The Vivid Pros and Cons of Freestanding Emergency Departments

Roger Stanmore MD, JDFreestanding emergency departments (FSED)  have proven to be the hot, new emergency care model, brandishing all of the expensive, life-saving equipment of traditional emergency rooms.

With that said, some are concerned that these 24-hour facilities, which offer on-site laboratory testing and diagnostic imaging, concentrate their services in high-income areas, predominantly servicing those with private insurance, rather than those with Medicaid.

Nothing stands still. Not time, not emergency care medicine. The surge and gains with regards to freestanding urgent care centers and emergency departments is a mark of progression, signifying the fact that the future of emergency care medicine is happening now. The economics of emergency medicine make sense for a number of communities, making emergency and ambulatory care more accessible.

Freestanding EDs are defined by the American College of Emergency Physicians (ACEP) as “a facility that is structurally separate and distinct from a hospital and provides emergency care.” There are two types of ownerships for these facilities: hospital outpatient departments (HOPD), which are owned and operated by medical centers, and independent freestanding EDs (IFECs).

Sources suggest that there are 10,000 urgent care centers, 5,000 hospital emergency departments, 5,000 ambulatory surgery centers, 2,800 retail clinics, and the 500 freestanding EDs. These functions have been enabled by technology and consumer preference, and ideally, both insured and uninsured parents are immunized from overbearing out-of-pocket debt that’s usually due following a visit to the standard emergency department. More than a visit costing about a third of emergency room costs, the wait time is also significantly shorter.

The freestanding ED has gained momentum in recent years, and this can be contributed to the fact that these facilities tend to be open 24/7. They’re equipped with CT scanners, labs, x-rays machines, and sophisticated diagnostic equipment than urgent care centers.

With that said, these facilities have been accused of precluding poor and non-white communities. These standalone ER facilities tend to be located in affluent, growing communities with high incomes, and often welcomes cherry-picked patients with private insurance. FSED have roused concern and criticism due to the fact that this particular type of care access blooms in areas that has higher annual spending, fewer minorities, and diminished need for emergency care access.

“In the states with the most freestanding EDs, it seems less likely that they will expand access to underserved populations,” corresponding author Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of Emergency Medicine, Brigham and Women’s Hospital, said in a statement, “as they are preferentially located in areas where people had more available health services, higher rates of private health insurance, lower rates of Medicaid and higher median incomes.”

The lowered rates of Medicaid users can be attributed to the fact that only HOPDs are able to bill for Medicare patients, influencing the cause for independent facilities to seek out those who are privately insured. On the most part, FSEDs exist in Texas, Colorado, and other states that don’t require a certificate of need.

Expanding nationwide, freestanding emergency departments are equipped to care for those in need of cardiovascular stress test as well as anything from chest pain, asthma attacks, allergic reactions, seizures, gastrointestinal bleeding, infections, and other conditions traditionally cared for at hospitals. FSED have helped to decrease admission at emergency rooms and lower costs nationally. Some researcher suggest that this effort could be furthered if FSED partnered with medical home models and feel the need for community-based medical care.

The Correlation Between the Affordable Care Act and Emergency Department Visits

Emergency_roomThe University of California published a study, titled “Relationship of Affordable Care Act Implementation to Emergency Department Utilization Among Young Adults,” which found that the Patient Protection and Affordable Care Act (ACA) extended eligibility for health insurance for young adults aged 19 to 25 years. It’s fairly unclear how expanded coverage has changed health care behavior, as well as how it promotes efficiency for emergency department services.

Researchers indicated that the objective of the research was to use population level emergency department data to characterize changes in diagnoses noticed by emergency departments among young adults since the incorporation of ACA dependent coverage expansion. Difference-in-differences analysis of 2oo9 to 2011 ED visits from New York, Florida, and California was performed, and they utilized all-capture administrative data to calculate just how the use of emergency department services have changed for clinical categories following the implementation of ACA provisions among those aged 19 to 25, compared to those slightly older (26 to 31 years).

Approximately 10,158,254 emergency department visits made by 4,734,409 patients were analyzed, and after implementation of the 2010 ACA provision, it was found that there was a .5 percent emergency department decreased for younger adults per 1,000, compared to the older group. Young adults’ rates and rate and risk of visits didn’t know change relative to the slightly older group following the implementation of the ACA. With that said, young adults’ emergency department visit significantly increased by 2.6 percent and there was a 4.8 percent increase in visits for diseases of the circulatory systems (eg, nonspecific chest pain).

There was a 3.7 percent decrease for pregnancy-related diagnoses and diseases of the skin (eg, cellulitis, abscess), compared to the 3.1 percent for the older group. The results indicated that coverage increases have kept young people out of the emergency department for conditions that are being cared for elsewhere. Conclusively, the report established, “As EDs face capacity challenges, these results are encouraging and offer insight into what could be expected under further insurance expansions from health care reform.”

Alabama Ranked one of the Top States for Being Employed as a Physician

physiciansThe state of Alabama has grappled with a number of health care challenges; nonetheless, it has managed to rank as one of the top states for being employed as a physician.

According to rankings published by Medscape, a medical specialist site, Alabama has been identified as the third best state in the nation to practice medicine in 2016. Chiefly, the rankings looked at the financial aspects of working as a physician in Alabama, as well as the malpractice environment, cost of living, and tax burden. Only North Carolina and Texas surpass Alabama as states that ranked higher.

For physicians living in the state of Alabama, the average salary is approximately $296,000, which is four percent higher the national average. That fact coupled with the state’s exceptionally low cost of living means that physicians in that state are faring well. The cost of living in Alabama is 10 percent less than the national average and there’s a tax burden of just 8.7 percent, which means that wages have a great lifespan in the state.

The Medscape study also revealed that malpractice payouts, suggesting a favorable malpractice environment. In Alabama, malpractice payouts only reach $4.15 per capita each year, which is the fourth lowest among all states. Birmingham’s physicians, specifically, are thriving due to good schools, growing suburbs, and premium health care facilities like the University of Alabama at Birmingham Hospital. The state may have ranked even higher if it weren’t for slow economic growth and above-average unemployment (6.2 percent vs. 4.9 percent nationally).

The report identified Birmingham (the state’s economic engine) and Hoover as the best cities in the state to practice medicine. Hoover happens to be one of the most in-demand suburbs in the state with ample shopping and good schools. However, there are a few cons for Hoover, including the fact that the housing costs are more than twice the state’s average.

What The Zika Virus Means For Blood Transfusions

Blood TransfusionThere is a lot of concern swirling around about Zika virus, but it is important in times like this that we stay informed. The American Medical Association has provided us with a Resource Center to keep us in the know about Zika Virus and what to do if it occurs. We may know that Zika virus comes from Aedes mosquitos, but there is much more to know about Zika virus and how to prevent it in our lives. There are many questions regarding blood transfusions and Zika circulating around, and it is important that we educate ourselves on the matter. Here are a few common questions and their corresponding answers.

Can Zika be transmitted through donated blood?

The knowledge regarding the ways Zika virus can be transmitted is limited. There is, however, evidence that implies there may be a risk to blood safety. For example, the virus has been detected within blood donors in locations where Zika is circulating. Related viruses such as dengue, West Nile virus, and chikungunya have been transmitted through blood transfusion. In addition, Brazilian health authorities have found two possible cases of transmission of the Zika virus via blood transfusion. This information points to the idea that there is a risk of transferring the Zika virus through blood transfusion.

What precautions can we take to avoid this?

As far as prevention is concerned, a number of precautions can be taken to ensure that the blood supply is safe in countries that are being affected by the Zika virus. Some recommendations include implementing top notch management programs throughout the transfusion process. We also need to ensure that blood donation is repeated, voluntary, and from low-risk populations. There also needs to be proper training for blood services staff and blood products users. Most importantly, blood services must be well organized.

Will blood donations still occur in areas that are affected?

It may be necessary for blood collection to continue in order to meet the needs for blood and its components. This need may arise when a large area of the country is being affected by the outbreak and it is not possible to get blood from unaffected regions.

How could blood donation be tested for the presence of Zika virus?

In some cases, it may be possible to test blood donation for the presence of Zika virus. This would be done using viral inactivation or pathogen reduction technology (PRT) for plasma and platelets. There also may be selective testing in some cases, such as nucleic acid testing for the presence of the virus in blood donors who have recently returned from affected countries. This testing may be considered as an alternative to the deferral that would otherwise occur.

Zika virus is spreading, and it is important to gather all of the facts. If you are thinking about donating blood, or if you or someone you know needs a blood transfusion, make sure that you get all of the facts regarding Zika virus and blood transfusions. Blood Transfusions will still occur, but precautions are being taken to make sure that the Zika virus does not spread through blood transfusions.

 

Putting A Stop To Prescription Drug Abuse: It Starts With Our Doctors

 Putting A Stop To Prescription Drug Abuse: It Starts With Our Doctors

Scientists have made leaps and bounds in the world of medicine, but there are still kinks in the medical field that will need to be worked out. One of those problems is the over-prescribing of painkillers.

While the drug abuse problem in the U.S. will not be single handily fixed with this change, working against over-prescribing will make a large difference. The way health professionals prescribe drugs is a large cause of prescription drug abuse, and tackling this problem from its source will work a lot better than simply pointing the finger at those who abuse the drugs.

Scientists became aware of the prevalence of over-prescribing through a study published in JAMA Internal Medicine. The study was led by Jonathan Chen, MD, a professor at the Stanford University School of Medicine. The study examined Medicare claims from 2013 to see which doctors prescribed opioids. The researchers also looked at how many prescriptions were filled. The term “opioids” refers to a class of drug that includes OxyContin, morphine, and codeine.

The study had some truly eye-opening results. These drugs are being prescribed by all different types of medical professionals, such as doctors, dentists, physician’s assistants, and nurse practitioners. The researchers were surprised to find that the majority of health professionals are contributing to the problem of overprescribing opioids, an issue which was originally thought to be caused by only a small minority of healthcare professionals.

Abuse of prescription painkillers has been a problem throughout the nation, causing concern among policymakers, law enforcement officials, and public health experts. According to the Federal Centers for Disease Control and Prevention, nearly 19,000 people died from overdosing on prescription painkillers in 2014. According to previous research, about 80% of opioids are prescribed by medical professionals. Dr. Chen’s research went further in depth to find that 57% of these opioid prescriptions were filled by 10% of doctors, nurse practitioners, dentists, and physician assistants. This figure implies that the pattern for the opioid prescription is in line with the patterns for other medications, including those that are not typically abused. This means that 10% of doctors and responsible for 63% of medical prescriptions. This shows that the opioid crisis is fueled by more than just a few doctors. The frequency that a doctor prescribes these painkillers is about the same as the frequency that a doctor recommends any other type of medication.

So, what are the real world implications of this research? Chen states that any public health initiatives that set out to end prescription drug abuse need to target all doctors, thus taking a systematic approach. This change can not be brought about unless medical professionals throughout a number of fields are informed about the prevalence of overdosing on opioids. The target needs to shift from a small percentage of doctors that were believed to be causing the crisis to the wide spectrum of medical professionals who are actually causing it. All healthcare professionals need to work to solve this issue in order to change the medical field, and the world, for the better.

3D-Printing Has Revolutionized the Medical Care Field

OLYMPUS DIGITAL CAMERALike everything, the medical care field has evolved, benefitting from maturing expertise, supplemental services, and advanced technologies. 3D-printing, which has been around since the 1980s, has been hammered and honed, and it’s inching its way toward perfection in order to better meet the needs of the medical industry and beyond.

Yes, 3D-printing seems like something imagined in a flashy 1960’s sci-fi spectacular, but 3D-printers have the capacity to save lives, which is no meager feat. These printers have fast-tracked the production of prototypes and lengthened lives through the production of airway splints and other useful functional tools. The dental and non-dental medical uses for 3D-printed technology proves 3D printing for medical applications can solve real problems. It’s the physical solution to responding to patient-specific needs, and this enables the development of personalized medicine that can be manufactured simply and shared widely, which means that cost becomes the secondary concern, and care remains at the forefront.

3D-printed applications are revolutionizing surgical practice. For example, the creation of a custom cardiac model helped surgeons to detect and patch a defect in the ventricles of a 2-year-old’s heart, which reduced operating time, produced better outcomes, and lowered the risk of complications. Professional 3D printers are also instrumental when studying CT scans, for skeletal operations, medical imaging, and 3D-modeling.

In the year 2014, the 3D industry grew by 35.2 percent ahead of a slight slowdown during the year to follow. Nonetheless, 3D printing continues to be cost-effective and accessible, which can, through various processes, be used to synthesize three-dimensional objects –thus revolutionizing healthcare. Within a decade, 3D-printed surgical guides and medical models will become standard procedure for spinal procedures, heart surgery, hip replacement, cranial implants, knee replacements and a variety of other operations. In years to come, engineers will become more experimental, testing the potential of life-changing consequences and healthcare solutions. Already, 3D-printable braces, prosthetics, devices, instruments, skin and organs helpful for face transplants, saving the lives of babies and assisting in cell reconstruction. Additionally, there are 3D-printed casts, 3D-printed ankle replacements, and 3D-printed pills.

The potential for 3D-printing is enormous, and it has the ability to bring treatment to millions of people requiring difficult surgery or prosthetics. Rather than paying $10,000 to $20,000 for a traditional transradial (below the elbow) prosthetic, 3D-printing can make customizable and functional prosthetics available for less than a few hundred dollars.

The possibilities truly are limitless.