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Houston telemedicine system cuts trips to the ER


It’s long been clear that most 911 calls don’t require a trip to the hospital!

Houston’s telemedicine system may be a model for paramedics around America for cutting the number of those very expansive trips. reports:

“In 2014, the city launched a telemedicine service that has reduced 80 percent of the number of unnecessary emergency visits. The program is called ETHAN, which stands for Emergency TeleHealth and Navigation. It works like this: When paramedics arrive at the scene of an emergency and realize a patient doesn’t need to be rushed to a hospital, they use a tablet to video chat with a specialist. For instance, a patient can chat with a nurse to get a prescription refilled or get an appointment scheduled on the spot with their primary care doctor for joint pain.”

The program is said to have  prevented 6,000 unnecessary ER transports. The average teleconference visit is only about seven minutes, and the cost of treating a patient virtually is around $220 — way less than the $2,200 to transport someone to the ER, Governing reported.

To read more, please hit this link.

Illinois system provides housing to reduce ER use


The University of Illinois Hospital (UI-Hospital) and Health Sciences System have an initiative to provide furnished apartments and support services for homeless patients, in part to reduce their use of hospital emergency departments.

FierceHealthcare reports that before the program, which started in 2015,  “seven of the top 10 users of the organization’s ER were chronically homeless and accessed the system between 30 and 120 times a year. The organization’s $250,000 investment in the program has led to impressive results, reported AHA News. So far, the monthly hospital visits have declined by 35% and the annual cost of care for these patients dropped more than 40%.”

“In addition to housing, patients are assigned a case manager who coordinates their care and helps them manage money,” reported the news service.

“Peter Toepfer, associate vice president of housing for the Center for Housing and Health, which partners with the hospital, told AHA News that hospitals and health systems must view patients who are chronically homeless the same way they consider chronic illnesses. The best prescription, he said, is providing a homeless patient with permanent supportive housing.

“SBH Health System, based in New York City’s Bronx borough, is working on a similar initiative by partnering with a developer to build housing for low-income patients,” reported FierceHealthcare.

To read more, please this link.


Community paramedics help keep patients out of ERs


Some health systems and paramedic organizations are pushing to do more work  in patients’ homes of the sort traditionally done in hospital emergency rooms.  That most commonly involves older patients, many of whom make frequent visits to the ER and then are admitted as hospital inpatients, at great cost to payers.

And, The New York Times notes, “Geriatricians have warned for years about the ways in which hospitalization can accelerate older patients’ decline, even when physicians succeed in fixing the medical problem at hand” in an ER.

“Emergency rooms often serve as gateways to longer stays, and the time spent in bed leads quickly to deconditioning. Older people who walked in on their own often cannot walk out, and need rehab and physical therapy to try to regain their mobility.”

“They’re also vulnerable to hospital-acquired infections, including the rampant C. difficile, that can prove difficult to eradicate. Newly prescribed medications can interact badly with those they already take.”

“For all these reasons, plus the sky-high costs of emergency medicine and hospitalization, community paramedic practices are multiplying across the country,” to help keep patients in what is often the safest (and certainly most comfortable) place for them — their homes.

The Times notes that ”the concept may spread even faster if insurers, particularly Medicare and Medicaid, would cover at-home treatment by paramedics. Right now, emergency services are reimbursed only for ferrying people to hospitals.”

To read The New York Times story on this growing trend, please hit this link.

Study: Longer PCP hours = fewer ER visits


A British study suggests that keeping primary-care practices open for more hours, particularly on nights and weekends, cuts visits to hospital emergency departments for non-life threatening illnesses and injuries, reports Medical Economics.

Researchers at the University of Manchester, in  England, determined that practices that extended their hours beyond the British standard of 8:30 a.m. to 6:30 p.m. had a 26.4 percent reduction in patients seeking local emergency department visits for minor problems.

“The difference amounted to 10,933 fewer ER visits in a year. For every three additional primary-care slots booked, one visit to the ER was avoided.” said Medical Economics in summarizing the study.

But are longer hours practical for most primary-care practices? Nitin Damle, M.D.,  president of the American College of Physicians and an internist in Rhode Island, told Medical Economics that they are.

“We have had after-hours and Saturday morning hours for 15 years,” he says. “We find it helpful to patients, and it seems to decrease ER use modestly along with providing continuity of care.”

To read the Medical Economics piece, please hit this link.

Using intensive care coordination to reduce costs of super users


Don Meade doesn’t like hospitals, but he uses them. In just one year, he made 62 trips to the emergency room. He rattles off the names of local hospitals in Orange and Los Angeles counties as if they’re a handful of pills.

“St. Joseph’s in Orange, (Saddleback Memorial in) Laguna Hills,” he says. “The best one for me around here is PIH in Whittier.”

At 52, Meade has chronic heart disease and other serious ailments, and he is recovering from a longtime addiction to crack cocaine. Today, he lives with his dog, Scrappy, in a small apartment in Fullerton, Calif.

Beyond making a trip to the ER pretty much every week of the year, Meade has had innumerable X-rays, scans, tests and hospital admissions – all of it on the taxpayers’ and hospitals’ dime, since he is a beneficiary of Medi-Cal, the state and federal program for the poor.

“The doctors and a few nurses knew me (by name), and I told them I should get some stock in the hospital because I was there so much,” he muses.

As healthcare costs continue to rise, attention has turned to a tiny number of expensive patients like Meade, called super-utilizers. A program that started in Orange County has taken a different approach to treating Meade and other high-cost patients: Over the past two years, it has tracked them, healed them and saved a ton of money along the way.

Meade received more than a million dollars’ worth of care in each of the two years before he entered the program, according to Paul Leon, CEO of the Illumination Foundation, a  health-services group for the homeless based in Irvine, Calif. Leon’s foundation runs the program, known as Chronic Care Plus, which has stabilized Meade and found him housing.

“It’s crazy,” said Maria Raven, an associate professor at the University of California at San Francisco who specializes in frequent-user policy. “This small group of people makes quite an impact on the healthcare system, and on the finances of the care system.”

In Medi-Cal, the state’s health-insurance program for the poor, frequent  users representing just 1 percent of the patient population account for about one-fourth of  spending, according to Kenneth Kizer, M.D., at the Institute for Population Health Improvement at UC Davis.

That’s why health professionals across California have started targeting this problem group.

In a small, busy room at a recuperative care center in Santa Fe Springs, just up Highway 5 from Disneyland, the Chronic Care Plus program’s lead nurse, John Simmons, directs treatment for a select group of homeless frequent users.

Simmons says the big secret about these healthcare frequent fliers is that they’re not necessarily the sickest patients – they’re often just homeless, with substance-abuse and/or mental health issues, and they routinely end up in the emergency room.

“It was them relying on the ER for everything,” Simmons said. “They got a common cold, they’d want to run to the ER.”

To break the cycle, Simmons conducts what is known as intensive care coordination. He helps the 37 participants, including Don Meade, find housing, get off drugs, get access to services, and make appointments with primary-care doctors.

The Illumination Foundation launched the program with the goal of breaking the vicious cycle into which these patients had fallen, then following them over a two-year period. Getting consistent care and support for that length of time, Simmons says, can change their lives for good.

“The beauty of the program was, we took those people and got them self-sufficient,” Simmons said, “and you notice their health (go) on an upward trend.”

The program saved $14 million in healthcare spending for just those 37 people over two years, compared with the two years prior to the launch of the program.

That doesn’t count the savings attained by using fewer police and emergency transportation services, Simmons said.

Saving so much money with so few participants is an open invitation to expand the program, said Pat Brydges, an administrator at St. Joseph’s Hospital, which helped fund the program.

“There are homeless people in every city in every state,” Brydges said. “There’s no reason why this wouldn’t work across the nation.”

The program is consistent with St. Joseph’s mission to help all people, and the cost savings is an extra perk, she said.

She pauses briefly to contemplate how much money would be saved if this tiny pilot program went national.

“Wow, I don’t even know if I could count that much,” Brydges said. “But if we can do $14 million in this one area alone, it’s amazing what we could do across the nation.”

Back in his Fullerton apartment, Meade said he now sees a primary-care doctor instead of going to the emergency room. He still has ongoing heart and health problems.

Being followed by program coordinators over such a long time has really made a difference in his life, Meade said.

“A lot of the stress leaves after you’re in your own home, but if you’re out in the street you’re worried so much all the time,” he said.

Getting off the street is one thing, Meade said, but the staying off it is another. It’s not just that he has his own physician now, and better health. He has a new life, he said.

The Illumination Foundation plans to release data at the end of June on its first two years.



Study details fall in ER use in Oregon


Because of Oregon’s expansion of  Medicaid,  the rate of visits to emergency departments  as well as hospital readmissions have dropped despite  a more than 50 percent increase in the number of people using the program, according to a new analysis by the state.

Key findings of the report include:

  • 83.8 percent of Medicaid beneficiaries were able to receive appointments and care when they needed it, up slightly from 83 percent in 2014.
  • 43.1 enrollees visited an emergency department per 1,000 member months, compared with 47.3 in 2014.
  • 8.6 percent of adult Medicaid beneficiaries were readmitted to a hospital within 30 days of discharge, down from 11.4 percent.

The drop in ER use is especially surprising. In 2008, the state used a lottery to expand its Medicaid program for low-income adults and studies  showed an uptick in ER use.


To read the state report, please hit this link.

Using ‘lean’ techniques to slash ER waits


An article in Healthcare Informatics reports on how Kaiser Permanente South Sacramento, one of California’s busiest emergency departments, slashed patient-wait times to far below the national average thanks to adopting the sort of ”lean” processes used in manufacturing.

Kaiser South Sacramento’s average wait time is only 19 minutes, less than half the national average of 58 minutes. Length of stay is also down to 43 minutes for low-acuity patients, compared to the 118-minute national average.

To help achieve this, Kaiser  streamlined its extensive triage process, cut its screening exam from 19 minutes to two minutes, and now has physician-nurse teams control patient flow.



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