incorrectly identified an infection in negative samples 14 percent of the time.

The test can also differentiate among the four strains of dengue. Getting infected with one strain, or serotype, doesn’t protect someone from contracting another strain later on, and those multiple infections increase the risk that the person will develop a much more severe illness called dengue hemorrhagic fever.

“Being able to distinguish the four serotypes is very important for epidemiology purposes and to know what viruses are circulating in an environment,” said Lee Gehrke, an engineer at MIT and one of the leaders of the research.

Currently, each paper strip is built to pick up on only one virus, so it would require five different versions to identify exactly what virus was causing an infection. But the researchers said they’re exploring how they could compile all five tests into one strip.

Nikos Vasilakis, a Zika expert at the University of Texas Medical Branch at Galveston who was not involved in developing the test, said the test’s cost and the simplicity could make it a widely used tool in the parts of the world where these viruses circulate. The cost per strip now is in the $5 range, but the researchers said they expect that to drop with scaled-up production.

“The test will be in a single dollar range, which is the biggest advantage in a resource-poor countries,” Vasilakis said. “The other advantage is that it’s very easy to use.”

The researchers traveled to places in Central and South America and India to validate their test on samples from patients with confirmed infections. The paper’s long list of authors includes many scientists from those countries who helped the researchers secure samples for testing.

The number of new Zika cases has dwindled since the major outbreak in the Americas in 2015 and 2016, but experts anticipate future outbreaks. The researchers also said they plan to apply the platform they used to build the Zika and dengue test to come up with diagnostic tests for other viruses.

Source: Cheap, fast test for Zika and dengue could cost just $1

Posted in Industry Updates, Zika Virus in U.S.

Cortland hospital may team up with Pennsylvania health system

SYRACUSE, N.Y. – Dr. Ross Sullivan used to tell heroin and painkiller overdose patients in Upstate University Hospital’s emergency room to stop using drugs and go to local addiction treatment programs for help.

Sullivan quickly learned that approach didn’t work because the wait to get into rehab took months, too long for people hooked on opioids to stay off drugs. Most patients would leave the ER and use heroin and other opioids again as soon as possible to ease the agony of withdrawal.

So last year Sullivan started his own clinic in the ER to provide addicts with short-term prescriptions of Suboxone, a brand-name version of the drug buprenorphine that eases cravings and withdrawal symptoms. The clinic tides patients over until they get into a rehab program or find a doctor in the community who prescribes Suboxone. The clinic has seen more than 175 patients so far and has steered about 80 percent of them to treatment in the community.

No other ER in Syracuse and few nationwide are doing this. Not many emergency medicine doctors are trained in addiction medicine like Sullivan, even though the growing opioid epidemic has become the worst drug crisis in U.S. history. Only 158 – less than 1 percent – of the nation’s 35,000 board-certified emergency medicine physicians are also certified in addiction medicine.

“The more you can engage them in the ER, the better chance we have to keep them alive and help them,” Sullivan says.

Frank Panico, left, was one of the first patients treated in an addiction clinic started by Dr. Ross Sullivan, right, in Upstate's emergency room.
Frank Panico, left, was one of the first patients treated in an addiction clinic started by Dr. Ross Sullivan, right, in Upstate’s emergency room.

Frank Panico, 59, of Syracuse, was one of the clinic’s first patients. The painting contractor injected heroin for nearly 30 years and says he would be dead were it not for Sullivan. He overdosed twice and was revived both times with naloxone, the overdose-reversing drug, by ambulance crews.

Panico contacted rehab programs a few times, but did not follow through after learning he’d have to wait a month to get in.

‘Roller coaster ride through hell’

Panico went to Sullivan for help after another addict he met at the Syracuse Rescue Mission told him about the doctor. Panico had just lost his job, his wife and been evicted from his home.

“I was on the street with nothing and I had to get myself help or die,” he says. “I was at the point where I wasn’t doing it (heroin) to get high, I was doing it just to function. It was like a roller coaster ride through hell.”

After Sullivan got him started on Suboxone, Panico got addiction treatment through Syracuse Behavioral Healthcare.

He’s been clean since Aug. 2, 2016.

The only local program similar to Sullivan’s is ACR Health’s outpatient clinic for injection drug users at 627 W. Genesee St. That clinic recently began providing short-term Suboxone prescriptions to opioid addicts waiting to get into treatment.

Treating addiction like any other chronic disease

Few hospital emergency rooms offer this type of treatment because emergency medicine doctors under federal law cannot give Suboxone to patients for more than 72 hours to treat withdrawal. Sullivan is not subject to that limitation because in addition to being an emergency medicine doctor, he’s certified in addiction medicine and federally-licensed to prescribe Suboxone.

Dr. Gail D’Onofrio, head of emergency medicine at Yale Medical School and an advocate of using medication in ERs to start addiction treatment, says emergency physicians like Sullivan who are trained in addiction medicine are “rarer than hen’s teeth.”

D’Onofrio, who is also certified in addiction medicine, co-authored a study published earlier this year that found patients started on medication in the ER to reduce cravings are more likely to receive addiction treatment and reduce opioid use long term.

Doctors should be able to start people with opioid addictions on medication like Suboxone in ERs the same way they treat other patients who come in with high blood pressure, diabetes and other chronic diseases, D’Onofrio says.

“It’s not usually what we do as emergency physicians,” she says. “We are great at saving lives in overdose events, but then we don’t continue it.”

NY wants to replicate Upstate program

Programs like Sullivan’s are helping reinvent the way ER doctors treat patients with opioid addictions, she says.

The New York State Office of Alcoholism and Substance Abuse Services is enthusiastic about Sullivan’s clinic.

“We are interested in exploring ways to expand and replicate innovative concepts like this throughout the state,” the agency said in a prepared statement.

In order for ER-initiated addiction treatment to lead to long-term benefits, there has to be enough treatment programs available in the community to provide follow-up care for addiction patients.

Sullivan says there’s not enough drug treatment available in the Syracuse area. But the shortage has eased a bit as some programs have expanded and more doctors have been trained and licensed to prescribe Suboxone, he says.

Maria Sweeney, a peer engagement specialist, works with Sullivan to help patients find treatment, support groups, health insurance, jobs, food stamps and housing. Thirty percent of the clinic’s patients are homeless.

Meeting patients in Rescue Mission or jail

After patients leave the hospital, Sweeney meets them at the Rescue Mission, the Onondaga County Justice Center or wherever else they end up to help them on the road to recovery. She works closely with case managers from addiction treatment centers, shelters and other agencies.

Patients must come to Sullivan’s clinic weekly for urine drug tests. The clinic also requires patients to be evaluated by a treatment program.

Sullivan says the clinic is a place where patients “can take a deep breath and set themselves up in a treatment center.”

“All they need is a prescription and someone who cares so they don’t have to go out and get heroin,” he says.

Terry Green, 54, of Syracuse, ended up in Upstate’s ER after overdosing on heroin Sept. 4, 2016 in Rose Hill Cemetery on the city’s North Side.

Grandmother overdosed in cemetery

Green, who has seven children and six grandchildren, became an addict when she began taking her husband’s Oxycontin, a prescription painkiller. After her husband died, Green switched to heroin because she couldn’t afford to buy Oxycontin on the street. Before long she was snorting about 10 bags of heroin daily. She paid $5 a bag.

Green’s adult children cut her off because they feared she would steal from them and did not want her around their kids. She ended up homeless, sleeping in shelters and on park benches. To support her drug habit, she shoplifted sneakers and other items, then sold them on the street.

At Upstate’s ER, Green was given a dose of Suboxone and told about Sullivan’s clinic. She made an appointment and saw Sullivan two days later. He began prescribing Suboxone and the clinic helped her get treatment at Syracuse Behavioral Healthcare.

Green hasn’t used heroin, which she calls “the devil,” since the overdose.

She has mended fences with her family and now lives with her daughter and grandchild.

“Nobody wants to wait a month for help,” she says. “That’s why there are so many people dying and overdosing.”

Source: Cortland hospital may team up with Pennsylvania health system

Posted in Industry Updates, Opioid Epidemic

New law seeks to prevent surprise medical bills from freestanding ERs

Patients who visit freestanding emergency rooms in Texas should now have a better idea of whether their health insurance will cover the bill.

A new state law that took effect Sept. 1 requires the facilities — which resemble urgent care clinics but often charge hospital emergency room prices — to post notice of what, if any, insurance networks they’re in.

The new law is about “protecting consumers,” said Jamie Dudensing, chief executive officer of the Texas Association of Health Plans. Meant to prevent patients from surprising — and often debilitating — medical bills, freestanding ERs can comply with the new rules by posting the insurance information on their websites, as long as written confirmation is also provided to patients.

“We take educating patients very seriously,” said Brad Shields, executive director of the Texas Association of Freestanding Emergency Centers, which represents such facilities in Texas.

In 2009, Texas became the first state to permit freestanding ERs, facilities independent of hospitals that provide acute care around the clock — and frequently aren’t in insurance networks. They have spread quickly across the state, profiting, their critics argue, by charging up to ten times more than urgent care centers to treat ailments like a fever or sore throat. These prices have blindsided unsuspecting consumers who realize too late that they were treated by an out-of-network provider.

Christopher Spector was startled to receive an $1,100 bill after visiting a freestanding ER in North Richland Hills for an eye injury. In a letter he wrote to contest the charge, Spector says he went to the facility after being hit in the right eye with a tennis ball and, after a series of tests, was told to see a nearby ophthalmologist for further treatment. He doesn’t remember asking if the freestanding ER was in or out of his health insurance network.

“For doing essentially nothing but giving me the name of an ophthalmologist,” he wrote in the letter, “First Choice billed my insurance (United Healthcare) an outrageous amount of $6,111. UH paid $4,400.10 (which is still a ludicrous amount) but First Choice isn’t satisfied. They say I’m responsible for $1,100.03 of the remaining amount.”

He called the charges “unreasonable, uncustomary and even predatory,” and described how the ophthalmology center he visited the next day provided him more comprehensive care at a fraction of the price.

“I wasn’t surprised to receive a bill,” he said, but freestanding ERs need to be more upfront about what care they provide and at what cost.

The new law aims to clarify a process all sides agree can be confusing.

State Rep. Tom Oliverson, R-Cypress, who authored the legislation, said it prevents Texans from being deceived. For the “90 percent of freestanding ERs that aren’t in the business of intentionally misleading people,” he said, “if it helps patients be less confused, they’re good with it.”

Shields said his group supported the bill through the legislative process. Most facilities are good actors, he said, that strive to inform consumers about what their insurance plan covers. The websites of some freestanding ERs in Texas, for example, advise that the facility may not be in-network and may charge rates comparable to a hospital ER. Some even suggest patients visit an urgent care clinic instead.

Shields said the benefit of freestanding ERs is that they provide more timely and convenient access to medical care. “Waiting in the hospital waiting room for five hours,” he says, “that doesn’t have to be the norm.”

The new law was one of several bills filed during the 85th Texas legislative session that took aim at freestanding ERs. Another that passed, authored by state Sen. Kelly Hancock, R-North Richland Hills, allows more patients to use a mediation system to dispute surprise medical bills, including those incurred at freestanding ERs.

Together, Dudensing said, the new laws provide better protection for consumers, who will have more information before making decisions about their treatment.

“We’re not trying to disrupt any business model,” she said.

Source: New law seeks to prevent surprise medical bills from freestanding ERs | The Texas Tribune

Posted in Freestanding ER, Government Regulations, Industry Updates, TX Hospitals

How to Fix the Emergency Room – WSJ

How to Fix the Emergency Room

ERs are notorious for long waits, endless forms and inconsistent care. Now researchers and hospitals are rethinking the ways they work—with impressive results.

Long wait times in the emergency room have bad effects for patient outcomes and satisfaction. 

Hospitals are making a push to fix one of the most irritating issues in health care: the emergency room.

Armed with new research and strategies borrowed from the business world, some facilities are trying to ease the frustrating experience of waiting, filling out forms, explaining a problem—and then waiting some more.

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These pioneering hospitals model different ways for hospitals throughout the country to rethink the way they handle emergency care.

“There’s a lot hospitals can do that they haven’t done yet,” says Jesse Pines, professor of emergency medicine at George Washington University, whose research published in the journal Health Affairs in 2015 shows that on average hospitals have adopted less than half of the proven interventions they were surveyed about.

Adding urgency to the search for solutions: Not only are wait times dauntingly long, but they’re not improving at the national level. The median length of stay for patients treated in the ER and then discharged was 138 minutes, according to data for October 2015 to September 2016 submitted to the U.S. Centers for Medicare and Medicaid Services. Researchers analyzing wait times in 2006 found virtually the same median.

Long waits don’t just bring patient frustration. Crowded ERs and long wait times have bad effects for patient outcomes and satisfaction, research shows. For instance, it takes longer for patients to get pain medications, antibiotics or the care they need if they’re having a heart attack.

The overall evidence “paints a pretty clear picture that under more crowded conditions, quality of care declines,” says Benjamin Sun, an emergency-medicine physician at Oregon Health and Science University, who was involved in a study on ER wait times and strategies recently published in the journal Annals of Emergency Medicine.

Improving conditions on a wide scale won’t be easy. Researchers say there must be sustained management support to make changes stick. And many of these solutions don’t just mean reorganizing the way things get done—they also mean taking on additional staff, which can be a hard sell.

That said, many hospitals are seeing strong results from their efforts, and the movement is spreading. Here’s a look at some of the interventions that are helping make things smoother for patients.

Rethink (or eliminate) triage. One of the biggest frustrations people encounter in the ER is one of the first things they have to put up with: registration and triage. After signing in and giving information, patients see a nurse who asks questions to judge how urgently they need care and the amount they’ll need, on a five-point scale. Then patients wait to see a doctor who may ask them the same things all over again.

With the traditional triage and registration, “there’s no way a patient can get to a physician in less than 30 minutes, even if there’s nobody in the ER,” says Assaad Sayah, senior vice president and chief medical officer of Cambridge Health Alliance, a hospital system with many uninsured and Medicaid patients.

In 2006, Cambridge Health Alliance set up a system where arriving patients give their name, Social Security number or birth date, and chief complaint. They are then brought to a treatment area so a provider can start caring for them right away, and don’t have to complete registration until they’ve gotten that initial help.

Patients in the Cambridge Health system waited to see a provider for a median of 10 minutes, compared with a national median of 29 minutes for other ERs seeing a comparable number of patients, government data show.

Rich Petrik, the ER physician director for Ocala Regional Medical Center in Ocala, Fla., has adopted another strategy to cut repetition: having a doctor listen to the patient during triage and begin to formulate and execute a plan of care. After Ocala Regional Medical Center put that change in place last year, as well as other fixes, patients were treated and sent home a half-hour faster than before. (The results don’t include patients who were admitted to the hospital.) Other facilities have gotten similar results from rethinking triage, according to researchers.

Eliminate details that waste time. Another approach to streamlining emergency rooms comes from the world of business—the “lean” management system where an organization looks at every step in its processes and figures out how to improve them, cutting out as much waste as possible.

As part of the Canadian province of Labrador’s efforts to reduce ER wait times, the staff at Labrador Health Centre in Happy Valley-Goose Bay went through lean training last April with consulting company X32 Healthcare. Looking at their operations through the lean lens, the staff noticed that “supplies were kind of everywhere,” says Donnie Sampson, co-chairwoman of the regional steering committee for emergency-department improvement, who oversaw the hospital’s work.

So the staff collected the supplies in one room, giving the nurses only one place to keep stocked—instead of the previous five carts—and look for the items they needed. The staff also noticed nurses were taking time to escort patients to other areas of the hospital for testing such as X-rays, so they put up colored tape that patients could follow to where they needed to go.

Another big change involved how doctors and nurses communicate. The hospital set up whiteboards for nurses and doctors to write up the most current patient information for other staff to see, such as the status of test completion. Instead of walking around the ER to find another staff member to ask, the boards “allowed people to see flow without actually having to talk to another provider,” says Ms. Sampson.

Help patients with minor complaints quickly… One of the most widely adopted fixes to emergency rooms has to do with patients who have minor issues. How to make sure that they don’t face endless waits—and crowd ERs—while doctors are dealing with seriously injured patients?

Some 40% of hospitals in the U.S. are giving the people with small complaints their own spot in the ER. Labrador Health Centre’s redesign included an area where patients in need of a medication refill or with mild complaints like a sore throat could be seen right away by a nurse practitioner or physician dedicated to seeing only such patients. Seeing the low-acuity patients quickly means there’s “not a huge pileup of people in the waiting area,” says Wanda Slade, Ms. Sampson’s co-chairwoman, who oversaw similar changes at another hospital in Labrador.

Labrador Health Centre measured its average wait time to see a doctor for a representative week before the change for low-acuity patients and found wait times ran to nearly 3½ hours, Ms. Sampson says. In a representative week afterward, that average had been cut in half.

According to the research Dr. Pines published in Health Affairs, about 40% of hospitals had similar fast-track areas for minor ailments by 2010—and other research finds hospitals with these treatment spaces decreased patient wait times and overall length of stay.

…And those who probably just need tests. In addition to creating specialized areas to care for low-acuity patients, some ERs have begun to separate out patients who require diagnostic testing but appear well otherwise. In the old system, those patients get put in a bed—but that takes space from sicker patients, and involves a lot of cleanup to make the bed ready for the next person. So Kaiser South Sacramento has patients wait for tests in chairs or wheelchairs.

Having these patients lie down on a gurney would have “no real benefit,” says Karen Murrell, Kaiser South Sacramento’s assistant physician in chief for the emergency department and hospital operations.

Schedule elective surgeries evenly. A big cause of snarls in emergency rooms doesn’t have anything to do with emergency-room patients at all. It is patients elsewhere in the hospital undergoing elective surgeries such as knee replacements.

Doctors often schedule those surgeries early in the week so that patients will recover by the weekend (and doctors won’t need to look in on them past Friday). The result: Early in the week, elective patients take up a lot of hospital beds, and there’s no room for ER patients who have been admitted. So these patients must stay—or “board”—in the ER instead, reducing its capacity and bringing longer wait times.

The uneven surgery scheduling “creates a very unbalanced demand for inpatient beds,” says Dr. Pines. Boarding is “the elephant in the room when it comes to crowding.”

In a study of one emergency room, researchers from Boston University calculated what happened on days when the hospital had a typical number of elective-surgery patients and the maximum number of ER patients. They found that elective admissions added 35 hours to the total time all patients spent in the ER, in their findings published in 2007 in Annals of Emergency Medicine.

Some hospitals have chosen to schedule elective surgeries evenly throughout the week to avoid buildups. The strategy “sounds great in theory and has been proven to work,” says Dr. Sun, “but is very difficult to do because of physician preferences and culture.” Dr. Pines’s research showed that in 2010 less than 5% of hospitals had smoothed their surgery schedules.

Another way hospitals can release pressure from boarding is through rules dictating that boarding patients must be taken from the ER to inpatient floors to wait for a bed when the ER is out of space. That makes room for new arrivals and patients waiting to be seen.

After the Canadian province of Alberta instituted full-capacity protocols for its hospitals in December of 2010, boarding decreased by nearly half. What’s more, the time admitted patients spent in the ER decreased to about 11½ hours from an average of 17, according to research led by the University of Calgary and presented at the 2012 Society for Academic Emergency Medicine Annual Meeting. Although the admitted patients still wait for open beds, moving them to wait in another part of the hospital allows other patients to move through the ER more quickly.

Ease admissions from the ER to the hospital. When emergency-room patients are admitted to the upper floors of the hospital, getting them from the care of one medical team to another can be complex. Especially in a teaching hospital, the process can involve multiple conversations between ER staff and a medical student, resident and then the attending physician on the upper hospital floor.

Beginning in 2006, Dr. Sayah at Cambridge Health Alliance oversaw changes to get the ER and inpatient floors working together better. They cut the handoff down to one phone call to discuss the patient’s care. The handoff between nurses was also simplified down to a single phone call between secretaries for the ER and inpatient floor.

Meanwhile, even before the phone call is made, a nurse upstairs has seen a brief page of information about the patient and, barring any concerns that would keep the person in the ER longer, the patient will be moved in 10 minutes after the call. The system’s hospital in Cambridge, Mass., cut the average total length of stay in the emergency room for all patients to about 2¼ hours from nearly 3½ hours, according to research Dr. Sayah published in 2014 in Emergency Medicine International.

Anticipate backups with software. It can be daunting for harried staffers to keep track of how many patients are in the emergency room and how long they’ve been waiting. So some hospitals are using software to deliver real-time data on patient numbers—and advice on how to shorten waits as they’re happening.

Mercy, a 44-hospital health system in Arkansas, Kansas, Missouri and Oklahoma, is using data collection and analysis software from health-care analytics company Qventus in nine of its ERs, and plans to roll out the program in another. The system monitors data including how many patients are in the ER, how urgently they need care, and how many patients are waiting to be seen or to go to a bed in the hospital. It also takes into account expected patient volume from historical data, as well as possible upward spikes from factors such as weather.

With all that information in hand, the system can predict when the ER will run out of capacity and alerts staff a few hours in advance, via text or another messaging mode. Staff members have specific tasks to do after they’re alerted, like accelerating the completion of lab and imaging tests and getting patients who have been either discharged or admitted where they need to go.

Qventus doesn’t direct treatment decisions, but it can recognize patients who have been waiting a long time and are likely to leave, then nudge staff to check in. The system can also recognize when lab tests or imaging studies for a patient haven’t been completed in a timely manner and alert the doctor or charge nurse before the patient has been waiting for two or three hours.

Mercy’s emergency room in Fort Smith, Ark., its first to adopt Qventus, in the summer of 2015, has reduced the average time patients wait to see a doctor by 15%, to about 60 minutes from the previous 70. The hospital also cut the average time patients spent in the ER before being discharged by about 23 minutes, to just under three hours.

Source: How to Fix the Emergency Room – WSJ

Posted in Industry Updates, Satisfaction Surveys

Dr. Overachiever: Award to honor Ovalo physician

Kyle Sheets jokingly calls himself an overachiever “in a bad way.”

Others probably say his overachieving is a great thing, considering all he’s done and is doing. Friends and associates call him “special,” “entrepreneurial,” “amazing.”

Patients call him “Dr. Sheets.” This week, however, everyone can add “Humanitarian of the Year” to the list.

That honor will be awarded Sheets during the annual conference of the American Academy of Family Physicians in San Antonio.

Sheets, a modest man, acknowledges that he’s proud to be receiving the award, but what led to it makes him even prouder. Several doctors who know him nominated Sheets through the Texas Academy of Family Physicians, the state chapter of the American academy.

“That’s pretty special to me,” Sheets said.

And pretty amazing for a man who didn’t enroll in medical school until he was 42. And that was after dropping out of Abilene Christian University halfway through his senior year in 1973.

“My parents nearly killed me,” he recalled.

Twenty years later, after starting, building and selling a number of businesses, Sheets re-enrolled at ACU, earning a degree in biology in 1993. Four years later, he had a medical degree and began serving a residency at Via Christi Family Medicine Residency Program in Wichita, Kansas.

It was an experience during that residency that led to the Humanitarian of the Year Award.

Family adventure

The primary reason that Sheets, who lives with his wife, Bernita, on a ranch near Ovalo in south Taylor County, was nominated for and won the honor was for his establishing Physicians Aiding Physicians Abroad (PAPA Missions) in 2003.

The organization provides practical help to other physicians who want to serve medical missions. The vision began in Zimbabwe and has expanded globally.

The seed for PAPA was planted in 1999, when Sheets was serving his residency in Kansas. Residents could spend one month in Zimbabwe helping at a hospital and receive credit toward completing their residency.

So, Kyle and Bernita and their 10 young children all headed to that African country for a month.

Aat their own expense.

“We’re still paying for that trip,” Sheets joked.

Several of the children live in or near Abilene, including the youngest, Cori, a student at ACU. One son, Tyler, was killed in a car wreck in 2006. He was 19. The ranch the couple lives on near Ovalo is the “Flying T Ranch,” named for Tyler. His mother recalled that as a child, Tyler dreamed of riding on a flying horse.

Whatever the cost of the Zimbabwe trip, it was a priceless experience for the entire family, Kyle and Bernita agreed. Their first impression, Sheets said, was that if the Americans could just help those extremely poor people make money, they would be happy.

But it didn’t take long to see that a mistaken view, Sheets said.

“They are so much happier than we are now,” he said. “All they have is ‘right now.’”
They don’t waste time storing up material goods or worrying about tomorrow. All they are concerned about is “today.”

That experience never left Kyle and Bernita and when the time was right, they started PAPA. The purpose is to help other physicians who have a desire to serve but not the experience to make a mission trip of that magnitude happen.

Larry Anderson, a physician in Wellington, Kansas, was one such doctor. He had heard of Sheets because the clinic where he practices is affiliated with the residency program in Wichita, where Sheets served his residency.

In 2006, Anderson went on a PAPA mission trip to Zimbabwe and recalled that it was “quite an education.” He has since done mission work in Mexico. Anderson, a former member of the board of directors of the American Academy of Family Physicians, put the bug in the ear of a colleague in Texas to nominate Sheets for the humanitarian award. No one is more deserving than Sheets and his wife, in Anderson’s mind.

“They’re special people,” he said, “and have been doing this a long, long time.”

A restless soul

If Kyle Sheets hadn’t been an overachiever, he most likely wouldn’t be getting the honor. In the 20 years between dropping out of ACU and returning to graduate, Sheets “overachieved” by starting, building and then selling business of all sorts from a fish farm to landscaping.

Joining him on that journey was his Bernita, a former ACU student. They didn’t know each other in school but were introduced by a friend. They married in December 1976.

“We kind of had a knack of starting and growing businesses,” Sheets said.

But always restless, Sheets began thinking about medical school, something he first considered as a biology major at ACU. He wasn’t ready then and dropped out instead. But the thought never completely left him.

So, at 42, he was accepted to the University of Texas Medical Branch in Galveston. The couple at that time had eight children, and two more were born there. After graduating, Sheets was accepted into the family practice residency program in Kansas, which suited him well.

He had grown up in Farwell and was recruited to join a practice in Muleshoe, just 20 miles from his hometown.

“Small town practice is what I was cut out for,” he said.

Today, in addition to flying to Muleshoe or Zimbabwe or Guatemala, Sheets oversees the company he founded in 2001, Concord Medical Group. It is a physician-owned and operated organization that assists with staffing rural hospitals in West Texas and in three states besides Texas.

Even while raising the family in Muleshoe, and loving the small town life, Sheets kept thinking about that trip to Zimbabwe, which eventually led him to start PAPA.

Other doctors involved

Not even a close call in 2010 keeps him away.

He was operating on an AIDS patient when he cut his hand.

A daughter, Heather Sample, an anesthesiologist who lives in Houston, was assisting.
Immediately after the surgery, Sheets began a regimen of drugs to ward off the disease.
He suffered severe reactions to the drugs, which attacked his liver, and had to be flown back to the United States for treatment.

On the flight, Sheets started failing quickly and his daughter began sobbing.

“It was terrifying,” Sheets said. “I was sure I was dying.”

Two men asked if they could help. They were doctors–in fact, the plane was carrying 100 doctors who were returning from a conference on infectious diseases. Sheets eventually recovered fully and HIV tests were negative.

The story was included in one of Max Lucado’s books on grace. Sheets and Lucado, a prolific writer on spiritual topics, a pastor, and fellow ACU graduate, are friends. When Lucado learned what had happened, he immediately recognized an amazing story of grace.

Despite that close encounter, Kyle and Bernita Sheets return to Africa about once a year to the 150-bed hospital they serve. When they go, they take teams of physicians, medical students, some family members, and people who just want to help, all recruited through PAPA Missions.

“”I’m the cook,” Bernita chimed in, a job she is well equipped to handle.

Not only did she raise a family of 10 children, she still is the primary mover and shaker behind an annual Thanksgiving feast at the ranch, attended by their children and families, and occasionally, friends. In all, 45 or so spend the Thanksgiving holiday at the ranch, with everyone divided into teams for cooking and cleaning.

After purchasing the ranch, which included a sprawling, four-bedroom house and two-bedroom guest house, the Sheets built a bunkhouse which sleeps 22. And the barn sleeps another 12.

Nothing seems too big for Kyle and Bernita Sheets to conquer — not starting multiple businesses, raising 10 children, serving medical missions all over the globe, flying back and forth to see patients in Muleshoe while running a multi-state hospital staffing business, or hosting 45 people for a long holiday.

Some would say that’s overachieving in “a good way.”

Humanitarian Award

According to the website for the American Academy of Family Physicians, the Humanitarian of the Year award created in 1997 “honors extraordinary and enduring humanitarian efforts both within and beyond the borders of the United States.”

Sheets had a family practice in Muleshoe for17 years and still flies there every couple of weeks in his own plane to see patients. In 1999, Kyle and his wife, Bernita, and their 10 children went to Zimbabwe for a month as part of the residency he was serving at Via Christi Family Medicine Residency Program in Wichita, Kansas. They were hooked immediately on medical missions.

In 2003, Sheets started Physicians Aiding Physicians Abroad (PAPA Missions) to provide practical help to other physicians who had a desire for medical missions. The vision began in Zimbabwe but since 2003, PAPA has sent hundreds of volunteers to six different countries and has shipped medical supplies worth millions to needy medical facilities around the world. 

In addition to operating PAPA and practicing medicine, Sheets started Concord Medical Group in 2001. Concord is a physician-owned and operated organization that assists with staffing in rural hospitals in West Texas and in three states besides Texas. 

Source: Dr. Overachiever: Award to honor Ovalo physician

Posted in Industry Updates, Providers Perspective, TX Hospitals

Journal republishes withdrawn paper on emergency care prices, amid controversy

The Annals of Emergency Medicine has republished a controversial paper it withdrew earlier this year which compared the cost of emergency care at different types of facilities.

Because the paper drew heavy criticism when it was originally released, the journal has published a revised version, along with several editorials and discussions between the authors and critics. One point of contention: The analysis stems from data provided by an insurance company — Blue Cross Blue Shield — which it declined to share.

The paper — originally published in February —  caught national attention (and raised concerns among some emergency care providers) when it reported the cost of treatment in emergency departments can be significantly higher than at urgent care centers, even for the same conditions. The journal withdrew the paper in spring, and re-published it Tuesday, with minor changes.

First author Vivian Ho at Rice University told us she made “slight changes”  to some headings, phrases, and the appendix, but:

the main results stay the same…I’m very happy the article has been re-released.

However, Ho added that she was “disappointed” the journal felt it had to publish so much extra “wording, and verbiage, and various editorials.”

Journal editor Michael Callaham at the University of California, San Francisco, told us:

We decided not to retract, and instead address and share the issues directly…We could not conclusively validate or exclude all the findings.

The findings have not been independently validated because the paper is based on data provided by health insurer Blue Cross Blue Shield, which it declined to share. Callaham told us:

…the entire analysis is still based on that data. We received an attestation of sorts from the Texas branch that they “stood behind the data”, but our efforts to find out if [Blue Cross Blue Shield] would allow impartial third party review of the data, went unanswered. And it certainly concerns me, but as you can see our efforts to resolve it, although very labor intensive, were unsuccessful.

Ho told us she has no doubts about the data:

I’m not at all concerned about the validity of Blue Cross Blue Shield’s data. I’ve seen their code, I’ve discussed the results extensively.

Both she and Callaham noted that other studies have relied on commercial insurance data to arrive at conclusions about clinical care; Callaham told us:

As far as I know, that data was not reviewed by anyone else either. This issue is a concern in our research community and has been discussed a good deal in our last several editorial board retreats, without arriving at any practical and moderately efficient solution.

Ho said insurers often can’t share the raw data due to issues with patient consent. It’s also an economic problem, she added, since insurers don’t want individual treatment centers to be able to compare reimbursements, which can vary significantly.

Conflicting reports

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers” reviewed insurance data from places that offer emergency care in Texas: hospitals, freestanding emergency departments, and urgent care centers. It found emergency departments charge sometimes 10 times more to treat the same conditions as urgent care centers. (Texas has the most freestanding emergency departments of any state.)

The original article quickly raised concerns — for instance, some argued costs can vary depending on patient severity. Ho said some values could be influenced by patient care, but one table in the paper compares procedures, which are not influenced by patient severity; that table shows a routine urinalysis cost $51 in a freestanding emergency department, and $3 at an urgent care clinic.

Ho told us she believes some of the criticisms have been politically motivated — specifically, that some critics “worked really hard to make this article withdrawn” while the Texas legislature (which meets only a few months every two years) was considering legislation around emergency care. Ultimately, the governor signed a bill that makes it easier for patients to challenge their bills following emergency care, and expands requirements to disclose if facilities are out of a patient’s insurance network.

One major critic of the paper has been Paul Kivella, president-elect of the American College of Emergency Physicians, which owns the journal. In one of his letters asking to retract the paper, he writes:

…we have grave concerns about the study’s methodology, the integrity of the data, the potential conflicts of interest on the part of the authors, and the possible serious consequences that the report’s flawed conclusions and recommendations could have in terms of supporting policy changes that could jeopardize access to emergency care and undermine the “prudent layperson” standard.

Before republishing the paper (a decision already reported by Health Data Buzz), it underwent extensive review, according to Callaham’s editorial:

This unusually extensive review took the energies and expertise of 4 peer reviewers, 1 regular editor, and 4 expert editorialists. Additionally, the editor in chief and 4 deputy editors, who have a collective total of more than 86 years of experience in high-level editorial decisionmaking, were engaged in many hours of discussion…After digesting all the assessments and arguments, we concluded the article had some original and important data to report (on a topic with a paucity of such information) and believed it should be published. But because the concerns were also important and could not be conclusively resolved, they should be published too.

Callaham’s editorial acknowledges that some critics had a range of conflicts of interest (in addition, some of the co-authors on the paper itself are based at Blue Cross Blue Shield):

These potential conflicts of interest included those of some individuals who had financial interest in freestanding EDs, and of others who participated in insurance company marketing campaigns to the public to limit freestanding ED use. These campaigns have led to the announcement in some states that Blue Cross Blue Shield will deny claims after the fact for ED visits that in their judgment could have equally well been cared for in an urgent care center. Obviously, this insurer could benefit directly in instructing patients to use less expensive care, so the integrity of the raw data used in this analysis may be more crucial than the analysis itself.

Kivella, for instance, reports that he is an investor in a facility that operates four freestanding emergency centers, and lectured at the National Association of Freestanding Emergency Centers conference last year.

Here are links to the other documents published alongside the revised paper and editorial:

Source: Journal republishes withdrawn paper on emergency care prices, amid controversy – Retraction Watch at Retraction Watch

Posted in ER Billing, Freestanding ER, Industry Updates, TX Hospitals

Comparing Utilization and Costs of 20 most common procedures by facility type – Annals of Emergency Medicine

Table 2 lists the 20 most common procedures by facility type for the study period 2012 to 2015. The prices in Table 2 include both the facility and professional component of each procedure’s price.

Rank by frequency, percentage of all visits, and mean prices of the most common procedures by provider type (2012 to 2015).
Procedure FSED (CPT) HBED (CPT) UCC (CPT)
Rank % Price, $ Rank % Price, $ Rank % Price, $
Bacterial culture, urine 19 6.1 83
Blood cell count, automated 5 22.8 109 3 39.7 67 10 4.7 7
Blood test: prothrombin time 17 7.2 48
CT scan, abdomen/pelvis 17 7.1 1,560 13 8.6 1,625
CT scan, head and neck 20 4.9 1,210 15 8.0 957
ECG 16 7.5 155 9 17.9 235 19 1.1 23
ED visits 1 98.3 1,049 1 97.1 937
Observation care 16 7.3 541
Immunology tests 15 1.7 7
Injections: immunizations 13 2.2 31
Injections: therapeutic/intravenous 3 37.6 123 2 41.7 111 4 20.6 17
Laboratory tests, organ/disease panel 6 22.1 198 4 38.8 149
Medical supplies and devices 2 38.0 46 12 9.0 145 8 5.6 13
Office visits, emergency 9 5.2 65
Office visits, established patient 1 53.1 130
Office visits, new patient 2 43.3 149
Office visits, other 5 9.4 21
Other chemistry tests 12 11.4 111 5 30.6 86 20 1.0 6
Other injections/noninjectables 13 10.2 47
Other microbiology tests 8 14.0 150 14 8.3 93 3 22.6 18
Other minor skin and breast surgery 19 4.9 393 17 1.4 141
Other nonsurgical pulmonary services 4 30.2 81 16 1.7 4
Other urinalysis 15 9.1 64 18 6.4 70 18 1.2 6
Respiratory therapy 14 1.9 22
Routine urinalysis 7 18.7 51 6 27.1 49 6 6.7 3
Specialty drugs 14 10.0 109 10 13.2 58
Transportation services 18 5.6 171 20 5.4 456
Venipuncture (draw blood) 10 12.4 19 7 21.0 12 12 3.0 3
Radiograph, chest 11 12.0 267 8 19.7 194 11 4.7 25
Radiograph, extremities 9 13.2 266 11 11.4 216 7 6.4 27

View Table in HTML

Source: Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers – Annals of Emergency Medicine

Posted in ER Billing, Freestanding ER, Industry Updates, TX Hospitals

Comparing Utilization and Costs of Care in FSED, HED, and UC

Results

Main Results

 

 Opens large image

Figure 1

Visits by Blue Cross Blue Shield customers in Texas by provider type and year.

The plotted values reflect increases of 10%, 24%, and 236% in visits between 2012 and 2015 respectively, for hospital-based emergency departments, urgent care centers and freestanding emergency departments.

Figure 2 graphs the average price paid for care by facility type and year. Between 2012 and 2015, the average price per visit at freestanding EDs increased 54%, from $1,431 to $2,199. During this same period, the average price per visit at hospital-based EDs increased 23%, from $1,842 to $2,259. Prices at urgent care centers were substantially lower and increased only 2% (from $164 to $168) between 2012 and 2015. As prices increased, the amount patients were liable for out of pocket also increased. Freestanding ED patients were liable for 32% out of pocket in 2012 ($462/$1,431) but 35% ($763/$2,199) in 2015. Patients treated in hospital-based EDs were liable for 29% out of pocket in 2012 ($541/$1,842) but 33% ($749/$2,259) in 2015. Even urgent care center patients were liable for more out of pocket over time: 36% in 2012 ($58/$164) versus 38% in 2015 ($63/$168). Median prices by provider type and year are reported in Table E1 (available online at http://www.annemergmed.com). The median prices are lower than mean prices for freestanding and hospital-based EDs, suggesting that payments to these providers are skewed to the right. Changes in mean prices paid out of pocket for freestanding ED patients are greater than the change in median prices, indicating that freestanding ED patients with the highest out-of-pocket costs fared the worst over time.

 

 Opens large image

Figure 2

Mean total price per visit and mean amounts paid by insurance versus out of pocket by provider type and year.*

*Number of visits in 2012 versus 2015 equals 54,696 versus 183,971 for freestanding EDs, 954,548 versus 1,046,545 for hospital-based EDs, and 748,213 versus 926,933 for urgent care centers.

At urgent care centers, the insurer-paid amount was $106 in 2012 and $104 in 2015. The amount paid out of pocket was $58 in 2012 and $63 in 2015.

Source: Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers – Annals of Emergency Medicine

Posted in ER Billing, Freestanding ER, Industry Updates, TX Hospitals

Forum Raises Question: Can EMS Providers Help Treat Addiction Before An Overdose?

One hundred health care and first-response experts will convene to share ideas, strategies, and specific tools for fighting Connecticut’s opioid epidemic in a first-of-its-kind conference at UConn Health in Farmington on Wednesday. Focused on pre-hospital preventative care, the forum, co-hosted by UConn Health and the state Department of Public Health, will also feature the release of a free online training programfor emergency medical services (EMS) providers.

“EMS providers are absolutely on the front line of a lot of the treatment and interaction with the folks who are suffering opioid abuse and addiction,” said Dr. Richard Kamin, the EMS program director at UConn Health. “They are in a phenomenal position to treat [them] … from a better understanding and raising awareness and possibly even preventing [overdoses].”

Connecticut Ranks High In Opioid-Related Hospital Visits »

The conference, featuring speakers ranging from overdose survivors to psychiatrists to paramedics to medical examiners, is organized in response to the statewide strategy for combating the opioid crisis announced by Gov. Dannel P. Malloy in October 2016. Connecticut is the 4th highest among 30 states in terms of opioid-related emergency room visits, a report by the Agency for Healthcare Research and Quality found in June.

Editorial: Worsening Opioid Crisis Demands Action »

By equipping EMS providers — essentially, first responders of any sort with up-to-date medical training — with greater context of the opioid crisis, conference organizers Kamin and Peter Canning, a practicing paramedic and the EMS coordinator for UConn’s John Dempsey Hospital, hope their online training will enable them to better fight the disease when they confront it in the field.

Their goal is for EMS providers to treat opioid addiction beyond just administering the overdose-counteracting drug naloxone once an overdose has already happened. “That is often a very teachable time because the awareness and importance of understanding this is probably never greater than when you have just been resuscitated from an overdose and when your loved ones are watching you go through this,” Kamin said.

“The problem [of opioid addiction and overdose] in and of itself is clinically fairly well-described. People are not breathing because they use too much of an opiate. The interventions that we provide historically have always focused on getting people to breathe again,” he said. “This educational emphasis takes a broader look at hoping to make our interventions more efficient and prevent the need to ‘get there once folks stop breathing’.”

The training, available at www.train.org/connecticut/course/1072448, is free and open to anyone, though Kamin said it is geared toward medical professionals and first responders. Registration for the conference is full.

source:
http://www.courant.com/health/hc-news-uconn-ems-opioid-forum-20170919-story.html

 

Posted in Industry Updates, Opioid Epidemic

UMC at Capacity, ER Wait Up to Eight Hours 

LUBBOCK, TX – University Medical Center started turning non-emergency patients away Tuesday morning after the hospital reached capacity. This is not the first time this happened and in fact, UMC said this happens often.

The hospital being at capacity affects nurses, resources and wait times. Recently, wait times for the ER lasted for more than six hours in some cases. The wait times are longer because the ER is full with patients from other areas of the hospital.

“Unfortunately, we have to hold patients in the ER,” said marketing director at UMC, Eric Finley. “That means is that we keep a patient in the ER until a bed is available for them in the hospital. Sometimes that’s 12 hours, sometimes that’s 24 hours.”

This causes the ER to operate differently and drains ER nurses who are not trained to work with these kinds of patients.

“It does wear on staff, we’re trying to listen to their needs because they are fully taxed every moment they are here,” said Finley.

A new facility with eight beds opened on Monday, but those beds are already full. As of this morning, they started having to turn away patients.

“This morning until about 9:30, we were on diversion for adult medical patients,” said Finley. “We’d take trauma or some type of bad car wreck but if your doctor said ‘Hey, I want to put you in the hospital for some testing,’ we wouldn’t accept that patient.”

Finley said a big part of the problem is people coming to the ER when they should be going somewhere else for their medical services, which adds to the wait time.

“One thing that we see at any given time is only about 30 percent of patients who are in the ER actually need to be there,” said Finley.

UMC is asking the community to avoid coming to the ER for symptoms like the flu or a bad cold and instead utilize the clinics around town. If it’s something more serious, the ER is the correct setting.

By spring, UMC hopes to add 45 more beds to their facilities. Currently, UMC is recruiting nurses to man those beds.

Source: UMC at Capacity, ER Wait Up to Eight Hours – Story

Posted in Industry Updates, TX Hospitals
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