News & Updates

  • 17 Jun 2019 7:51 AM | AIMHI Admin (Administrator)

    Health Affairs Source Article | Comments Courtesy of Matt Zavadsky

    This is a very comprehensive, (i.e.: long) interpretation of the new HRA regulations. 

    Seems that these changes could have significant impact on both employers and employees.

    -----------------------  

    Final Rule On Health Reimbursement Arrangements Could Shake Up Markets

    Katie Keith

    JUNE 14, 2019

    On June 13, 2019, the Departments of Health and Human Services, Labor, and Treasury issued a new final rule to expand the use of health reimbursement arrangements (HRAs) by employers to fund premiums for their employees in the individual health insurance market. The final rule reverses prior federal guidance by allowing HRAs to be used to fund both premiums and out-of-pocket costs associated with individual health insurance coverage. The Departments also released new frequently asked questionsmodel attestations, and model notices.

    The final rule is largely similar to the proposed rule, which received more than 500 comments from a stakeholders that include state regulatorsinsurers, and employers, brokers, and benefit advisors. The final rule’s major significant changes focus primarily on new “integration requirements” for HRAs. The rule also allows a new “excepted benefit HRA” option that employees can use to pay premiums for excepted benefits and short-term coverage. Individuals who gain access to an HRA or qualified small employer health reimbursement arrangement are eligible for a special enrollment period in the individual market.

    CONTINUE READING►


  • 16 Jun 2019 8:39 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky

    Interesting approach for providers in states that have a state income tax. 

    Wonder if this option could be used for federal income tax refunds – that would help everyone, including providers in states without a state income tax.

    Note Allina EMS’ use of the program to collect ambulance bills from patients who don’t pay, but do not quality for charity care.

    Allina Health, which reported revenue of $4.3 billion in 2018, uses a provision of the Minnesota revenue recapture law allowing licensed ambulance services, public or private, to seize refunds for unpaid bills. It’s garnered nearly $5.7 million from more than 15,000 claims over the past five years.

    Mark Anderson, director of finance for Allina Health Emergency Medical Services, acknowledged that the statutory provision originally was written to help struggling volunteer ambulance services in rural parts of the state. Still, Allina has used the system in its Minneapolis-St. Paul service area.

    Allina only seeks a patient’s tax refund after repeated letters and at least one phone call to the patient to try to work out a payment arrangement, he said. It first makes sure the person doesn’t qualify for charity care or financial assistance and has the ability to pay. Anderson wasn’t sure if the letters specifically warn people that their tax refunds may be seized.

    “The typical ambulance bill is about $2,000, and taking people to court isn’t very cost-effective,” he said. “No one wants to create hardships for anyone, but some individuals just don’t cooperate.”


    When collection efforts fail, some hospitals seize patients' tax refunds

    June 15, 2019

    Duluth, Minn.-based Essentia Health collects only about 20% of the $125 million its patients owe for self-paid services, deductibles and cost-sharing.

    To boost those collections, the 11-hospital, not-for-profit system takes advantage of a Minnesota law allowing it to seize state tax refunds from people who have unpaid bills. Under the law, five of its rural hospitals can use the “revenue recapture” program since they lease facilities from state or local governments.

    In 2018, the tax refunds it intercepted totaled more than $500,000, a small percentage of Essentia’s nearly $4 billion in total patient revenue.

    “We get excited about anything we recover,” said Melanie Wilson, Essentia’s vice president of revenue services. “We invest a lot of money to serve those communities. This is just a small way to balance our commitment with their commitment back to us.”

    CONTINUE READING►


  • 14 Jun 2019 9:11 AM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    If these provisions make it all the way through the legislative and fiscal process, there is good news for the healthcare system and the patients we serve. 

    • Having a unique national patient ID number would make care coordination, quality assurance, outcome measures and EMS/MIH partnerships much more effective.
    • Enhancing surge capacity for large scale emergencies would be very helpful.
    • Funding for rural and critical access hospitals would help with access to healthcare in rural areas.

    ----------------------------------------

    House votes to overturn ban on national patient identifier

    Susannah Luthi and Jessica Kim Cohen

    June 13, 2019

    https://www.modernhealthcare.com/politics-policy/house-votes-overturn-ban-national-patient-identifier

    The U.S. House of Representatives passed a $99.4 billion HHS appropriation bill with several amendments including reversing a longtime ban on developing a national patient identifier, money for hospital emergency departments dealing with opioid overdoses, and a nod to the anti-vaccination controversy.

    For decades, Congress has prohibited HHS from funding the development or promotion of any national program where patients would receive permanent, unique identification numbers.

    Lawmakers previously argued such a program could violate privacy issues or raise security concerns, while the medical community and insurers claimed the ban kept them from properly matching patients with the correct medical information.

    The measure by Rep. Bill Foster (D-Ill.) to overturn the ban passed late Wednesday with the first tranche of amendments to the appropriations bill.

    Several amendments focused on the opioid epidemic, including a measure by Reps. David McKinley (R-W.Va.) and Mike Doyle (D-Pa.) that would deploy $10 million to set up a coordinated-care model for overdose cases in emergency rooms, according to a provision of last year's major opioid legislation.

    Others focused on the impact of addiction on children, with one measure to shift $2 million for research on neonatal abstinence syndrome. A second boosts funding for the National Survey of Child and Adolescent Well-Being by another $2 million to look at children affected by a parent's addiction.

    Rep. Adam Schiff (D-Calif.) secured his amendment that essentially tells HHS to prioritize its national campaign to encourage vaccines and counter the anti-vaccination rhetoric that has increasingly raised worry in Washington amid measles outbreaks across the country.

    The full legislation incorporates provisions to boost rural hospitals and rural healthcare access.

    The final report adds $10 million to the previous year's budget for state surveys and certification reviews of nursing homes, home health agencies and hospice facilities.

    It also increases funding for the Hospital Preparedness Program by $52 million. The initiative coordinates state, local and territorial health departments to get ready for patient surges during public health emergencies.

    House appropriators suggested that federal agencies should follow the enhanced reimbursement model offered for the academic health centers that treated Americans with Ebola for other serious communicable diseases.

    "Given the significant cost of preparedness and care associated with any serious communicable disease, when any federal agency refers any highly contagious individuals to a designated treatment center, the committee encourages the use of the previously developed reimbursement model for Ebola to be applied," appropriators wrote in the bill.

    While the House wrapped up a chunk of its appropriations work this week, Senate appropriators have yet to mark up their own bill as Congress prepares for a battle to lift the spending caps and then the debt ceiling later this year.


  • 12 Jun 2019 10:20 PM | Matt Zavadsky (Administrator)

    Top 7 Reasons That Mobile Integrated Healthcare-Community Paramedicine Programs Benefit Everyone

    Kevin Amell

    May 30, 2019 

    https://medium.com/@kevin.amell/top-7-reasons-that-mobile-integrated-healthcare-community-paramedicine-programs-benefit-everyone-9ece5513a894

    A new model of healthcare has arrived in the form of mobile integrated healthcare community paramedicine (MIH-CP).

    You’ve heard all the buzz about these programs and partnerships with local EMS and ambulance companies. You’ve heard about how specially-trained paramedics can visit the homes of selected residents. You’ve heard about how it’s supposed to help EMS agencies to create patient-centered, mobile resources in an out-of-hospital environment. Do MIH-CP programs live up to the hype? In today’s post, we’ll look into seven reasons that MIH-CP programs benefit everyone.

    1. Lowering super-utilizers

    In Milwaukee, Wisconsin, a 2015 review of more than 60,000 annual 911 calls found that 7 percent, or 4288 calls, came from the same 100 people. California’s Alameda County has a list of the top 25 “frequent fliers” who call 911 regularly; in just two years, 25 people had collectively called the 911 line 4,291 times. A 2009 MedStar study found that in the Fort Worth, Texas area, 21 patients had been transported to local EDs a total of 800 times over a 12-month period, generating over $950,000 in ambulance charges and even more significant ED expenses. Most of these individuals did not have health insurance and relied on EMS and local EDs for health services. The Tucson Fire Department had been able to identify 50 individuals who accounted for more than 300 non-emergency 911 calls over a 12-month period.

    This is no surprise. All EMS workers know this: super-utilizers and “frequent flyers” are prevalent everywhere across the country.

    This certainly isn’t ideal. It’s a waste of EMS services, time, effort, and money, especially when most of the problems that these frequent flyers have, and this system abuse seems only to be getting worse. How can communities combat this?

    The answer is not to limit people’s access to 911, of course. Instead, MIH community paramedicine is an answer. MIH-CP programs aim to solve this by attacking the underlying causes of these many 911 frequent flyers, or at least mitigate the load and give these patients the proper care. MIH-CP can improve the health and wellness of underserved populations — especially those with chronic conditions who use the ER as their primary source of healthcare. People needing mental health care can be directed to the proper facilities through proper transportation. Slowly, they’ll learn to better take care of themselves instead of using 911 as their catch-all. By helping patients in the community improve mental and physical health, the frequent flyer and super-utilizer phenomenon decreases.

    2. Relieve the EMS system in 911 Calls

    The community paramedicine program in North Memorial, Minnesota, is seeing a decline in 911 calls after implementing an MIH-CP program. For the first half of 2018, North Memorial found no cost savings during that time period, but in the second half of 2018, the costs of patients who had received those visits declined by $1,969 per member per month.

    Fort Worth, Texas, saw similar results as well. Between July 2009 and August 2011, the Texan community saw the volume of 911 calls fall by 58 percent, from an average of 342.3 monthly calls during the 6-month period before enrollment to 143.3 monthly calls afterward. Unsurprisingly, the decline in calls corresponded to a drop in wasted money; the annualized EMS transport costs for these patients decreased by over $900,000 (from $1,577,472 to $660,128) and charges falling by over $2.8 million ($4,929,600 to $2,062,899).

    An EMS1 article wrote that “81 percent of [MIH-CP] programs in operation for two or more years reported success in lowering costs by reducing 911-call use and emergency department visits for defined groups of patients.”

    Give the EMS and emergency room workers a break — and let them focus on the emergencies they need to focus on.

    3. Educate and help the underserved populations

    When community paramedics can visit underserved populations, it saves time for everyone. MIH-CP programs allow paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community. Ultimately, allowing EMS workers to do this helps improve access to care, as many populations currently don’t know how to access that care. Instead, community paramedicine brings that care to them.

    By focusing on medically or socially underserved populations, which are the ones who tend to have a higher risk of using emergency departments, MIH-CP programs become first responders with community health worker skills.

    Healthy Hennepin, a publication managed by Minnesota’s Hennepin County Public Health Department reported the following story: “A community paramedic was on-site when an asthmatic shelter resident, who had recently been discharged from the hospital, began wheezing. ‘Normally someone would have called 911 about him,’ the paramedic remembers. ‘Instead, they called me.’ After showing the resident how to properly use his nebulizer and inhaler, his wheezing subsided. Crisis averted. Calm achieved. Costs contained.”

    In a California study of MIH-CP in over five counties, patient self-assessments after receiving community paramedic visits showed several improvements: a 16% increase in their rating of overall health, 11% in their understanding of discharge instructions, 4% in their understanding of when to take medications, and 9.5% in their understanding of medication side effects.

    4. Provide the proper care for the caller

    The point of community paramedicine is to outgrow the outdated system currently in place. Anyone working in EMS knows that the 911 calls they receive are often for non-urgent needs or those that a hospital emergency room is not equipped to handle. Research has shown that 11 to 52 percent of 911 calls aren’t from people in serious health emergencies.

    Additionally, many visits are made for patients with conditions that are better treated in a primary care setting. Going to an emergency room for acute upper respiratory infections, viral infections, otitis media, and acute pharyngitis is often worse off for the patient because the emergency room is already so busy that the doctors and nurses don’t have enough time to explain the patient’s condition to them adequately, nor how to properly take care of themselves during the recovery process.

    Importantly, the real underlying problems of many 911 callers, especially for frequent flyers, are psychosocial problems that cannot be effectively treated in the emergency room. An emergency room doctor or surgeon cannot fix someone’s alcohol or drug dependency problem, nor can they do much to help a patient with depression. With community paramedicine programs, paramedics will be allowed to transport a person experiencing a behavioral health problem directly to a crisis care center instead of the emergency room first, which will enable patients to get the help they need much faster. Inebriated individuals can be sent to sobering centers.

    Although some might argue that this could lead to the under-triaging of patients, but it’s already been well established that a hefty portion of 911 calls don’t require emergency room treatment. It makes more sense to paramedics to transport patients to the most appropriate location for their condition instead of trying to funnel all patients through a more-likely-than-not costly and crowded emergency department.

    Many callers use 911 because they don’t know where else to go for healthcare-related problems. By allowing paramedics to transport them (or suggest that idea to the patient), patients can slowly learn about the available solutions to their problems.

    5. Reducing hospital readmissions

    One specific subset of also routinely call 911 and visit the emergency room with exacerbations of chronic conditions that could be avoided with proper condition management. Community paramedics aim to help those with complex chronic conditions improve their health and wellness at home. Through home visits, community paramedics teach patients how to use and why they should use their medication. Additionally, these paramedics can assist in filling prescriptions, sorting medications, and explaining how to take them as prescribed. They can supplement information by providing counseling on hospital and clinic discharge instructions.

    Community paramedics can assess the patient’s lifestyle — often the culprit of hospital readmissions, especially in those with chronic conditions — and educate them on how or why they should change certain things. This allows healthcare providers insight into a part of the patient’s life that even doctors don’t get to see and has had proven benefits in reducing the number of hospital admissions.

    In a 2017 California MIH-CP study in the Alameda, Glendale, San Bernardino, Solano counties, hospital readmissions rates decreased by about 10%. Other studies have shown up to a 50% decrease in readmissions

    6. Build more trust with the community

    Since MIH-CP programs aim to solve everyone’s problems, having an effective MIH-CP helps people have more confidence in their EMS and network of healthcare providers in the area. By making routine visits to patients’ homes, paramedics not only help improve patients’ physical health but also feel more cared-for and supported. Relations between all network healthcare providers would be improved, especially given the logistical and financial benefits for everyone involved. When people know that their community healthcare providers can provide them with the support that they need, the community inherently will learn to trust them more.

    Additionally, everyone in the community will be in better shape. Emergency room doctors see fewer non-emergency cases, and hospital charges decrease, urgent care centers get better access to the people who need them, and the patients get the care they need.

    7. It’s easier than ever to do this

    The good news is that the technology is finally where it needs to be. Implementing an MIH-CP program is easier than ever because software and systems that bring entire local healthcare provider workforces together to effectively collaborate finally exist. With Julota, for example, a community’s health systems, EMS, law enforcement, social services, mental health, and all other community care organizations can benefit from more collaboration, better health, and lower overall costs. As comprehensive HIPAA-/mental health (42 CFR part 2)-/Criminal Justice Information System-compliant solution that manages secure multidirectional sharing of consented information, Julota helps patients get better and more appropriate treatments that they would otherwise lack.


  • 12 Jun 2019 10:17 PM | Matt Zavadsky (Administrator)

    Kudos to the folks in Lexington, Kentucky for this program!!

    Tip of the hat to NAEMT’s Melissa Trumbull for the heads up on this news story…

    --------------------------

    Community Paramedicine Program helps hundreds in Lexington, saving taxpayers millions

    By Miranda Combs

    May 29, 2019

             

    https://www.wkyt.com/content/news/Community-Paramedicine-Program-helps-hundreds-in-Lexington-saving-taxpayers-millions-510585041.html

    LEXINGTON, Ky. (WKYT) - At last count, the number of homeless people living in shelters and on the street had dropped drastically in the past few years -- by almost half.

    In the last couple of years, a new program in Lexington called the Community Paramedicine Program has helped connect the homeless and the people who regularly visit Lexington's emergency rooms with resources in the community to keep them off the streets and out of the ER.

    Cecil Brown was a man who did both. He was homeless, and he'd show up at UK Good Samaritan emergency room regularly. So often, that Physician Assistant Julie Stumbo took an interest in his life.

    "He had told me a lot about his family. Just bits and pieces through the time that I saw him," Stumbo said.

    Stumbo said she'd see him so much, that if time went a few months without showing up, she'd worry.

    "He was respectful and never rude and was grateful for everything we gave him," she said.

    Cecil's visits with Stumbo went on for seven and a half years. He'd been hit by three cars over his lifetime. The last time landed him in the hospital for 22 days.

    "I'm so grateful for the car that hit him," Stumbo said of what would be a life-altering moment.

    "I just said, 'I'll never drink again God, for the mercy that you've shown me," Cecil said.

    He headed to rehab after the hospital, and when he got out, the community paramedicine program hooked him up with a group that provided housing for free.

    Cecil said his friends from UK Good Samaritan Hospital showed up to make the apartment home.

    "When they found out I had an apartment, I didn't ask for nothing. They come with this stuff," Cecil said.

    "We never set out to furnish his apartment. I just wanted him to have a bed. There's truly more good in the world than evil," Stumbo said.

    The Community Paramedicine Program director said the program has had at least 290 unique individual cases since July 2018.


  • 12 Jun 2019 10:05 PM | Matt Zavadsky (Administrator)

    Source Study | Comments courtesy of Matt Zavadsky

    ----------------------------------- 

    Concerning report on NPR’s Morning Edition… 

    MedStar crews, in cooperation with UT Health, have been making a HUGE difference in finding solutions to this problem by our participation in the DETECT project! 

    The results of DETECT Phase I have recently been published.

    https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-016-0084-3

    In cooperation with UT Health, MedStar will begin Phase II of DETECT this summer. 

    -------------------------

    Reports Find Health Workers Still Aren't Alerting Police Regarding Likely Elder Abuse

    June 12, 2019

    By Ina Jaffe

    Correspondent, National Desk

    Heard on Morning Edition

    https://www.npr.org/sections/health-shots/2019/06/12/731820729/reports-find-health-workers-still-arent-alerting-police-regarding-likely-elder-a?

    Two reports from the federal government have determined that many cases of abuse or neglect of elderly patients that are severe enough to require medical attention are not being reported to enforcement agencies by nursing homes or health workers — even though such reporting is required by law.

    It can be hard to quantify the problem of elder abuse. Experts believe that many cases go unreported. And Wednesday morning, their belief was confirmed by two new government studies.

    The research, conducted and published by the Office of Inspector General of the U.S. Department of Health and Human Services, finds that in many cases of abuse or neglect severe enough to require medical attention, the incidents have not been reported to enforcement agencies, though that's required by law.

    One of the studies focuses solely on the possible abuse of nursing home residents who end up in emergency rooms. The report looks at claims sent to Medicare in 2016 for treatment of head injuries, body bruises, bed sores and other diagnoses that might indicate physical abuse, sexual abuse or severe neglect.

    Gloria Jarmon, deputy inspector general for audit services, says her team found that nursing homes failed to report nearly 1 in 5 of these potential cases to the state inspection agencies charged with investigating them.

    "Some of the cases we saw, a person is treated in an emergency room [and] they're sent back to the same facility where they were potentially abused and neglected," Jarmon says.

    But the failure to record and follow up on possible cases of elder abuse is not just the fault of the nursing homes. Jarmon says that in five states where nursing home inspectors did investigate and substantiate cases of abuse, "97 percent of those had not been reported to local law enforcement as required."

    State inspectors of nursing homes who participated in the study appeared to be confused about when they were required to refer cases to law enforcement, Jarmon notes. One state agency said that it only contacted the police for what it called "the most serious abuse cases."

    Elder abuse occurs in many settings — not just nursing homes. The second study looked at Medicare claims for the treatment of potential abuse or neglect of older adults, regardless of where it took place. The data was collected on incidents occurring between January of 2015 and June of 2017.


  • 30 May 2019 8:54 AM | AIMHI Admin (Administrator)

    Source Study | Comments courtesy of Matt Zavadsky

    Interesting study recently conducted on the EMS professional’s perspectives of Community Paramedicine:

    Emergency Medical Services Professionals’ Attitudes About Community Paramedic Programs

    10.5811/westjem.2017.3.32591

    Introduction: The number of community paramedic (CP) programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS) professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program.

    Methods: We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program. Approximately 350 licensed EMS professionals currently working for an EMS service that provides coverage to four states (Missouri, Arkansas, Kansas, and Oklahoma) were invited to participate in an electronic survey regarding their perceptions toward a CP program. We analyzed interval data using the Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Pearson correlation as appropriate. Multivariate logistic regression was performed to examine the impact of participant characteristics on their willingness to perform CP duties. Statistical significance was established at p ≤ 0.05.

    Results: Of the 350 EMS professionals receiving an invitation, 283 (81%) participated. Of those participants, 165 (70%) indicated that they understood what a CP program entails. One hundred thirty-five (58%) stated they were likely to attend additional education in order to become a CP, 152 (66%) were willing to perform CP duties, and 175 (75%) felt that their respective communities would be in favor of a local CP program. Using logistic regression with regard to willingness to perform CP duties, we found that females were more willing than males (OR = 4.65; p = 0.03) and that those participants without any perceived time on shift to commit to CP duties were less willing than those who believed their work shifts could accommodate additional duties (OR = 0.20; p < 0.001).

    Conclusion: The majority of EMS professionals in this study believe they understand CP programs and perceive that their communities want them to provide CP-level care. While fewer in number, most are willing to attend additional CP education and/or are willing to perform CP duties. [West J Emerg Med. 2017;18(4)630-639.]


  • 30 May 2019 8:42 AM | AIMHI Admin (Administrator)

    WFAA Source Article | Comments Courtesy of Matt Zavadsky

    Excellent news story by Teresa Woodard on the plight of high ER utilizer patients, and the expense to the community in caring for them. 

    Community collaborations, often including an EMS-Based Mobile Integrated Healthcare (MIH) program like the one here at MedStar, have demonstrated significant improvements in care coordination (including addressing the important social determinants of health), enhancing patient experience of care, improved health status, and significant reduction in acute care utilization, including EMS resources (and the cost associated avoiding preventable utilization).

    Note that Parkland estimates the cost to the community for caring for high utilizer patients at $14 million!

    ----------------------

    80 people went to Dallas emergency rooms 5,139 times in a year — usually because they were lonely

    Parkland Hospital officials say the cost of taking care of repeat ER patients is “absolutely passed on to you.”

    Teresa Woodard

    May 28, 2019

    DALLAS — Michael Johnson is 57. He’s from Dallas. He’s diabetic. He has a job in fast food. He rents a home. He gets by.

    Until recently, no one ever explained to him how hospitals, doctors and emergency rooms work.

    “My momma always told me when something’s wrong with you, go see the doctor,” Johnson said.

    The only way he knew to see a doctor was go to the emergency room at Parkland Hospital, which is why he racked up 31 ER visits in 24 months.

    Johnson’s numbers are not at all surprising for administrators at Parkland, which has one of the busiest emergency rooms in the country.

    “It’s not unusual for us to see in excess of 700 people in a 24-hour period in our emergency room,” said Dr. Esmail Porsa, executive vice president and chief strategy and integration officer for Parkland Health and Hospital System.

    Parkland’s ER is busy for countless reasons, but chief among them is repeat patients like Johnson. He’s considered a high emergency department utilizer because of those repeated visits.

    High ER utilizers often take up valuable space which can lead to long waits, Porsa said. Because Parkland is a public hospital, these frequent patients cost Dallas County taxpayers money.

    The hospital wanted to determine why these high utilizers keep coming in. But to do that, they needed to identify who they are.

    “We looked at the data every which way. We looked at zip codes, gender, race, education, income. One day we sorted the data by medical record and realized — lo and behold — there were three patients on the top of the list,” Porsa said.

    Those three patients visited the hospital 500 times in one year.

    "Five hundred times," Porsa repeated.

    Porsa and his team expanded their research to include data from other health systems in Dallas County, which led to a revelation.

    They identified 80 patients who, collectively, went to four Dallas County emergency rooms 5,139 times in a 12-month period.

    “The same people are basically going from emergency room to emergency room,” Porsa said.

    Parkland estimates those visits cost more than $14 million.

    “It is absolutely passed on to you,” Porsa said of the cost to taxpayers.

    Once they determined who those high utilizers were, it was time to get back to why they keep coming in.

    That research led to a painful reality: the cause for most of the repeat visits is loneliness.

    “It’s a lack of relationships and support structure,” Porsa said.

    Poverty and food shortage are factors for the frequent visits, but they aren't the main reason.

    "The No. 1 determinant of high emergency department utilization is relationships," Porsa said.

    Dr. Jeffery Metzger, chief of emergency services at Parkland Health and Hospital System, calls the challenges some of these patients face heartbreaking.

    “In medical school, we get taught how to take care of medical illnesses, but there’s a group of patients who come in who are here for some other reason,” he said. “If we just throw medicines at them when they keep coming in, they’re not going to get better.”

    Parkland began intense case management with the high ER users. Teams of administrators, doctors, nurses, social workers and chaplains meet regularly to track them. 

    Every 90 days, Parkland re-evaluates the data to identify new high users.

    Freedom McAdoo, chaplain at Parkland Health and Hospital System, is also leading a new DFW Faith Health Collaborative.

    Baylor Scott and White Health, Methodist Health System and Children’s Health are working together on the effort, to partner church and community organizations with patients who need companions, “so they’re not alone,” McAdoo said.

    “If you are isolated and lonely, but you have someone that you remember, like nurse April, nurse Tina, or nurse John, and they’re like, ‘Hey, how are you doing?’ And you’re greeted with warmth and love, well yeah, I’m gonna come back,” she said, explaining why patients keep returning.

    Michael Johnson didn’t know community clinics, like Parkland’s Bluitt-Flowers Health Center, even existed. The clinic on Overton Road is near the fast food restaurant where he works.

    After social worker Jo Black began managing his case and educating him, his ER visits fell by 70 percent.

    “We just look at what constitutes an emergency, what (the ER) is there for and what we can do here,” Black said. “A lot of times, patients just really do not know.”

    Black shows tough love with patients like Johnson, holding them accountable for missed appointments and follow up visits.

    “Now I know,” Johnson said. “And I’m glad I know.”

    Johnson is a success story, but he’s just one patient among many.

    He’s proof that human connections matter. Widespread change depends on all of Dallas realizing that and then living it.


  • 28 May 2019 7:50 AM | AIMHI Admin (Administrator)

    Washington Post Source Article | Comments Courtesy of Matt Zavadsky

    This is one of the most amazing articles about the plight of healthcare and hospitals in rural America.  Yes, it’s very long, but exceptionally well written.

    Strongly encourage you to read this, and click on the link to see some of the photos – it wrench your gut, and likely bring tears to your eyes.

    EMS agencies in these areas, often volunteers, face immense struggles as they become the default healthcare in areas where hospitals have closed – and have to transport patients great distances, taking resources away from the community for longer periods of time.

    --------------------

    ‘Who’s going to take care of these people?’

    As emergencies rise across rural America, a hospital fights for its life

    By Eli Saslow 

    MAY 11, 2019

    https://www.washingtonpost.com/news/national/wp/2019/05/11/feature/whos-going-to-take-care-of-these-people/ 

    Fairfax, Okla. - The hospital had already transferred out most of its patients and lost half its staff when the CEO called a meeting to take inventory of what was left. Employees crammed into Tina Steele’s office at Fairfax Community Hospital, where the air conditioning was no longer working and the computer software had just been shut off for nonpayment.

    “I want to start with good news,” Steele said, and she told them a food bank would make deliveries to the hospital and Dollar General would donate office supplies.

    “So how desperate are we?” one employee asked. “How much money do we have in the bank?”

    “Somewhere around $12,000,” Steele said.

    “And how long will that last us?”

    “Under normal circumstances?” Steele asked. She looked down at a chart on her desk and ran calculations in her head. “Probably a few hours,” she said. “Maybe a day at most.”

    Continue Reading at The Washington Post►


  • 28 May 2019 7:47 AM | Amanda Riordan (Administrator)

    CBS News Source Article | Comments Courtesy of Matt Zavadsky

    Scary statistics from the National Safety Council:

    • 71% of drivers admitted to taking photos and texting while driving by emergency workers.
    • Sixteen percent of drivers say they've struck or nearly struck an emergency vehicle or first responder on the side of the road.
    • Forty first responders were killed on the side of the road last year, up 60% from 2017.
    • So far this year, 21 have died, including 10 police officers; 14 officers were hit and killed in all of 2018.

    Please help keep our First Responders safe as they try to keep others safe!

    ----------------------------------

    Distracted drivers an increasing threat to first responders

    CBS NEWS May 27, 2019, 7:40 AM

    New research shows that many drivers are profoundly distracted by their phones when they're going past first responders working accidents on the roadways.

    New research from the National Safety Council found 71% of drivers admitted to taking photos and texting while driving by emergency workers; that's nearly triple the 24% who admitted to doing it under normal driving conditions. Sixty percent admitted to posting to social media; two-thirds have emailed about what they're driving by.

    And the results are increasingly deadly. Sixteen percent of drivers say they've struck or nearly struck an emergency vehicle or first responder on the side of the road. Forty first responders were killed on the side of the road last year, up 60% from 2017. And so far this year, 21 have died, including 10 police officers; 14 officers were hit and killed in all of 2018.

    "What surprised us most about this study was the magnitude of people who are really exercising very dangerous behavior," said Kelly Nantel of the National Safety Council. "They're adding another level of exposure to these first responders."

    Last December, Florida Highway Patrol Trooper Mithil Patel was on the shoulder of interstate 95 working an accident when, despite a traffic lane being closed as a safety buffer, a suspected distracted driver was the cause of a car losing control and swerving towards him.

    Video captured Patel throwing another man to safety right before being hit by the car himself.

    "It's a different feeling definitely, seeing where I almost got killed – definitely a weird feeling,' Patel said.

    "Do you feel lucky to have survived that?" Van Cleave asked.

    "I feel extremely lucky," Patel replied. "I have seen people, you know, pretty much die from this."

    Patel admitted to some nerves as he hit the road in his patrol car for the first time since the accident. "I still have the butterfly in my belly," he told Van Cleave. "Whenever you see the brakes squeeze really hard, you're always going to be back to be, like, is he coming toward my way or not?"

    Patel hopes to be back to full duty and working calls on the side of the road in the coming months.

    In Miami, Fire Captain Steve Perez, heading to a traffic accident, said as soon as they flip on the lights and sirens, drivers behave differently.

    Van Cleave asked, "Every call you see people paying more attention to their phones than the road? Is it that common?"

    "Sure, I'll venture to say it's very common to see somebody either on their phone or taking their phone out to try to videotape or get a snap of what's going on," said Captain Perez.

    Patel said, "I have seen it where they pull out the phone outside the window and take start taking pictures, not paying attention to the road."

    All 50 states have a "move over" law that requires drivers to give first responders room to work, but police say it's about 50-50 if people actually do it.

    Trooper Patel says, bottom line, put down the phone.


© 2019 Academy of International Mobile Healthcare Integration | www.aimhi.mobi | hello@aimhi.mobi

Powered by Wild Apricot Membership Software