iLoveBenefits: Industry News Blog

Innovations to Reduce Non-Urgent Use of Emergency Services

The Agency for Healthcare Research and Quality (AHRQ) announces the August 17 issue of the Health Care Innovations Exchange (

  • The featured Innovations describe how an ambulance provider redesigned its emergency medical services system to create new care and referral pathways for 911 callers not facing true emergencies; a community paramedic program that significantly reduced unnecessary 911 calls from a local shelter and enhanced access to primary care for shelter residents; and a city EMS program that used a multipronged strategy to reduce unnecessary ambulance transports and ED visits, connecting non-emergent patients to primary care.
  • The featured QualityTools include resources for reducing inappropriate emergency department use and tools to support community paramedicine programs.
  • The featured Perspective, Convening a Learning Community to Reduce Non-Urgent Use of Emergency Services, describes the collaborative work of the Innovations Exchange Emergency Services Learning Community, based on an interview with its champion and expert faculty.

Diabetes Spending Reached $16,021 Per Capita in 2014

The Health Cost Institute recently released a study on healthcare spending for diabetes patients. Here are some key findings from the report:

  • Spending on people with diabetes reached $16,021 per capita in 2014, an $897 increase from 2013.
  • Health care spending for people with diabetes rose 6% compared to 3.2% for people without diabetes.
  • The number of ER visits among people with diabetes rose 8.1% annually from 2012-2014.
  • People with diabetes had 7x more filled days of cardiovascular drugs than those without diabetes.
  • Young adults (19-25) with diabetes had 4x more hospital admissions for mental health and substance use.
  • In 2014, insureds with diabetes spent $1,944 out of pocket compared to $752 for those without diabetes.

Source: Health Cost Institute, June 20, 2016

Emergency Doctor’s Perspectives on Getting and Paying for the Care of their Patients

As you look at this survey keep in mind who they are asking and how they are responding. For example, 8 out of 10 are seeing patients…who are foregoing or delaying medical care. While it seems to say that 80% of physicians are seeing at least one patient who is delaying health care, it is not providing the detail about how many patients on the whole are delaying medical care…

And what percent of patients understand their health insurance coverage and how it works?

According to a recent nation-wide survey of emergency physicians:

  • 96% said that emergency patients do not understand what their health insurance policies cover for emergency care
  • 8 in 10 are seeing patients with health insurance who have forgone or delayed medical care because of high costs
  • 62% say most health insurance companies provide less than adequate coverage for emergency care visits
  • Over 60% have had trouble finding in-network specialists to care for patients in the last year
  • A quarter of them say they have trouble finding in-network specialists on a daily basis

Source: “Insurance Companies Mislead Patients By Selling “Affordable” Policies That Cover Very Little,” American College of Emergency Physicians News Release, May 9, 2016,

Patrick Conway on lower hospital ED use

Patrick Conway will be one of the Novembe 2015 Cracking the Code on Health Care speakers in Rochester, NY

CMS official links lower hospital, ED use to support for primary care
A 2% decrease in hospital admissions and emergency department visits can be linked to increased CMS support for primary care, the agency’s chief medical officer, Patrick Conway, told the National Quality Forum’s annual conference. He highlighted several population health and coordinated care projects, initiated by hospitals and physician practices, that have reduced costs and improved quality of care. HealthLeaders Media

Health Care: People are not going to the places closest to their homes

According to a recent analysis of data from the 2009-2010 National Hospital Ambulatory Medical Care Survey:

  • The emergency departments (EDs) that patients visited were located an average of 6.8 miles from the patient’s home, although the nearest ED was an average of 3.9 miles from the home
  • 43.8% of all ED visits occurred at the ED closest to the patient’s home
  • Only 37.2% of ED visits within metropolitan areas took place at the closest ED, compared with 70.1% of visits outside of metropolitan areas
  • In metropolitan areas, the average wait time for being seen (by a physician, physician’s assistant, or nurse practitioner) at the ED closest to a patient’s home was 52.3 minutes, compared withan average wait time of 62.3 minutes for visits to EDs that were farther away

Source: “Emergency Department Visits and Proximity to Patients’ Residences, 2009–2010,” Centers for Disease Control and Prevention, NCHS Data Brief Number 192, March 2015,


Finding waste and potential harm in usual practice

Study finds head CT for dizziness, syncope often unnecessary A study in the American Journal of Roentgenology found 7.1% of emergency department patients who had head CT scans due to dizziness showed acutely abnormal findings, as did 6.4% of those who presented with syncope or near syncope. Researchers said the results suggest imaging may be overused in such cases, exposing patients to radiation and additional cost with no benefit. Patients who may benefit from CT are those older than 60 or who have a focal neurologic deficit or a recent history of head trauma, they said. Medscape (free registration)

February 4, 2015 | Categories: healthcare,hospitals,quality | Tags: , , , , | Comments (0)

Use of copays do not reduce Medicaid members use of ERs

JAMA internal Medicine published a study conducted by Johns Hopkins Researchers showing that Medicaid copayments do not significantly reduce Medicaid recipients’ use of emergency rooms.  “Our study suggests they will need to look at other strategies besides requiring copayments. There was little evidence that cost-sharing would have any impact on the use of emergency rooms by poor people, who often have few other health care options,” said the lead author of the study.

5% of Seniors Admitted to Hospital within 1 Week After ER Release

Study: Close to 5% of older ED patients are hospitalized within a week A study in the Journal of the American Geriatrics Society revealed close to 5% of seniors who visit the emergency department are hospitalized within a week of being released. Old age was among the predictors of hospitalization, and end-stage renal disease, chronic kidney disease and congestive heart failure were the conditions tied to the highest likelihood of admission. News (1/23)

Hospital Utilization, Four-Year Annualized Rate of Change

As cited in a Truven Health Analytics Health Leaders Media Fact File, hospitals have experienced flat or declining utilization of key services. The exception is among major teaching hospitals which have stronger performances in key areas.

% Change Major teaching hospitals All hospitals
Observation visits 6.90% 4.23%
Emergency room visits 3.56% 0.65%
Ambulatory surgery cases 4.56% 0.11%
Operating room cases 5.09% -0.09%
Acute care discharges 3.65% 0.02%

Note: Data from July/August 2014.

Source: Truven Health Analytics

Providing a written plan. . . of care

Most cancer patients enter survivorship with little direction from oncologists or primary care providers, according to a national survey.

Two-thirds of 1,130 oncologists said they always or almost always discuss survivorship with patients, but only a third told patients where to seek cancer-related or other care. Fewer than 5% of oncology respondents provided patients with a written plan for survivorship care.

Read more here: Of 1,020 primary care providers surveyed, 12% reported regular discussions about recommendations for survivorship care or provider responsibility, as reported online in the Journal of Clinical Oncology.

Most who follow me know that I have a vision for how health care will evolve. The next two big things that need to occur are transparency of pricing – what patients are expected to pay for the services they receive – estimates if not actual prices based on the insurance they have and the current terms of that insurance. And not necessarily in this order a plan of care.

Let me explain what is meant by a plan of care. It goes well beyond the story in the Journal of Clincal Oncology. That is just one example.

It is a plan that every person should have. It is the equivalent of a financial plan. It is something that the patient has the key to access, a portal and a document through which to view and understand their medical condition and the actions that they or their caregivers need to take to optimize the outcomes that patient is seeking. It is something that the patient enables others including their providers and caregives to view and to add to with their special knowledge and information. It spans every episode of care. Whether that is a prevention episode, a wellness episode, an acute episode, a chronic episode, even a secondary prevention episode.

It enables hospital discharge instructions to be cleanly handed off to family caregivers, rehabilitation caregivers, other physcians or nurses caring for the patient. It enables the primary care physician to view what all other parts of the health system are contributing to the health of the patient. It provides a means of communicating with the patient while in the office and to be sure that the instructions are clear when they leave the office. It helps turn the office visit into a counselling session rather than simply a visit and script.

It links physician to nurse, pharmacy to physician, hospital to rehab or nursing facility. It helps turn siloed health care services into a system of organized and informed health processes focused on the patient.

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