News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. Since January, 2021, over 1,800 news reports have been chronicled, with 49% highlighting the EMS staffing crisis, and 34% highlighting the funding crisis. Combined reports of staffing and/or funding account for 83% of the media reports! 96 reports cite EMS system closures/agencies departing communities, and 95% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log as of 3-27-24 READ Only.xlsx

  • 3 Aug 2017 2:00 PM | AIMHI Admin (Administrator)

    CMS has issued its Inpatient Prospective Payment System final rule for fiscal year 2018, which increases payments to acute care hospitals next year.

    The 2,456-page rule also includes proposed rates for long-term care hospitals. Overall, the final rule applies to about 3,330 acute care hospitals and 420 long-term care hospitals.

    Here are 10 key points from CMS’ final IPPS rule.

    Payment update
    1. Under the final rule, acute care hospitals that report quality data and are also meaningful users of EHRs will receive a 1.2 percent increase in Medicare operating rates in fiscal year 2018.

    2. CMS arrived at its rate of 1.2 percent through the following updates: a positive 2.7 percent market basket update, a negative 0.6 percentage point update for a productivity adjustment, a positive 0.45 percentage point adjustment required by the 21st Century Cures Act, a negative 0.75 percentage point update for cuts under the ACA and a negative 0.6 percent updated to remove the adjustment to offset the estimated costs of the two-midnight rule.

    3. CMS projects the rate increase, together with other changes to IPPS payment policies, will cause total Medicare spending on inpatient hospital services to increase by approximately $2.4 billion in fiscal 2018.

    Medicare disproportionate share hospital payments
    4. CMS will use data from its National Health Expenditure Accounts instead of data from the Congressional Budget Office to estimate the percent change in the rate of uninsurance, which is used in calculating the total amount of uncompensated care payments available to Medicare Disproportionate Share Hospitals. CMS said this change will result in Medicare DSH payments increasing by $800 million in fiscal year 2018.

    5. CMS will use worksheet S-10 data to determine uncompensated care payments and distribution beginning in fiscal year 2018.

    Hospital Inpatient Quality Reporting Program
    6. Under the final rule, CMS will replace the pain management questions in the HCAHPS Survey to focus on the hospital’s communications with patients about the patients’ pain during the hospital stay. This change will take effect with surveys administered in January 2018.

    7. CMS finalized several changes to the electronic clinical quality measures and updated the extraordinary circumstances exception policy.

    Hospital Readmissions Reduction Program
    8. CMS will implement the socioeconomic adjustment approach mandated by the 21st Century Cures Act for the fiscal year 2019 Hospital Readmissions Reduction Program. CMS will assess penalties based on a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and Medicaid.

    EHR Incentive Program
    9. For 2018, CMS modified the EHR reporting periods for hospitals attesting to meaningful use from a full year to a minimum of any continuous 90-day period during the calendar year.

    Hospital Value-Based Purchasing Program
    10. CMS will remove one measure in fiscal year 2019 and adopt one new measure in FY 2022 and another in FY 2023. CMS will remove the PSI 90 measure from the safety domain beginning in FY 2019, and adopt the patient safety and adverse events composite PSI 90 measure beginning in FY 2023. CMS will also adopt the hospital-level, risk-standardized payment associated with a 30-day episode of care for pneumonia measure for the efficiency and cost reduction domain in FY 2022.

    For those who want more info on the PSI 90 measures, here’s more info:
    https://www.qualityindicators.ahrq.gov/News/PSI90_Factsheet_FAQ.pdf

  • 25 Jul 2017 1:30 PM | AIMHI Admin (Administrator)

    Kohlberg Kravis Roberts & Co., the private equity giant that sold most of its stock in HCA a year ago, agreed Monday to acquire WebMD for about $2.8 billion, KKR announced Monday.

    KKR is paying $66.50 per share for publicly traded WebMD, a 20% premium over WebMD’s closing price Friday of $55.26.

    WebMD’s shares jumped to $65.98 by 11 a.m. ET Monday.

    WebMD is the nation’s largest online health information portal, serving consumers and clinicians with public and private sites and publications.

    The company’s board and management put the business up for sale in February when its stock was trading about 30% below KKR’s offer Monday.

    KKR’s Internet Brands is the umbrella company buying WebMD. KKR will begin a tender offer of the shares within 10 days, it said in a release Monday.

    The private equity firm, which has about $100 billion under management, is no stranger to healthcare. It was one of the main investment groups that took hospital chain HCA private in 2006, then public again in a 2011 initial public offering.

    A year ago, KKR sold back to HCA about 9.4 million of HCA’s common shares for $750 million.

    Despite the divestiture of shares, KKR remains one of HCA’s largest institutional shareholders with 5.2 million shares outstanding or 1.5% of its stock as of Dec. 31, according to Morningstar.

  • 21 Jul 2017 4:00 PM | AIMHI Admin (Administrator)

    The CMS is interested in launching a new pay model that will target behavioral health services and is seeking public comment on what the new effort should look like.

    On Thursday, the CMS announced that its Innovation Center would like to design a payment or service delivery model to improve healthcare quality and access for Medicare, Medicaid or Children’s Health Insurance Program beneficiaries with behavioral health conditions.

    The model may address the needs of beneficiaries battling substance use or mental disorders. It could also target Alzheimer’s disease and related dementias.

    The Innovation Center will be soliciting ideas at a public meeting on Sept. 8 at CMS headquarters in Baltimore.

    The announcement comes at a time when agency officials say they are still committed to value-based care. For months, there have been concerns the CMS would abandon its move toward value-based pay models after Dr. Tom Price became HHS secretary. Price had been critical of the Innovation Center and bundled-pay efforts when he was a member of Congress.

    These concerns intensified when the CMS delayed the effective dates for four Obama-era bundled-payment initiatives covering cardiac and orthopedic care and announced it was seeking public comment on the overall future of the models. The agency also announced plans to allow up to 800,000 small and rural providers to be exempt from the new quality reporting system outlined in the Medicare Access and CHIP Reauthorization Act.

    Since then, CMS officials have reiterated that clinicians who have invested millions in implementing pay models or the quality reporting system under MACRA don’t need to worry about the CMS changing course.

    “The horse is out of the barn on this,” Dr. Kate Goodrich, chief medical officer at the CMS said at a bundled-pay summit in late June. “We will be continuing this progress towards value-based care under this new administration.”

    However, the Trump administration’s value-based efforts may differ from the prior administration’s in terms of how much Medicare spending will be tied to new models of care.

    The Obama administration wanted 30% of payments for traditional Medicare benefits to be tied to alternative payment models such as accountable care organizations or bundled-pay models by the end of 2016 and had set a goal of hitting 50% by the end of 2018.

    The Obama administration hit the first goal last March, but it’s unclear if the Trump administration will shoot for the second one, according to Goodrich.

    “We are currently thinking about what we want the next set of goals and targets to be,” Goodrich said.

    Freezing implementation of various models was merely new leadership’s attempt to better understand them and their potential benefits, according to Christina Ritter, director of the patient care models group at the CMS.

    “These kinds of delays a very typical for a new administration,” Ritter said at last month’s summit. “I want to make sure people understand that before there is a whole ton of reading tea leaves.”

  • 21 Jul 2017 10:00 AM | AIMHI Admin (Administrator)

    Patients in rural areas face long waits for paramedics to arrive, according to a new study.

    Researchers reviewed data on more than 1.7 million emergency medical services runs from 485 agencies in 2015 and found that 1 in 10 rural patients waited half an hour for emergency personnel to arrive. The average wait in urban and suburban areas was 6 minutes, while the average was 13 minutes in rural areas. The findings were published Wednesday in JAMA Surgery.

    The average wait time overall was 7 minutes, according to the study. The findings underscore the importance of training more people in CPR and other potentially life-saving techniques. The American College of Emergency Physicians (ACEP) has launched a campaign called “Until Help Arrives” that aims to empower people to provide care to the ill or injured while they wait for emergency responders to arrive.

    “Those 7 minutes—or even longer in rural areas—are ripe for bystander intervention, especially for bystanders trained in first aid and/or CPR,” Howard Mell, M.D., a spokesperson for ACEP and one of the study’s authors, said in an announcement.

    Patients in rural areas face a number of healthcare challenges outside of trauma and emergency care, but a 2016 study found that just 29% of rural patients treated by EMS personnel are taken directly to a major trauma center, whereas 79% of patients in urban areas are taken to Level 1 or Level 2 facilities.

    In addition to patients in more remote locations having limited access to care options, many rural providers are cash-strapped and at risk of closing, which could leave some people in “medical deserts” where they have no care options nearby at all.

    Emergency crews in these regions are also being asked to do more with less, and a number perform procedures in patient homes, like starting intravenous antibiotics or intubating patients, based on the distances they have to travel.

  • 17 Jul 2017 5:00 PM | AIMHI Admin (Administrator)

    A new Commonwealth Fund report finds the U.S. has the highest costs and lowest overall performance compared to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.

    http://www.fiercehealthcare.com/healthcare/when-it-comes-to-healthcare-u-s-once-again-ranks-last-quality-care-compared-to-other

    The United States spends more on healthcare than other wealthy nations, yet ranks dead last on equity, access, efficiency, care delivery and healthcare costs.

    Despite progress made in providing coverage to previously uninsured Americans via the Affordable Care Act, the latest report from The Commonwealth Fund finds that the United States offers its citizens the least financial protection among the 11 high-income countries surveyed. It is also the only one without universal health insurance coverage.

    Indeed, the U.S. has the highest costs and lowest overall performance compared to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. The U.S. spent $9,364 per person on healthcare in 2016, compared to $4,094 in the U.K., which ranked first on performance overall.

    Forty-four percent of lower income Americans and 26% of higher income U.S. citizens reported financial barriers to care. Remarkably, the report noted, someone with a high income in the U.S. was more likely to report financial barriers to healthcare than a low-income person in the U.K.

    “What this report tells us is that despite the substantial gains in coverage and access to care due to the Affordable Care Act, our healthcare system is still not working as well as it could for Americans, and it works especially poorly for those with middle or lower incomes,” Commonwealth Fund President David Blumenthal, M.D., said in an announcement. “The healthcare policies currently being contemplated in Congress would certainly exacerbate these challenges as millions would lose access to health insurance and affordable healthcare.”

    This isn’t the first time the U.S. has fared poorly compared to other nations. Since 2004, it has ranked last in every one of six similar reports. This year the Commonwealth Fund added new measures and refined the scoring to give each country an overall score, as well as a score on five specific areas of performance. The new approach ranked the U.K. Australia and the Netherlands as top performers. New Zealand, Norway, Switzerland, Sweden and Germany were in the middle of the pack. Canada and France were near the bottom but performed better than the U.S.

    Another recent global report found massive inequity within the United States in terms of access to care and the quality of care provided.

    But it’s not impossible for the U.S. to move from last place to first among wealthy countries if it heeds the lessons offered from top performing countries, notes Eric Schneider, M.D., the lead author of the study and senior vice president for policy and research at the Commonwealth Fund, and David Squires, former senior researcher to the president at the Commonwealth Fund, in a piece for The New England Journal of Medicine.

    This would mean the U.S. must expand health insurance coverage, such as universal coverage that provides citizens with healthcare they need at little or no cost; invest more in primary care so that it is accessible on nights and weekends; cut down on the administrative paperwork that physicians must complete so they can spend time on providing care; and invest more in social services to reduce healthcare disparities.

    “If we are going to be the best, we have to do better for patients,” Schneider said in the announcement. “We are not the U.K., Australia or the Netherlands, and we don’t have to be. Each of those countries follows a different path to top performance. A country that spends as much as we do could be the best in the world. We can adapt what works in other countries and build on our own strengths to achieve a healthcare system that provides affordable, high-quality healthcare for everyone.”

  • 14 Jul 2017 3:30 PM | AIMHI Admin (Administrator)

    A low-income person, eligible for Medicaid but not enrolled, is hit by a car or a bullet. Gravely injured, she arrives at the hospital unconscious. Thanks to expert, intensive care that lasts for days or weeks, she gradually recovers. Eventually, her health improves to the point where she can complete the paperwork needed to apply for Medicaid.

    Such a hospital can be paid today, thanks to Medicaid’s “retroactive eligibility.” Even if the combination of medical problems and bureaucratic delays prevents an application from being filed and completed for several months, Medicaid will cover the care if the patient was eligible when services were provided.

    The newest version of the Senate health bill—the Better Care and Reconciliation Act, or BCRA—would end this longstanding feature of the Medicaid program for beneficiaries who are neither elderly nor people with disabilities. If services are received in one calendar month and the application is completed the following month, the hospital would be denied all payment, even if the patient was eligible and the services were both essential and costly.

    It does not matter if the state is led by a governor who understands the devastating impact of this change on hospital infrastructure, especially in rural areas where many hospitals are hanging on by a thread. Today, states have the flexibility to seek waivers that limit retroactive eligibility. Under the BCRA, that flexibility would disappear, as states are forced to end retroactive coverage, whether they like it or not.

    Almost certainly, this provision would come as a surprise to most senators who are being asked to support the BCRA. It is only one of many unpleasant surprises lurking largely undiscovered throughout the bill.

    Following are other selected examples.

    A Massive Expansion In Federal Power Over State Budgets
    The BCRA grants the federal government startling new power over state Medicaid programs and state budgets. Federal dollars per person would be capped, based on state data about prior spending. But in setting the initial cap for each state, the secretary of Health and Human Services (HHS) could change the amount to rectify what the secretary views as problems in the “quality” of state data. In later years, many states could have their caps adjusted up or down by as much as 2 percent per year. That may sound like a small number, but when applied to billions of federal Medicaid dollars going to a state, it could make or break a state’s entire budget. Medicaid costs triggered by a public health emergency are exempt from the cap, but only if “the Secretary determines that such an exemption would be appropriate.” No statutory limits bound the Secretary’s use of this decision-making authority, which can have an extraordinary fiscal impact on states experiencing an epidemic or other public health crisis.

    These provisions would give HHS remarkable new leverage over states, which current or future administrations could use to compel state policy changes in any desired direction. The aggressive use of available leverage has been an unfortunate feature of past administrations’ relationships to state Medicaid programs, but it could become substantially more pronounced with the increased federal authority granted by the Senate bill.

    Adding To Uncertainties Surrounding State Expenditures
    One recurring theme in Medicaid’s history involves state efforts to claim federal matching funds without spending the requisite state dollars. The Senate bill appears to increase this risk. Under Section 207 in the Senate bill, new opportunities emerge for states desperate to counteract the loss of billions of federal dollars. The bill authorizes unprecedented waivers involving federal funding for tax credits that help consumers buy private health insurance. So long as officials complete a form explaining how the waiver’s replacement of federal safeguards would provide an “alternative means” of increasing “access to comprehensive coverage, reducing average premiums, and increasing enrollment,” a state arguably could convert some or all of this federal money into so-called “pass-through” funds that can be used for purposes unrelated to health care. Unlike the Senate bill’s new public health emergency provisions, which require federal audits of state expenditures, states’ use of pass-through dollars has no statutory audit requirement. A state could convert subsidies meant for health insurance to other uses, or simply use the money to close a budget shortfall. As the Congressional Budget Office (CBO) explained about the virtually identical prior version of this section, the Senate health care bill would “substantially reduce the number of people insured” if states “reduced subsidies, received pass-through funds, and used those funds for purposes other than health insurance coverage.”

    Medicaid Treatment For Mental Health And Substance Use Disorders
    The bill repeals the current requirement that Medicaid programs must cover all “essential health benefits,” including treatment of mental health and substance use disorders. CBO found that, as the per capita limits in the Senate bill grow progressively tighter, federal Medicaid funding would eventually decline by more than a third, compared to current law. States facing such an enormous drop in federal support may see themselves as having no alternative but to cut services classified as optional, which the Senate bill redefines to include mental health and substance abuse treatment.

    A Disordered Process
    These problems could have been averted had the legislative process followed regular order, with hearings, legislative staff explaining the bill’s provisions, expert testimony, a public markup, and opportunities to address policy and drafting anomalies. Embedded in a measure with underlying policy goals that the authors of this blog post find fundamentally questionable, the picture that emerges is extraordinarily troubling—a legislative effort to divert more than a trillion dollars away from health care for people who are sicker, poorer, older, and indigent, while leaving states with such massive funding deficits and federal leverage that some states may attempt to stem their losses in ways that harm their vulnerable residents even more.

    Even people sympathetic to the bill’s core aims, however, have good reason to oppose the Senate making such consequential decisions without taking the elementary legislative steps needed to detect and avoid terrible mistakes. Continuing to shun all the protections of regular order, the Senate appears poised to act on a bill that almost certainly includes additional unpleasant surprises going beyond those discussed here. With legislation that governs one-sixth of the US economy and that directly affects the health and economic security of millions of constituents, Senators are being asked to vote largely in the dark.

  • 14 Jul 2017 12:00 PM | AIMHI Admin (Administrator)

    About one-quarter of 700 health executives polled in a new survey said they had no value-based reimbursement initiatives planned for 2017.

    Health systems are transitioning from a model that emphasizes volume to value, albeit slowly. The escalating cost of care, a lack of standardization in how quality is defined, a disengaged workforce that leads to more medical errors, and a lack of trust and transparency between providers, payers and regulators have impeded their transition, according to a survey global consulting firm EY released Thursday.

    Smaller organizations were far more reticent to pursue value-based reimbursement initiatives, some of which include the Medicare shared savings program and variations of accountable care organizations, than larger organizations.
    Around two-thirds of the organizations that reported between $100 million and $1 billion in annual revenue were not pursuing value-based initiatives in 2017, while the vast majority of larger firms that have the resources needed to integrate these models into clinical operations had some form of value-based models in place.

    “This creates a competitive disadvantage for smaller hospitals, and quite frankly, puts their financial futures, sustainability and corporate existence in jeopardy,” Dr. Yele Aluko, an executive director in the advisory health practice at EY, said in an accompanying report. “Many smaller hospitals and health systems lack the strategic management processes, corporate resources and capabilities to remain competitive in the short term or relevant in the long term.”

    Transparency, coordination and communication are essential attributes for any organization striving to transform culture and achieve value-driven care, said Dana Alexander, an executive director in the advisory health practice at EY.

    “The industry is beginning to grasp the concept that quality is a driver to reducing costs and that the cost-cutting measures of yesterday were short-term band-aid approaches that did not achieve a sustainable balance of cost and quality,” she said.

    Providers are pursuing measures to help reduce medical errors and increase reliability. Morale among the front-line staff must improve to ensure the endeavor to reduce errors is a sustainable one, Aluko said.

    “Otherwise, avoidable medical errors will exponentially place patient lives at risk and transformation toward value-driven healthcare will remain nothing but a theoretical conversation,” he said.

    The next highest cost-control measures included decreasing unnecessary variation and utilization, increasing patient access to primary and specialist care, and reducing hospital and emergency department use for high-cost patients.

    A holistic, cultural shift is needed to fully embrace value-driven care, researchers said. That involves delivering effective care that produces measurable results, increasing transparency to reduce medical waste and redundancy, gauging and improving patient experience—an endeavor 93% of respondents said they are currently undertaking—and making sure employees are engaged and satisfied, they said.

    As to improving quality, 49% of respondents have initiated quality audits, 31% had implemented physician performance scorecards that include a quality measure and 38% plan to institute facility scorecards.

    While it can be costly, providers can better leverage new technologies to improve outcomes and patient experience, researchers said. Only 26% of respondents ranked new technologies as one of their top three priorities for 2017 and only 8% are using patient-centric analytics to improve patient experience.

  • 13 Jul 2017 8:30 AM | AIMHI Admin (Administrator)

    Anthem Blue Cross Blue Shield of Missouri will no longer cover emergency department services it considers unnecessary, according to St. Louis Public Radio.

    The goal of the discretionary ED coverage policy is to direct non-emergent patients to urgent care or primary care physicians to reduce costs and emergency room wait times.

    In these nonemergency situations, policyholders could foot the bill if their visit does not meet emergency requirements.

    The policy has several exceptions, including if the patient is under 14, the visit occurs on Sunday or there are no urgent care clinics within 15 miles, according to the report.

    Similar policies are enacted in Kentucky and Georgia under Anthem-affiliated plans.

    “We are looking to expand the policy to other markets, but we have not brought it to other states yet,” Anthem’s Public Relations Director Joyzelle Davis told Becker’s Hospital Review.

    Physicians are worried that the policy may cause patients to shy away from seeking care when they need it since there is a threat of receiving large medical bills, according to the report.

    In Kentucky, where the policy has been in place since 2015, Ms. Davis said the insurer has only issued denials for a “small percentage” of claims for unnecessary ER use, but the number of members with “repeat avoidable ER claims” has declined.

  • 12 Jul 2017 3:55 PM | AIMHI Admin (Administrator)

    Last November in Frisco, Candie and Dustin Sandlin entered a Legacy ER & Urgent Care center—a walk-in clinic that also operates as a freestanding emergency center—because the couple’s primary-care physician was unavailable. Candie, experiencing symptoms of a migraine headache, was told by the on-site doctor that a CAT scan was needed to rule out any serious diagnoses.

    Candie was reluctant, but agreed to the procedure. Afterward, Dustin says the doctor diagnosed his wife with a headache. The Sandlins returned to Legacy ER & Urgent Care five days later, with Candie still in pain. This time, Dustin says, another doctor suggested she may have vertigo, and ran a blood test to confirm the hunch. Once the diagnosis was confirmed, he says, the doctor could only provide “over-the-counter motion-sickness medicine, because the facility did not have medicine to specifically treat vertigo.” The total bill for the two visits? “$7,000,” Dustin says.

    When asked by Dustin in a formal complaint why the bill was so high, he says the facility replied it was because Candie had received a CAT scan and a blood test and that these services were categorized as “emergent,” allowing Legacy to charge freestanding ER prices, without verbally notifying the patient. (Emergent care typically is required in case of a threat of grave disability, or an immediate threat to a patient’s life.)

    Later, the Sandlins did recall seeing, in fine print, a reference in Candie’s paperwork to the possibility of some services being “emergent,” which for them meant out-of-network insurance care, carrying a higher price tag. For Dustin, though, a bigger question arose: “Why weren’t patients being notified which medical procedures are classified as urgent care—or emergency services—so they knew the difference?” Legacy didn’t return our calls seeking comment.

    The Sandlins aren’t alone in their experience, or in their question. In Frisco alone, freestanding emergency centers owned by Legacy, Code 3 ER & Urgent Care, and other independent operators have attracted more than 10 pages of website reviews. There, patients have complained variously about exorbitant, hidden costs for the treatment of problems ranging from minor injuries to colds.

    This is mostly because independently owned urgent care or freestanding emergency centers in general are able to “bait and switch consumers,” Dustin Sandlin alleges. “People are coming in for urgent care—it’s not our goal to go to the ER,” he says. “The transparency of what is and what isn’t considered an ‘emergent’ service determines the price point. There should be a list of services that is distinctly offered, so people are aware. But that list doesn’t exist.”

    In Dallas-Fort Worth, according to a national urgent care database, there are at least 45 urgent care centers—26 of which operate as both urgent cares and freestanding ERs. There are more than 490 urgent care centers total in Texas. In addition, there are at least 40 freestanding ERs in North Texas, mostly in middle-to-high income areas, according to the Texas Association of Freestanding Emergency Centers (or TAFEC), and 325 such facilities statewide. Two-thirds of these ERs are independent, while the rest are hospital-operated.

    Of course, not everyone believes like the Sandlins that independently operated, freestanding medical facilities are misleading patients. One who doesn’t is Dr. Carrie de Moor, president and CEO of Frisco-based Code 3 Emergency Physicians, and chairman of the American College of Emergency Physicians’ Freestanding Emergency Centers Section. She believes a lack of cooperation between insurance providers and the facilities is what leads to higher-than-expected, out-of-network bills.
    In an April commentary for D CEO Healthcare titled “Willing healthcare providers seek fair in-network contracts,” de Moor wrote about the resistance by insurance companies to accepting these facilities as healthcare providers. She describes the facilities as providing expeditious, cost-effective emergency services in a transparent manner.

    In an interview, de Moor adds, “I believe having a dual model—both an urgent care and a freestanding emergency center—actually helps us be transparent. We can distinguish if a patient has an emergency or not, and diagnose them on how to treat it.” According to TAFEC, urgent care facilities serve as alternative care options for patients with non-life-threatening injuries or illnesses. Meanwhile, freestanding emergency centers serve as facilities—staffed with 24/7, ER-trained physicians—that treat cases requiring immediate attention.

    But Stephen Mansfield, CEO of Dallas-based Methodist Health System, contends that, in reality, there is little difference between the two. Mansfield says he knows of a few facility owners who “basically turned an urgent care into a freestanding ER, by changing [their] operating hours to be open 24/7, 365 days. They didn’t really change the staffing model, clinics, or equipment. They may add a CAT scan and a small lab. But the main difference is that the facility needed only four more visits a day [to stay in business], since the reimbursement is so much higher” for emergency centers.

    With a highly profitable business model, and free rein to plant seeds in higher income areas following the passage of a 2010 Texas licensing law, it’s no wonder that freestanding ERs are proliferating here. “For a private entity investing in private money … there’s not any stipulation that you can’t set up a freestanding ER,” Mansfield says. “We don’t have [certificates-of-need] in Texas. … If you want to put one at an intersection or by a hospital, and you can get the land, you can do it. There is no regulatory body to tell you otherwise.”

    While it may be relatively easy to set up shop, de Moor says independent freestanding centers face other obstacles. Her struggle working with insurance providers, for example, prevents her patients from being billed in-network, she says. “We’re trying to get patients to understand their healthcare plans better, and educate them so they know we’re trying our best to be in-network with them,” de Moor says. “ … We’re doing what we can.”

    Kevin O’Donnell, managing partner at Dallas-based Healthcare Resources of America, believes patient safety is an additional concern with some of these facilities. “Urgent care centers and freestanding ERs have a lot of limitations on what medical services they can provide,” O’Donnell says. “In a serious emergency like a stroke or heart attack, [patients] won’t get the care they need there. They may be able to stabilize them for the next move—which is a hospital emergency room—but you’re putting their safety at risk, losing time.”

    Says Mansfield: “Hospital systems pay millions of dollars every year for specialists to be on-call. If you go to an emergency room there, you’ll have a doctor that can cater to your problem well. At a freestanding ER, you’ll see a doctor with a limited skill set. What ends up happening is an ambulance will take you to a hospital ER. Then you have to pay for two visits, while putting your health at risk.”

    Mansfield’s Methodist Health is one of the largest DFW healthcare systems that has yet to contract with any independently operated, freestanding ERs. Other systems have opted to open freestanding emergency centers, sometimes partnering with independent operations.

    In a D CEO Healthcare article last year, Barclay Berdan, CEO of Texas Health Resources, said THR decided to partner with the First Choice Emergency Room chain, adding a number of freestanding emergency rooms in order to increase access to care.

    As of now, Mansfield says, Methodist has no similar plans. “We believe everything we do either needs to improve quality of care for the patient or lower the cost,” he says. “So far, we’ve had a hard time convincing ourselves that freestanding ERs do that.”

  • 5 Jul 2017 4:30 PM | AIMHI Admin (Administrator)

    It’s common for emergency care clinicians to order more tests if they suspect the patient may have acute coronary syndrome (ACS). But researchers found that routine testing may increase the use of resources but not necessarily improve the outcomes of patients who come to the ER with chest pain but no other evidence or initial diagnosis of ischemia, according to a new study published in JAMA Internal Medicine.

    The retrospective cohort analysis looked at national claims data of more than 925,000 privately insured patients between the ages 18 to 64 years old who came to the ER with chest pain. Weekday patients were more likely to receive testing compared to patients who came to the ER on the weekend. Researchers found that invasive and noninvasive cardiac testing of the relatively young patients didn’t lead to a reduction in subsequent hospital admissions for acute myocardial infarction.

    “Our results show that cardiac testing is overused and reinforces the need to evaluate which, if any, patients with chest pain without evidence of ischemia benefit from noninvasive testing,” write lead author Alexander T. Sandhu, M.D., Stanford University Center for Primary Care and Outcomes Research, and the research team.

    The findings, according to an accompanying editorial in JAMA, are consistent with a rapidly “expanding evidence that challenges the current paradigm of early noninvasive testing after an ED evaluation for suspected ACS.”

    In addition to the costs involved, the noninvasive testing may expose patients to injuries associated with radiation exposure, invasive angiography and cardiac revascularization procedures, Benjamin C. Sun, M.D., Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University and Rita F. Redberg, M.D., Division of Cardiology, University of California–San Francisco, wrote in the commentary.

    They agree with researchers that further study is necessary to determine whether there is a benefit to the testing for patients who are at higher risk for ACS.

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