The use of CT scans or MRIs in emergency departments nearly tripled over a 10-year period without a corresponding change in the prevalence of life-threatening conditions among ER patients, according to a study published in the Journal of the American Medical Association.
Between 1998 and 2007, the share of injury-related ER patients who received MRI or CT scans rose to 15 percent up from 6 percent, based on a nationwide sample of more than 300,000 ED visits from the Center for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey.
Dr. Frederick Korley, lead author and an assistant professor of emergency medicine at Johns Hopkins University, characterized the change as "a really significant increase," Reuters reports. "It implies there is a potential amount of overuse or use that is not directly yielding any meaningful clinical results," he said.
Although researchers did not say the use of advanced imaging was unwarranted, MedPage Today reports, they did call for more investigation into why CT or MRIs are increasingly used in EDs "to optimize the risk-benefit balance of advanced radiology use."
Besides raising healthcare costs with scans that can cost several hundred to a few thousand dollars, the possibly unnecessary radiation exposure and longer ER stays (an average of two hours longer) are issues worth considering, according to the authors.
What's behind the growing use of scans?
The pressure to get patients discharged as quickly as possible might drive the decision to order an imaging test, Dr. Levon Nazarian, a professor of radiology at Thomas Jefferson University Hospital in Philadelphia, told HealthDay News. He added that fear of lawsuits due to missed diagnosis is another factor.
Another expert told HealthDay that the authors failed to address the significance of a negative scan. The ability to rule out an intracranial hemorrhage, for example, is invaluable, said Dr. Raul Uppot, director of the Abdominal Imaging Fellowship Division at Massachusetts General Hospital.
FierceHealthCare
10-6-2010
Wednesday, October 6, 2010
Surgeon Shortage Jeopardizes Patient Care
Shortages of surgeons--especially in small, rural communities--threaten patient access to safe, high-quality and affordable care, concludes the American College of Surgeons. Currently, population demand for surgical care is undersupplied by about 30 percent.
"Places with greater resources and better living situations attract practitioners with relative ease; while areas with fewer amenities and struggling economies may be challenged to retain surgeons or attract new ones," noted the ACS at the 96th Annual Clinical Congress in Washington.
To help practitioners, policy makers and patients identify areas lacking adequate access to surgeons, the ACS launched the Surgical Workforce Atlas. The interactive, web-based map shows the geographic distribution of surgeons relative to populations in 2009.
"This website allows users to quickly identify the supply of surgeons in their county and compare it to all other counties in the U.S.," said Thomas C. Ricketts, PhD, MPH, managing director of the ACS Health Policy Research Institute. "[W]e hope it will help decision makers understand the needs some communities have for access to surgical care."
According to the Atlas, patients in need of surgery should steer clear of Nevada, as it retains the least number of per-capita surgeons with only 34. Of its 16 counties, seven have no surgeons at all. But patients in the District of Columbia have access to the most surgeons per 100,000 people--118.
On a county level, Montour, Pa., is the best bet for surgical services, as it has about 454 surgeons per 100,000 people, the largest density of surgeons nationwide.
ACS said it is already developing a second version of the Atlas that will include surgical subspecialties, overlay facilities and visual displays using alternative geographic units.
FierceHealthCare
10-6-2010
"Places with greater resources and better living situations attract practitioners with relative ease; while areas with fewer amenities and struggling economies may be challenged to retain surgeons or attract new ones," noted the ACS at the 96th Annual Clinical Congress in Washington.
To help practitioners, policy makers and patients identify areas lacking adequate access to surgeons, the ACS launched the Surgical Workforce Atlas. The interactive, web-based map shows the geographic distribution of surgeons relative to populations in 2009.
"This website allows users to quickly identify the supply of surgeons in their county and compare it to all other counties in the U.S.," said Thomas C. Ricketts, PhD, MPH, managing director of the ACS Health Policy Research Institute. "[W]e hope it will help decision makers understand the needs some communities have for access to surgical care."
According to the Atlas, patients in need of surgery should steer clear of Nevada, as it retains the least number of per-capita surgeons with only 34. Of its 16 counties, seven have no surgeons at all. But patients in the District of Columbia have access to the most surgeons per 100,000 people--118.
On a county level, Montour, Pa., is the best bet for surgical services, as it has about 454 surgeons per 100,000 people, the largest density of surgeons nationwide.
ACS said it is already developing a second version of the Atlas that will include surgical subspecialties, overlay facilities and visual displays using alternative geographic units.
FierceHealthCare
10-6-2010
AMA: Nurses Are Not Our Equals
The American Medical Association was swift to respond to yesterday's Institute of Medicine report that called for nurses to take on a larger, more independent role in transforming healthcare in America. By 2 p.m., it had shot out a board member's response to media outlets. It's main message: Nurses are not equal to physicians. Besides reinforcing the importance of a physician-led team approach, the statement underlined the difference in education and training between nurses and physicians.
The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, "Nurses are critical to the healthcare team, but there is no substitute for education and training." She goes on to compare physicians' seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners' two to three years of postgraduate education and less clinical experience than that of a first-year medical resident.
It's possible the physicians fear the report's proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses--such as nurse practitioners and anesthetists--at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses' scope of practice.
Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report's recommendations. In response to the AMA's comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers.
She argued against limiting their practice to whatever could be supervised by physicians. "If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we've just cut off access to primary care in that community," she said. "We're not using nurses to the full extent. They are an untapped resource."
FierceHealthCare
10-6-2010
The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, "Nurses are critical to the healthcare team, but there is no substitute for education and training." She goes on to compare physicians' seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners' two to three years of postgraduate education and less clinical experience than that of a first-year medical resident.
It's possible the physicians fear the report's proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses--such as nurse practitioners and anesthetists--at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses' scope of practice.
Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report's recommendations. In response to the AMA's comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers.
She argued against limiting their practice to whatever could be supervised by physicians. "If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we've just cut off access to primary care in that community," she said. "We're not using nurses to the full extent. They are an untapped resource."
FierceHealthCare
10-6-2010
Tuesday, October 5, 2010
Should Nurses Scope Of Practice Be Expanded?
The manner in which nurses work in America needs to change in order to meet the rising demand for care, according to a report released today by the Institute of Medicine.
Perhaps the most striking recommendation to come out of the report is the IOM's call for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training." The rationale is that millions more patients are expected to gain access to healthcare through the healthcare reform.
The report notes that of the roughly 3 million nurses in the U.S., more than 250,000 are advanced practice registered nurses, who have master's or doctoral degrees and have passed national certification exams. Yet what they are allowed to do at work varies, depending on state regulations, which may limit their scope of practice. Already about 28 states are considering expanding the role of nurse practitioners to fill the void created by the primary-care physician shortage.
Because the healthcare system today does not offer enough incentives for nurses to pursue higher degrees and more training, the U.S. faces a shortage of nursing professors and advanced practice nurses. The report calls on public and private organization to offer resources to help nurses with associate's degrees and diplomas to go on to get their bachelor's degrees in nursing.
With the doctor shortage projected to hit 63,000 by 2015, it's not surprising that the report calls for nurses to play a bigger role in healthcare. In a potentially controversial recommendation, it suggests that nurses become "full partners" with physicians and other healthcare professionals in redesigning healthcare in America. In the past, the American Medical Association has warned that broadening nurses' authority could pose a danger to patients.
FierceHealthCare
10-5-2010
Perhaps the most striking recommendation to come out of the report is the IOM's call for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training." The rationale is that millions more patients are expected to gain access to healthcare through the healthcare reform.
The report notes that of the roughly 3 million nurses in the U.S., more than 250,000 are advanced practice registered nurses, who have master's or doctoral degrees and have passed national certification exams. Yet what they are allowed to do at work varies, depending on state regulations, which may limit their scope of practice. Already about 28 states are considering expanding the role of nurse practitioners to fill the void created by the primary-care physician shortage.
Because the healthcare system today does not offer enough incentives for nurses to pursue higher degrees and more training, the U.S. faces a shortage of nursing professors and advanced practice nurses. The report calls on public and private organization to offer resources to help nurses with associate's degrees and diplomas to go on to get their bachelor's degrees in nursing.
With the doctor shortage projected to hit 63,000 by 2015, it's not surprising that the report calls for nurses to play a bigger role in healthcare. In a potentially controversial recommendation, it suggests that nurses become "full partners" with physicians and other healthcare professionals in redesigning healthcare in America. In the past, the American Medical Association has warned that broadening nurses' authority could pose a danger to patients.
FierceHealthCare
10-5-2010
Monday, October 4, 2010
What The HealthCare Reform Bill Will Mean For You
The Patient Protection and Affordable Health Care Act went into effect this past March. This important piece of legislation has the potential to impact the lives of every American, from the way they receive health care from their doctors to the types of coverages they receive from their insurers.
The main provisions of the health care reform bill strive not only to ensure that more than 90% of Americans have meaningful health insurance coverage, but also to fix some of the biggest problems facing the US health care system. These include wasteful spending on excess tests and procedures, unacceptable rates of infection and medical errors and high rates of hospital re-admittance.
Below you will find information on some of the key provisions of the law and how they may impact the way you receive medical care.
Changing the Delivery of Care
Care teams
The health care reform bill will impact the way patients interact with their physicians and other health care professionals. For example, a team of professionals, referred to as a "care team", will handle patient care. The members of the team will vary depending on the patient's circumstances, but may include nurse practioners, physician assistants, specialists, nutritionists and others in addition to the patient's primary care physician. Many believe that a team approach can help cut down on medical errors because more than one person is responsible for overseeing the patient's care.
Electronic medical records
Requiring the use of electronic medical records is another way the health care reform bill may help reduce medical errors and improve patient care. Putting patient records in an electronic format will make it more accessible to members of the patient's care team and cut down on the time it takes to transfer records from one care facility to another, or even between physicians. Electronic records also can help eliminate the problem of ineligible handwriting and missing pages from a patient's file.
Improved treatments
As part of the Affordable Health Care Act, the federal government is funding research through the Patient-Centered Outcomes Research Institute that will help physicians pinpoint the best, most efficient types of treatments for certain medical conditions. Once this research is complete and doctors begin using it in practice, it can help cut back on the number of unnecessary tests and treatments physicians may use to diagnose and treat a patient.
Focus on keeping patients healthy
The new health care law also hopes to re-orientate the practice of medicine from only helping those who are sick to keeping patients healthy. In practice, this may mean check-in calls from family practioners to remind patients to come in for physicals and have other preventative treatments, like cancer screenings. It also may mean home visits from nurses after patients with serious illnesses and injuries have been discharged from the hospital.
New Insurance Rules
For 2010, the biggest changes under the health care reform bill will affect insurance coverages. These changes include:
-Insurers cannot deny coverage to children due to pre-existing condition
-No more lifetime caps on insurance coverage
-Coverage under employer-sponsored group policies will cover dependent children up to age 26
-Insurers will have to provide coverage for certain preventative measures, including screenings for high blood pressure, osteoporosis, diabetes and sexually transmitted diseases; colonoscopies and smoking cessation counseling
-Those with serious health conditions who have been unable to obtain private insurance can purchase a policy subsidized by the federal government at rates similar to those for healthy adults
More Changes to Come in 2014
Many of the measures under the health care reform bill are not set to go into effect until 2014. Some of these measures include:
- Pre-existing conditions: health insurers will no longer be able to deny coverage due to pre-existing conditions
- Penalties: those who have not purchased a health insurance policy will be assessed a penalty of $95 or up to 1% of their income for individuals, whichever is greater. The fine increases to $695 or 2.5% of an individual's income in 2016.
- Insurance exchange: insurance premiums subsidized by the federal government under the state-based insurance exchange will become available for those who fall within income guidelines. Currently, those with incomes above 133% of the federal poverty level and below 400% of the federal poverty level will be eligible on a sliding scale for the subsidies.
- Maternity care: insurance companies will be required to provide coverage for maternity care
- Nursing mothers: employers will be required to provide nursing mothers unpaid reasonable break times for pumping breast milk as well as a private place other than a bathroom to do it in
- Continuing coverage: those who quit or lose their jobs will not lose their health coverage. They will have the option to purchase coverage subsidized by the federal government through the insurance exchange. Those whose only source of income is unemployment benefits may be eligible for Medicaid.
- Expansion of Medicaid: the Medicaid program will be made available to any adult under 65 years of age who falls within the income guidelines, currently set at 133% of the federal poverty limit, or less than $29,327 for a family of four.
Conclusion
Once all of the provisions of the Patient Protection and Affordable Health Care Act go into effect, it will have a profound impact on the US health care system. Whether or not it will be able to tackle all of the problems facing the nation's health care system has yet to be seen. However, these reforms could go a long way towards improving patient care, including decreasing the number of medical errors currently plaguing our system.
24/7 PressRelease
10-4-2010
The main provisions of the health care reform bill strive not only to ensure that more than 90% of Americans have meaningful health insurance coverage, but also to fix some of the biggest problems facing the US health care system. These include wasteful spending on excess tests and procedures, unacceptable rates of infection and medical errors and high rates of hospital re-admittance.
Below you will find information on some of the key provisions of the law and how they may impact the way you receive medical care.
Changing the Delivery of Care
Care teams
The health care reform bill will impact the way patients interact with their physicians and other health care professionals. For example, a team of professionals, referred to as a "care team", will handle patient care. The members of the team will vary depending on the patient's circumstances, but may include nurse practioners, physician assistants, specialists, nutritionists and others in addition to the patient's primary care physician. Many believe that a team approach can help cut down on medical errors because more than one person is responsible for overseeing the patient's care.
Electronic medical records
Requiring the use of electronic medical records is another way the health care reform bill may help reduce medical errors and improve patient care. Putting patient records in an electronic format will make it more accessible to members of the patient's care team and cut down on the time it takes to transfer records from one care facility to another, or even between physicians. Electronic records also can help eliminate the problem of ineligible handwriting and missing pages from a patient's file.
Improved treatments
As part of the Affordable Health Care Act, the federal government is funding research through the Patient-Centered Outcomes Research Institute that will help physicians pinpoint the best, most efficient types of treatments for certain medical conditions. Once this research is complete and doctors begin using it in practice, it can help cut back on the number of unnecessary tests and treatments physicians may use to diagnose and treat a patient.
Focus on keeping patients healthy
The new health care law also hopes to re-orientate the practice of medicine from only helping those who are sick to keeping patients healthy. In practice, this may mean check-in calls from family practioners to remind patients to come in for physicals and have other preventative treatments, like cancer screenings. It also may mean home visits from nurses after patients with serious illnesses and injuries have been discharged from the hospital.
New Insurance Rules
For 2010, the biggest changes under the health care reform bill will affect insurance coverages. These changes include:
-Insurers cannot deny coverage to children due to pre-existing condition
-No more lifetime caps on insurance coverage
-Coverage under employer-sponsored group policies will cover dependent children up to age 26
-Insurers will have to provide coverage for certain preventative measures, including screenings for high blood pressure, osteoporosis, diabetes and sexually transmitted diseases; colonoscopies and smoking cessation counseling
-Those with serious health conditions who have been unable to obtain private insurance can purchase a policy subsidized by the federal government at rates similar to those for healthy adults
More Changes to Come in 2014
Many of the measures under the health care reform bill are not set to go into effect until 2014. Some of these measures include:
- Pre-existing conditions: health insurers will no longer be able to deny coverage due to pre-existing conditions
- Penalties: those who have not purchased a health insurance policy will be assessed a penalty of $95 or up to 1% of their income for individuals, whichever is greater. The fine increases to $695 or 2.5% of an individual's income in 2016.
- Insurance exchange: insurance premiums subsidized by the federal government under the state-based insurance exchange will become available for those who fall within income guidelines. Currently, those with incomes above 133% of the federal poverty level and below 400% of the federal poverty level will be eligible on a sliding scale for the subsidies.
- Maternity care: insurance companies will be required to provide coverage for maternity care
- Nursing mothers: employers will be required to provide nursing mothers unpaid reasonable break times for pumping breast milk as well as a private place other than a bathroom to do it in
- Continuing coverage: those who quit or lose their jobs will not lose their health coverage. They will have the option to purchase coverage subsidized by the federal government through the insurance exchange. Those whose only source of income is unemployment benefits may be eligible for Medicaid.
- Expansion of Medicaid: the Medicaid program will be made available to any adult under 65 years of age who falls within the income guidelines, currently set at 133% of the federal poverty limit, or less than $29,327 for a family of four.
Conclusion
Once all of the provisions of the Patient Protection and Affordable Health Care Act go into effect, it will have a profound impact on the US health care system. Whether or not it will be able to tackle all of the problems facing the nation's health care system has yet to be seen. However, these reforms could go a long way towards improving patient care, including decreasing the number of medical errors currently plaguing our system.
24/7 PressRelease
10-4-2010
Friday, October 1, 2010
Brief Consultations Cut Chronic Pain Patient Visits to ED
A simple 15- to 30-minute behavioral health consultation can cut chronic pain patients' visits to emergency rooms, according to a study in the September issue of the Journal of Emergency Nursing. The reduction in visits is especially pronounced for frequent pain patients who pre-intervention visited a hospital ED more than four times in six months.
Although hospital emergency rooms are not the best place to get help for less pressing health issues, patients with chronic pain continue to turn to them, regardless. Researchers hypothesize that a behavioral health intervention would better serve chronic pain patients and help hospitals provide cost-effective treatment at the appropriate level of care. They conducted their study in a small acute-care hospital with a 15-bed emergency department that sees 16,500 patients a year.
The intervention involved 15- to 30-minutes of counseling during which someone taught the patient pain management strategies and reinforced the need for a primary-care physician to manage pain medication, HealthDay News reports. Six months after the consultations were added, a low-use group used the ED an average of 1.4 times compared with 1.8 times in the six months before the intervention. The high-use group, saw its mean utilization drop to 4.0 ED visits from 6.8 visits in six months.
"This study suggests that an emergency department-based behavioral health consultation may be useful for reducing high utilization of emergency department services by some chronic pain patients, particularly those who consume the most services," the authors conclude.
FierceHealthCare
10-1-2010
Although hospital emergency rooms are not the best place to get help for less pressing health issues, patients with chronic pain continue to turn to them, regardless. Researchers hypothesize that a behavioral health intervention would better serve chronic pain patients and help hospitals provide cost-effective treatment at the appropriate level of care. They conducted their study in a small acute-care hospital with a 15-bed emergency department that sees 16,500 patients a year.
The intervention involved 15- to 30-minutes of counseling during which someone taught the patient pain management strategies and reinforced the need for a primary-care physician to manage pain medication, HealthDay News reports. Six months after the consultations were added, a low-use group used the ED an average of 1.4 times compared with 1.8 times in the six months before the intervention. The high-use group, saw its mean utilization drop to 4.0 ED visits from 6.8 visits in six months.
"This study suggests that an emergency department-based behavioral health consultation may be useful for reducing high utilization of emergency department services by some chronic pain patients, particularly those who consume the most services," the authors conclude.
FierceHealthCare
10-1-2010
Doctor Shortage Expected To Hit 63,000 By 2015
By 2015, one year after health reforms will take effect in the U.S., there will be a physician shortage of roughly 63,000 doctors, according to new estimates from the Association of American Medical Colleges. Earlier figures had pegged the doctor shortage at slightly less than 40,000.
The AAMC calls for an end to a freeze on Medicare support for residency training to stem the potential problem. A fact sheet accompanying the estimates notes that since 1997, Medicare support for doctors in training has not grown, despite an increase in the number of actual residents.
"Because of the concern with likely shortages, the number of medical schools is increasing, and there will be an additional 7,000 graduates every year over the next decade," the AAMC argues. "Medicare must continue paying for its share of training costs by supporting at least a 15 percent increase in GME positions, allowing teaching hospitals to prepare for another 4,000 physicians a year to meet the needs of 2020 and beyond."
While the U.S. can expect a 36 percent increase in the number of Americans over age 65 within the next 10 years, the number of doctors to treat those American will grow by only 7 percent, AAMC notes.
"In addition to the 15 million patients who will become eligible for Medicare, 32 million younger Americans will become newly insured as a result of healthcare reform," the AAMC adds, "and thereby intensify the demand for physicians even further."
FierceHealthCare
10-1-2010
The AAMC calls for an end to a freeze on Medicare support for residency training to stem the potential problem. A fact sheet accompanying the estimates notes that since 1997, Medicare support for doctors in training has not grown, despite an increase in the number of actual residents.
"Because of the concern with likely shortages, the number of medical schools is increasing, and there will be an additional 7,000 graduates every year over the next decade," the AAMC argues. "Medicare must continue paying for its share of training costs by supporting at least a 15 percent increase in GME positions, allowing teaching hospitals to prepare for another 4,000 physicians a year to meet the needs of 2020 and beyond."
While the U.S. can expect a 36 percent increase in the number of Americans over age 65 within the next 10 years, the number of doctors to treat those American will grow by only 7 percent, AAMC notes.
"In addition to the 15 million patients who will become eligible for Medicare, 32 million younger Americans will become newly insured as a result of healthcare reform," the AAMC adds, "and thereby intensify the demand for physicians even further."
FierceHealthCare
10-1-2010
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