WhiteCoat

Healthcare Policy Update June 16, 2009

Want fries with that? Stanford Hospital experiments with the first drive-thru emergency department. Examining people sitting in their driver’s seat may “keep them from infecting others” but it will also keep doctors from fully examining a patient. Would be interested to see outcomes measures with this idea. If outcomes are similar, what is the big leap between drive up EDs and telephone medicine? After all, you can just ask a patient to put the telephone receiver to their heart for a moment …

Ohio is breaking new ground in its tort reform attempts. According to this article, the legislature is seeking to make it harder to file lawsuits against emergency physicians and against obstetricians (text of bill here). Other states such as Florida and Georgia have already passed such laws. Good idea?

What’s with violence in the EDs lately?
A Washington man walks up to the emergency department doors and shoots himself in the head while ED staff watches on the security camera.
A cop cuffs a stabbing victim to a wheelchair in the ED and then beats him with a sap. Smile, bud, you’re on Candid Camera. That lapse in judgment will get you a few years in the Greybar Motel.

One way to reduce wait times in the ED — order sets. Instead of waiting for the physician to see a patient to order tests, nurses order tests at triage and have the test results ready before the doctor goes into the room. This Canadian hospital reduced wait times by 50% after implementing such a system.

A hospital in the lower Florida Keys used to receive a subsidy to treat indigent patients who were not eligible for Medicaid. Now the subsidy is gone. So is a lot of the care.

UTMB in Galveston is reopening its hurricane-damaged emergency department effective August 1, 2009. Second article here. Previously commented about UTMB’s decision to close its emergency department and open an urgent care clinic, therefore being able to skirt EMTALA requirements.  One commenter to the article jokingly wonders whether a forecast for a hurricane to hit the area on August 2, 2009 had any bearing on the opening date.

Another Texas hospital is using a nursing call-in line to direct patients to “the right place to go.” They’re apparently trying to direct non-urgent patients away from the emergency department. But is their idea of doing phone triage on patients already in the emergency department going a little too far?

OK, ACEP and Chicago Tribune, dust off your pitchforks. The nation flipped out about the University of Chicago’s plan to discharge non-urgent patients from its emergency department if the patients could not or would not pay for their medical care. Now HCA, the nation’s largest for-profit hospital chain, is planning to do the exact same thing. In a pilot study at several of its hospitals, HCA noted that 40% of ED visits were classified as non-urgent. When given the opportunity to pay in advance to receive medical care, only 1% of the non-urgent patients decided to do so. Lest you had any doubts … in the article, the Chief Operating Officer of HCA assured everyone: “It isn’t about the cash.”

14 Responses to “Healthcare Policy Update June 16, 2009”

  1. supastar says:

    u sure the anderson cooper link’s correct?

  2. ERP says:

    That part on wait times being reduced by RN’s ordering tests in traige is ultimately a bad idea. One of two things happen at my hospital when they do this. A. They order TOTALLY unnecessary tests – like septic w/u’s on people with fever and flu sx or cardiac w/u’s on totally bogus, noncardiac chest pain. B. They don’t order the right tests. They x-ray the wrong part of the body. They don’t order the right blood tests because they either don’t understand enough or don’t get enough info during the quick triage process.
    Unnecessary tests cost money and make people wait even longer for them to come back – and often necessitate unnecessary other tests to confirm or refute the results of the first one!
    Tests that are necessary but not ordered just cost the whole process more time.

  3. k says:

    WRT Chicago police officer Cozzi: Hospital security called CPD due to the victim’s drunken, belligerent behavior. Cozzi admitted his poor judgment, served his sentence and was ready to return to work. CPD Supt., former FBI agent Jodi Weis, turned the case over to the Feds as a civil rights matter. This circumvented double jeopardy but cost Cozzi 3.5 years in the penitentiary, his job, and both his police and military pensions. Needless to say, this has p.o.’d many Chicago POs. I do not condone Cozzi’s behavior, but I question Weis’s judgment and decision. (Disclaimer: I am not a cop.)

    It’s nice to be have HCA to pick on. UCMC deserves a chance to help Provident (a Cook Co. owned/operated hospital) take care of certain financial needs in return for the ability to send uninsured and Medicaid patients there:

    University of Chicago Medical Center plans to pour money into Cook County’s Provident Hospital as officials work toward a major affiliation.

    [UCMC] has lined up $5 million in state funding for upgrades at nearby Provident. U of C intends to match that amount and eventually could help arrange up to $20 million in funding to equip Provident for much-needed specialty services, urgent care and a maternity unit… Provident is key to making U of C’s program work: It’s just 12 blocks away, desperately needs fresh revenue and has plenty of empty beds thanks to a bad reputation forged by years of poor management.

    Meanwhile, Provident may have to cut the number of patients it treats to make ends meet.

    The hospital’s chief operating officer, Sidney Thomas…said the hospital is short 25 nurses. Nurses are less likely to apply for jobs at Provident, he said, because of media attention on the possibility of the hospital closing due to county budget cuts…The hospital is considering cutting an undetermined number of its 119 beds.

    All of this after a group of UCMC workers, patients, and US Representative Bobby Rush all say UCMC is ignoring its medical responsibility to the community.

    “We are turning away patients that we used to take,” said Debra Hughes, a hospital admissions staffer and liaison to Teamster 743….Hospital staffers are being pushed out because they cannot afford care at U of C. “You can clean it, but you can’t afford the deductable,” [Hughes] said…The university denies it is pushing poor patients out, and says it sees more Medicaid patients than any hospital in the state.

  4. scalpel says:

    Your first link doesn’t work. Try this one.

  5. BK says:

    the anderson cooper link is broken

  6. Max Kennerly says:

    The Ohio article didn’t give any details, so I followed the link, which has a proposed bill only for emergency physicians: http://bit.ly/vUWFe

    There’s a lot of issues raised by it, but let me highlight one. One portion says “… a physician who provides emergency medical services … in compliance with the Emergency Medical Treatment and Active Labor Act, … is not liable in damages to any person in a tort action for injury, death, or loss to person or property that allegedly arises from an act or omission of the physician in the physician’s provision of those services or that treatment or care if that act or omission does not constitute willful or wanton misconduct.”

    That’s an interesting one. So are they only protected while they do the “screening & stabilization” required under EMTALA? If so, then this “immunity” gets sliced up by a lot of the case law out there limited EMTALA’s reach.

    Take your “Trial of a WhiteCoat” patient: his problem, and the alleged malpractice, occurred once he was already in the ER, and apparently after a basic screening had been done and had found no emergency condition. At that point, EMTALA stopped applying; I’d argue the immunity did, too.

    I don’t know what the drafters of the bill are getting at, but, as worded, I’d say they’ve just handed a couple million dollars in extra billing to insurance defense lawyers, and have subtracted from plaintiffs’ lawyers (and judges!) thousands of hours trying to interpret federal case law on EMTALA.

  7. Chris says:

    To Max’s point, the goal of the legislation is to protect any doctors working in EDs that are in compliance with EMTALA (essentially all hospitals EDs). There is some confusion about this and there will likely be revisions in the bill (there was a second hearing to hear testimony scheduled this week).

    We just published a longer story: Emergency doctors nationwide finding protection from ERs gone wild. Ohio is the latest state to tackle the issue.

  8. Matt says:

    I’m curious as to why we would want a policy insulating ER docs from their negligence, even gross negligence? Are there some statistics out there showing that Ohio has some problem this will solve?

  9. [...] « Healthcare Policy Update June 16, 2009 [...]

  10. thales says:

    Matt;

    “I’m curious as to why we would want a policy insulating ER docs from their negligence, even gross negligence? Are there some statistics out there showing that Ohio has some problem this will solve?”

    You are curiously adept at missing the point. There is a serious and growing shortage of ER docs, as well as ERs nationwide. Defensive medicine is variously estimated to cost the US $200 billion to $700 billion.

    Every normal person expects trial lawyers to argue eloquently and persistently against tort reform, just as buggy whip manufacturers argued against the advent of the automobile. This is probably the main reason why more people do not take you seriously.

  11. Matt says:

    “There is a serious and growing shortage of ER docs, as well as ERs nationwide. ”

    How many are there supposed to be?

    ” Defensive medicine is variously estimated to cost the US $200 billion to $700 billion.”

    If you have an estimate that wide, your number doesn’t mean much.

    “Every normal person expects trial lawyers to argue eloquently and persistently against tort reform, just as buggy whip manufacturers argued against the advent of the automobile. This is probably the main reason why more people do not take you seriously.”

    Perhaps. But no one takes it seriously until it’s them who is injured by someone else’s negligence.

  12. [...] Call Room — the author of which is going through his own malpractice lawsuit — has picked up and run with the discussion we started over whether emergency physicians deserve the civil immunity [...]

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