Tag Archives: emergency room

Shedding light on upcoding in the ER

Photo: Micheal J via Flickr

The Houston Chronicle’s Jenny Deam delved into emergency room billing – hospital facility fees as well as “upcoding,” which means categorizing relatively minor conditions as serious or even life-threatening ailments and charging a lot for them.

It raises costs to both the patient and the insurer. Continue reading

Personal story illustrates multiple barriers to health care, need for navigators

Image by FutUndBeidl via Flickr

Image by FutUndBeidl via Flickr

Elizabeth Piatt begins the narrative of her reluctant journey into the Medicaid dental care system this way:

“In the spring of 2010 a terribly infected tooth forced my sister, Veronika, to the emergency department (ED). This story began, however, several months before. It is flica story of Medicaid, access to the best care, information and misinformation, and the gap between the haves and the have-nots.”

Piatt’s piece, “Navigating Veronica: How Access, Knowledge and Attitudes Shaped My Sister’s Care” was featured in February’s Health Affairs. (AHCJ members have free access to Health Affairs.)

Piatt, an assistant professor and chair of the Sociology Department at Hiram College in Hiram Ohio, brings a social scientist’s eye and a story-teller’s flair to the tale. Continue reading

R.I. program provides care outside hospitals in effort to reduce ER use

Emergency department

Photo by KOMUnews via Flickr

Using community health workers to work with frequent emergency room visitors is showing some success in reducing ER use.

The latest installment of “Cost of Diabetes,” a yearlong series by Rhiannon Meyers of the Corpus Christi (Texas) Caller-Times, looks at what Rhode Island is doing to help prevent and manage diabetes.

A “Communities of Care” program pairs peer navigators, who are community health workers, with Medicaid patients who are seen in an emergency room four or more times in a year. The peer navigators “try to figure out why [the patients] keep going to the emergency room and help them access resources they need, from housing to transportation to doctors’ appointments. The peer navigators also continuously check in with patients to make sure they are seeing the doctor as needed and taking their prescriptions to avoid unnecessary hospitalizations.”

Officials at UnitedHealthcare, which contracts with Rhode Island Medicaid, say they’ve seen a 30 percent decrease in ER use and have possibly saved up to $600,000, according to preliminary results. And those results are prompting people to look at the program as a model, said Dr. Rene Rulin, medical director of Rhode Island Medicaid at UnitedHealthcare.

(Hat tip to Keldy Ortiz.)

Seattle hospitals love building costly ERs

The Puget Sound emergency room construction boom is in full swing, and Seattle Times reporter Carol Ostrom has taken a pointed look at the cost-related consequences of local hospital expansion.

She examines why hospitals are opting for more and glitzier ERs over lower-cost alternatives such as clinics and urgent care facilities. She also considers why state efforts to guide hospitals toward more efficient spending have failed, and explains how hospitals justify their actions. If you don’t have time for the full story, here’s a relatively tame excerpt:

The ER building boom has prompted a backlash from some lawmakers and advocates of affordable health care, who complain that nearly all Washington hospitals get substantial tax breaks and construction financing through tax-exempt bonds.

Free-standing ERs, these critics charge, are cash cows for hospitals, strategically built in affluent areas to lure busy, well-insured patients and collect fat reimbursements.

Canadians fight for disclosure of medical treatment

It took eight years, a whistleblower and intervention from a state commissioner to uncover a fatal medical error in a Newfoundland hospital, one committed by a doctor with an (undisclosed) record of such actions. As Canadian broadcaster CTV reports, Canada’s free access to health care doesn’t translate to free access to information.

Here’s my summary of the story’s key events, as I understand them:

  1. A woman in Newfoundland dies soon after her ER doctor misdiagnosed a blood clot in her lung and gave her treatment that a colleague said would have been equivalent to a “lethal injection.”
  2. The victim’s family doesn’t know that anything was out of the ordinary until six years later, when the colleague contacted the family directly to explain what he believed to be a mistake.
  3. The family approaches the hospital for information, and gets a few treatment records, but is denied access to records from an internal investigation of the incident.
  4. Using the province’s FOI laws, the family again pushes for the investigation information. Their request is denied.
  5. Finally, “the family appealed to the province’s Information Commissioner, who ordered Eastern Health to hand over the records.”
  6. A year later, the records were disclosed – but key EKG information was not. Thus, the family’s fight for disclosure continues unabated.