News & Updates

  • 15 Aug 2019 10:18 PM | Matt Zavadsky (Administrator)

    Nice article by Charlotte Huff, who has been a big supporter of EMS collaborations designed to reduce preventable acute care utilization. 


    Paramedics providing care before it is an emergency

    EMS providers are making house calls and helping people gain access to primary care with the goal of reducing unnecessary ED utilization.

    July 5, 2019


    Amid heightened efforts to reduce unnecessary emergency visits, including a recently announced federal pilot to treat low-acuity patients elsewhere, some insurers have already been striving to intervene even before patients resort to 911.

    Some patients return to the emergency department again and again because they don’t know where else to seek help, says Eugene Sun, MD, chief medical officer at Blue Cross Blue Shield of New Mexico. “A lot of times it’s a social issue,” Sun says. “They’re hungry. They’re lonely. And sometimes it’s a clinical issue,” he says, “but they don’t know how to get into primary care or they don’t have a primary care doctor assigned.”

    So starting in 2016, the New Mexico insurer began contracting with Albuquerque paramedics to provide home support for frequent users of the emergency department as well as some recently discharged hospital patients. Once at-risk patients are referred, a paramedic visits the home at least once, checking on everything from home safety to medication difficulties.

    The New Mexico program is just one of a number of initiatives that have health care systems, payers, and others teaming up with local emergency responders to reduce unnecessary ED trips. By 2017, there were at least 129 such programs, according to the most recent survey by the National Association of Emergency Medical Technicians. Until recently the lack of payment was a hurdle, but now the money is beginning to flow.

    Since early 2018, Anthem has been paying ambulance providers for treatment of minor injuries and illnesses at home or another site, an option that’s now available in all 14 states where Anthem has commercial plans, according to a spokeswoman. In February, CMS announced a pilot program in which it will reimburse ambulance providers for treatment on scene or transport to a nonemergency site, such as an urgent care clinic or a doctor’s office.

    Like the New Mexico Blues plan, other payers are channeling payment upstream for services delivered to at-risk patients before they seek out emergency care. In Milwaukee, for example, UnitedHealthcare Community Plan has contracted with the city fire department to make home visits—typically four of them—to vulnerable patients. The first eight patients referred to the program had visited the emergency department a total of 96 times during the prior six months, says Kathleen Schoenauer, director of medical and clinical operations at the plan, which manages care for Medicaid and dual special needs patients in Wisconsin. During the visits, paramedics help patients with their medications and identify any hurdles to primary care access, among other challenges. UnitedHealthcare coordinators accompany the paramedic on the fourth visit to introduce themselves as the patient’s new contact moving forward. “They know that they can call us, if their housing is at risk again, if they are having trouble getting transportation to their doctor, if they want to change doctors,” Schoenauer says.

    In the first group of eight patients, costs from ER visits dropped by 42% from the six months prior to their enrollment compared with the six months after. Schoenauer says that as additional patients enrolled in the program who weren’t as-frequent users of the ED, the reduction in ED visit costs leveled off to 27%. Currently the program is enrolling about 60 people annually.

    In 2018, Blue Cross Blue Shield of New Mexico’s program reached about 2,000 high utilizers. The reduction in emergency visits has stayed pretty consistent in recent years at 50% to 60% when comparing before and after enrollment, according to Sun. In 2018, the total savings was about $1.3 million due to reduced emergency visits and hospital readmissions.

    Now the New Mexico Blues plan is also looking at contracting with additional first responders to provide in-home support, Sun says. The insurer is talking with other hospitals, ambulance services, and health care organizations in Albuquerque about developing a triage system for the city and its surrounding county that would, among other things, send nonemergency patients to urgent care centers instead of hospital EDs. The approach being discussed is similar to what federal officials plan to pilot, says Scott Kasper, executive director of the Albuquerque Ambulance Service. “Lots of patients don’t need to go to the ED,” he says. “We could be taking them to a more appropriate place.”

  • 12 Aug 2019 6:04 PM | AIMHI Admin (Administrator)

    Source Article | By Chuck Gipson, MEDIC EMS

    Knowing and studying engagement can yield some great techniques to encourage engagement with your staff but nothing beats firsthand knowledge of what motivates your staff. When we started asking this of the crews, we had some of the same questions that others may have. What would make anyone in their right mind run into, rather than away from, a stressful and possibly dangerous situation day after day to altruistically care for others? Some of the answers are what you would expect and others were somewhat of a surprise. Many of the usual answers of why our staff was motivated to come to work was the great partner that they had, the good equipment they had to use, the desire to be part of something bigger than themselves and do something for others. Some of them are engaged to come to work simply to collect a paycheck and pay their bills. Many of them were engaged by not knowing what was going to happen next in their course of work, appreciating the excitement of the unknown, as well as the varied work environment...

    Read on in JEMS!►

  • 1 Aug 2019 8:29 AM | AIMHI Admin (Administrator)

    MobiHealthNews source articles | Comments courtesy of Matt Zavadsky

    Big time disruptive innovation!  Tip of the hat to EMS industry icon Don Jones for sharing this article!


    Uber Health inks deal to integrate with Medpod

    The new plan will help doctors send practitioners with a medical microcart out to patients' homes.

    By Laura Lovett

    August 01, 2019

    Uber Health is diving into remote care this week after it inked a deal with medical supply company Henry Schein Medical and Medpod, maker of the medical microcart MobileDoc 2, on Monday. The former agreed to integrate into Medpod's platform, allowing doctors to conduct remote telediagnostic exams. 

    As part of the deal doctor’s using Medpod’s telediagnostic platform will be able to tap into Uber Health to send a trained practitioner out to a patient, or send a patient to a clinical location and perform a remote exam. This initial announcement will be followed by a pilot of the program. 

    The MobileDoc 2 is still in the works. Right now, the system is patent pending, but eventually the company said it will be able to offer remote consultations. It will also have professional diagnostic tools that will be able to gather information including temperature, peripheral capillary oxygen saturation (Sp02), blood pressure, height, weight and BMI. The service will also include a “mobile medical infrastructure” with services like video chats. 


    Missed medical appointments cost the healthcare industry billions of dollars each year. Now many are looking for ways to make both medical appointments and diagnostic exams easier for patients. 

    “Our new partnership with Uber Health, and launch of Medpod MobileDoc 2, will help break down barriers that had previously required diagnostic exams to take place in traditional care settings,” Jack Tawil, chairman and CEO of Medpod Inc., said in a statement. “With the MobileDoc 2’s ability to take the physician office environment into patients’ homes and other non-traditional settings, we can create new convenient care delivery options and access points for patients.”


    The ridesharing app has been increasingly interested in the health space. Last year it officially launched its healthcare arm Uber Health at HIMSS18

    “What we did, from the ground up, we built an infrastructure,” Aaron Crowell, head of Uber Health, told MobiHealthNews in February. “We brought in consultants who were experts in those fields to make sure we were doing it right. Our data is encrypted, our staff is HIPAA-trained. Those things are really important or you can’t work in the space; we wouldn’t really be protecting the clients and organizations we work with. Obviously from a patient standpoint, [we have] GPS tracking, knowing exactly where riders are, and obviously the background checks.”

    Since its launch, Uber Health has inked a number of deals including with Grand Rounds and Carisk

    However, it is hardly the only ridesharing service targeted at the health space. Lyft has become a competitor in this space as well. In fact, in June Lyft announced its move into the Medicaid space following an announcement this morning that the rideshare company has landed approval as a Medicaid provider in Arizona, specifically as a non-emergency medical transportation service. This new approval means that Arizona Medicaid patients will have the option to use Lyft to get to and from medical appointments. 

  • 1 Aug 2019 8:23 AM | AIMHI Admin (Administrator)

    Governing source article | Comments courtesy of Matt Zavadsky

    Mattie did a great job on this article in this month’s Governing Magazine - a very important publication for our profession!


    Can we Fix 911? Bringing EMS into the 21st Century


    An ambulance’s wailing sirens, a fire truck’s flashing lights: These are a constant feature of urban life, as ubiquitous as a Starbucks on every corner or a traffic jam at 5 p.m. 

    But nearly a third of the times an ambulance or a fire truck speeds by to answer a 911 call, there is no actual emergency.

    The number of 911 callers who don’t need to go to a hospital emergency department sits at around 30 percent, according to Kevin McGinnis of the National Association of State EMS Officials. 

    The “false alarms” are more than an annoyance; they are a drain on the public purse, a frustration for responders and often an unhelpful source of assistance for the caller. It’s a problem that’s been around almost as long as 911 systems have. What is changing is the approach some cities and counties are taking to the way emergency medical services are delivered. Namely, a number of EMS officials are working to align their services with other community health goals. For instance, instead of automatically dropping a 911 caller at a hospital’s emergency department, an ambulance could, when appropriate, be rerouted to bring a person in distress to a sobering center, an urgent care clinic or a warming center. “Frequent flyers” -- those who call 911 more than once a month -- could be enrolled in a program that would help them address their chronic health conditions. Health issues that aren’t truly an emergency could be triaged by a nurse watching via an iPad in a call center when the call comes in. 


  • 29 Jul 2019 8:08 AM | AIMHI Admin (Administrator)

    NYT source article | Comments courtesy of Matt Zavadsky

    Interesting article in the NYT. 

    Here are a few of the key statements that illustrate the difference in ambulance economic models, compared to other healthcare providers, and the impact of government subsidies on provider charges:

    Congress has shown little appetite to include ambulances in a federal law restricting surprise billing. One proposal would bar surprise bills from air ambulances, helicopters that transport patients who are at remote sites or who have life-threatening injuries. (These types of ambulances tend to be run by private companies.)

    But that interest has not extended to more traditional ambulance services — in part because many are run by local and municipal governments.

    Anthony Wright, executive director of Health Access California, worked on a 2016 California law to restrict surprise billing. Initially, he thought it made sense to include ambulances in that legislation.

    But obstacles quickly began to mount. Some were about policy, like whether California would need to offset the revenue local governments would lose.

    Local governments generally finance their ambulance services through a mix of user fees and taxes. If ambulances charge less to patients, they typically need more government funding.

    Municipal governments often publish the prices of their ambulance services online, and they can range substantially. In Moraga and Orinda, in the Bay Area, the base rate for an ambulance ride is $2,600, plus $42 for each mile traveled. In Marion County, Fla., the most basic kind of ambulance ride costs $550, plus $11.25 per mile.


    Politicians Tackle Surprise Bills, but Not the Biggest Source of Them: Ambulances

    A legislative push in Congress and states to end unexpected medical bills has omitted the ambulance industry.

    By Sarah Kliff and Margot Sanger-Katz

    July 22, 2019

    After his son was hit by a car in San Francisco and taken away by ambulance, Karl Sporer was surprised to get a bill for $800.

    Mr. Sporer had health insurance, which paid for part of the ride. But the ambulance provider felt that amount wasn’t enough, and billed the Sporer family for the balance.

    “I paid it quickly,” Mr. Sporer said. “They go to collections if you don’t.”

    That was 15 years ago, but ambulance companies around the nation are still sending such surprise bills to customers, as Mr. Sporer knows well. These days, he oversees the emergency medical services in neighboring Alameda County. The contract his county negotiated allows a private ambulance company to send similar bills to insured patients.


  • 26 Jul 2019 8:00 PM | AIMHI Admin (Administrator)

    Civil Beat source article | Comments courtesy of Matt Zavadsky

    A VERY well done article and even better program!  Kudos to our pacific island EMS crews and their governing body for taking this step!

    Note the use also of Community Health Workers.  And, Hawaii has a nearly universal payer system, which helps these types of programs demonstrate value.

    We were blessed to host Jesse Ebersole and Vern Hara from Hawaii County EMS at MedStar a couple of years ago, they have very unique challenges and now, it seems, unique solutions!


    State Aims To Reduce Unnecessary ER Visits By Empowering Paramedics

    Hawaii is creating a community paramedicine program that officials hope will mean fewer ambulance trips to hospitals.

    By Lorin Eleni Gill

    July 26, 2019

    Minor wounds, rashes, gout pain — these are some of the many medical conditions that should be taken seriously, but they may not merit a 911 call or a trip to the emergency room.

    Hawaii health officials are considering how to reduce unnecessary ER visits through a community paramedicine program. The revised emergency transport system that could begin next year would allow medical professionals to transfer patients to predesignated destinations, such as urgent care clinics, or even provide complete treatment at the scene.

    “Can paramedics go treat people in the field, in the community setting under a physician’s direction, and offer a treatment when they don’t need to go anywhere?” asked James Ireland, a nephrologist and the former director of the Honolulu Emergency Services Department. “Can they do some simple wound cleaning and start the patient on some antibiotics under the guidance of a physician? I think that’s where the huge cost savings can be.”

    When Gov. David Ige signed Act 140 into law June 25, it marked the latest development in an effort to make Hawaii’s emergency response system run more smoothly. Starting as early as next year, the law will allow paramedics or other medical professionals to treat some patients at the scene of an emergency — or nonemergency —  and navigate them to appropriate care at other clinical sites.


  • 23 Jul 2019 10:42 AM | AIMHI Admin (Administrator)

    Fierce Healthcare source article | Comments courtesy of Matt Zavadsky

    A very interesting perspective on our healthcare system as experienced by an “insider”.  We’ve all heard similar tales from our partners IN the healthcare system. 

    This is why healthcare system partners, especially that payer community, is more and more looking to partner with “EMS” to assist with patient navigation from 9-1-1 activations, and to help manage super-utilizer patients.

    Here’s a link to a tragically ironic video depicting what it would be like if air travel worked like our healthcare system.  It’s hilarious, but only because it’s sadly true – worth the 7 minutes you will invest watching the video – you’ll laugh, but maybe it will spur some thoughts on how we fix this.

    Editor's Corner—I write about healthcare. I still found myself lost in the unnavigable healthcare system

    by Jacqueline Renfrow | 

    Jul 15, 2019


    We need a healthcare system that uses all of the amazing technology and ingenuity that is available in 2019 while staying affordable and, most importantly, puts the patient’s well-being first.

    It began back in January with a simple rash—or so we thought.

    My daughter had a rash all over her body, so I took her to the pediatrician. “Maybe it is a virus, or maybe it is just dermatitis. Don’t worry about it,” the doctor said. I was told to apply lotion and give it time.

    A month later, we were at the dermatologist. We went back two weeks later, and then four weeks later, and then again another two times. With each visit, we got another cream, another possible diagnosis. No change in the rash.

    So we returned to our pediatrician's office, which employs more than half-a-dozen physicians. 

    Each of the five times we went back, a different physician offered a different diagnosis. I'd repeat the same story and answer the exact same line of questioning (both to a nurse and a doctor at every visit). At doctor after doctor, my daughter’s height and weight were taken, to the point that she’d announce, “47 inches and 47 pounds” before she even got on the scale. She knew the drill by heart, as did I.

    The ones not in the know were the physicians.

    Each specialist we saw asked which creams she had tried, which antibiotics she had taken and which labs had been run. After my daughter’s second blood draw, I realized that from one doctor to another, no one knew which tests had already been performed. So I started carrying a folder with lab results and a bag of medicine bottles so I had the answers in hand.

    As a mother, I knew something serious was wrong. My daughter had headaches, stomachaches, she couldn’t sleep and was barely eating. Plus, she had one dilated pupil. And her skin was so itchy that she scratched until she bled, meaning several rounds of antibiotics had to be taken to avoid infection.

    We met with an ophthalmologist, an allergist, a rheumatologist and then another dermatologist. I was given ridiculous answers such as: “It’s most likely that the headaches are just behavioral.”

    I was also given scary possible scenarios such as: “There could be a mass behind her eye.”

    And beyond my new role as the walking data collector, I had to fight to get my child in for an appointment.

    Apparently, specialists for children are few and far between, even around the major metropolitan area in which I live. I was told I’d have to wait more than two months to get an appointment with a pediatric ophthalmologist and around the same amount of time for a pediatric allergist.

    But how can you tell a mother that her child could have a brain mass and then expect her to wait to see a physician for more than eight weeks?

    I called in favors. I called friends with specialists and doctors and asked them to get me in. I was willing to pay out of pocket. Insurance was an afterthought at this point. I was willing to travel to any office, any time of day or take any cancellation. And I considered myself lucky to get scheduled with a nurse practitioner at the rheumatologist’s office because the doctor could not get us in until the fall.

    Almost six months after this all began, I reluctantly took my daughter to yet another dermatologist. I’d been on his waiting list awhile. I was told he was older, unfriendly and very off-putting to children. But at this point, I had nothing to lose: The next step was the neurologist.

    Bedside manner aside, this gruff physician finally gave us the answer we'd been searching for. He found a rare bacteria on my daughter’s skin and told us how to treat it. Two weeks later, her rash, along with all of her other symptoms, were gone. It was a relief. 

    But the experience left me feeling frustrated, exhausted, lost and desperate for a different way. I wondered how anyone, sick or healthy, could be expected to navigate a system so divided in communication.

    As a reporter, I’m well aware of the challenges in the U.S. healthcare system. I’ve followed the debates on pricing transparency, drug rebates, value-based care, electronic health record connectivity, physician burnout and access to care. But I learned how frightening it is to be a patient—or the parent of a patient—and have so many physicians give you so many varying opinions and diagnoses.

    I also learned that no one in the healthcare system was going to advocate for my daughter, so it was going to have to be me.

    And I learned that healthcare providers and systems do not communicate with one another. There is no sharing of opinions, lab results, data or doctor-patient relationships.

    I am left with a stack of medical bills and a pit in my stomach that this country has a long way to go to create a clear, navigable system for Americans. We need a system that uses all of the amazing technology and ingenuity that is available in 2019 while staying affordable and, most importantly, puts the patient’s well-being first.

  • 23 Jul 2019 9:57 AM | AIMHI Admin (Administrator)

    FierceHealthcare source article | Comments courtesy of Matt Zavadsky

    Interesting brief from UnitedHealthcare – this is likely a driver for payers discussing in earnest alternate payment models for EMS, models that add value to the payer through appropriate navigation of beneficiaries who access 911 for their healthcare needs.


    UnitedHealth: Healthcare could save $32B annually by diverting avoidable ED visits

    by Jacqueline Renfrow

    Jul 22, 2019

    UnitedHealth Group says 27 million annual trips to the ED are unnecessary. 

    One of the biggest contributors to the rising costs of healthcare is avoidable visits to hospital emergency departments (EDs). In fact, up to two-thirds of the annual 27 million ED visits by privately insured people in the U.S. are avoidable, according to a new brief (PDF) from UnitedHealth Group.

    The average costs of treating these conditions in an ED is $2,032, which is 12 times higher than the $167 it would cost in a physician’s office. The cost is even 10 times higher than visiting urgent care—on average $193.

    Overall, UnitedHealth Group says the healthcare system could save $32 billion a year by diverting these ED visits to primary care or urgent care.

    UnitedHealth Group defines an “avoidable trip” as one that could be treated in a primary care setting. In other words: not an actual emergency. Some of the conditions seen in EDs that could be handled by a primary care physician include bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection.

    “The high number of avoidable hospital ED visits is neither a surprise nor a new problem,” L.D. Platt, UnitedHealth Group vice president of external affairs communications told FierceHealthcare in an email. “Uneven access to timely, consumer-friendly and convenient primary care options is a longstanding problem, and there is a need to bolster and expand primary care capacity through urgent care centers, physician offices and nurse practitioners.”

    Platt notes, however, that until there are better options, consumers will continue to visit EDs for primary-care-treatable conditions.

    What are the main contributors that make ED visits so much more expensive?

    First, hospital facility fees, which cost an average of $1,069 per patient visit. And second, lab, pathology and radiology services cost around $335 per visit at a hospital and $31 at a doctor’s office.

    “Increasing primary care capacity and making primary care options more available and accessible to consumers beyond normal business hours will help consumers avoid unnecessary and costly visits to hospital EDs,” Platt said.

    Of course, taking direct action to curb avoidable visits under control has proved to be a trickier proposition as insurers' attempts to target non-emergency use of the ED have faced heavy criticism and lawsuits.

    For instance, Anthem’s Blue Cross Blue Shield of Georgia was sued last year after instituting a policy to retrospectively deny payments for emergency department encounters it deemed “non-emergent." UnitedHealth also announced it was adopting a new policy for emergency services last year, saying that if it decided a coding— denoting intensity of emergency services provided in an ED—was not justified, they could downcode provider reimbursement or reject it completely. It has faced some pushback from some providers over its claims denial policies.

  • 10 Jul 2019 1:16 PM | AIMHI Admin (Administrator)

    Health Affairs source article | Comments courtesy of Matt Zavadsky

    Interesting data report in this month’s Health Affairs.

    Original and highlighted versions of the published study attached.  Highlighted sections replicated below for your convenience.


    Air Ambulances With Sky-High Charges

    Ge Bai, Arjun Chanmugam, Valerie Y. Suslow, and Gerard F. Anderson

    JULY 2019


    Charges for air ambulance services were 4.1–9.5 times higher than what Medicare paid for the same services in 2016. The median charge ratios (the charge divided by the Medicare rate) for the services increased by 46–61 percent in 2012–16. Air ambulance charges varied substantially across the US, and some of the largest providers had among the highest charges.

    In 2017 two-thirds of air ambulance services with available billing information on network status for privately insured patients were out of network.4 In 2016 the national median charges for air ambulance services were 4.1–9.5 times the Medicare rates; in contrast, the national median charges for ground ambulance services were 2.8 times what Medicare paid (exhibit 1).


    As shown in exhibits 1 and 2, the national median charges for initial fees and mileage rates for air ambulances for rotary-wing air ambulances were 5.3 and 7.3 times the Medicare rate, respectively, compared to 4.1 and 9.5 times that rate for fixed-wing air ambulances. In contrast, the national median charges for initial fees and mileage rates for ground ambulances were 1.7–2.8 times the Medicare rate.

    Charges increased substantially over this time. The median charge increased by approximately 60 percent, from $24,000 to $39,000, for both types of air ambulances (appendix exhibit A2).6In the same period, the median charge ratios for the mileage rate increased for rotary (55 percent, from 4.7 to 7.3) and fixed wing (46 percent, from 6.5 to 9.5) (exhibit 4). The median ratios for the initial fee also increased, by 61 percent (from 3.3 to 5.3) for rotary and 46 percent (from 2.8 to 4.1) for fixed wing.

    The high charges might be the result not of lack of entrants or limited supply, but of a market failure.

    Encouraging the market entry of new air ambulance providers could spur competition and reduce charges, but since many incumbent providers possess underused capacity, the market may already be saturated.8 The high charges, therefore, might be the result not of lack of entrants or limited supply, but of a market failure. Patients lack control over which air ambulance provider transports them, nor can they check provider network status or conduct price comparisons in the midst of an emergency serious enough to require air ambulance service.

  • 4 Jul 2019 11:00 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky HCA has been investing heavily in the Urgent Care model – as referenced in the article, they acquired 24 of them back in October 2016, and they are part of our current ambulance transport alternatives program for a capitated payment agreement we have with a commercial payer.

    They have been very willing to partner on data and outcome sharing, as well as making it easy for us to refer patients to them, both through our 9-1-1 Nurse Triage program, as well as part of a 9-1-1 response.  HCA/CareNow have already reached out with interest in being part of ET3 models as a non-participating partner.


    HCA buys two dozen urgent-care centers from Fresenius Medical Care

    July 2, 2019

    HCA Healthcare purchased 24 MedSpring urgent-care centers from Fresenius Medical Care, the investor-owned hospital chain announced Tuesday.

    The urgent-care centers will operate under HCA's Medical City Healthcare division and be rebranded as CareNow Urgent Care. The acquisition adds eight centers to CareNow's 37 North Texas locations. In 2018, CareNow and Medical City Children's Urgent Care clinics served about 10% of the Dallas-Fort Worth population, with more than 770,000 patient visits, HCA said.

    "Like many of our communities across the country, Austin, Dallas and Houston are experiencing significant growth, and increasingly people want to be able to access healthcare services closer to where they live and work," HCA CEO Sam Hazen said in prepared remarks. "The addition of these urgent-care centers will complement our already robust healthcare networks and help us provide more convenient access for our patients."

    Medical City Healthcare has invested more than $1.7 billion over four years in access points, including CareNow urgent-care locations, infrastructure and new technology, HCA said.

    With the addition, CareNow will operate 160 urgent-care centers across the country. Terms of the deal were not disclosed.

    Investors have targeted urgent care and medical offices, particularly in rapidly growing markets, as the industry pushes for more convenient, affordable care.

    The number of U.S. urgent-care centers swelled to 8,774 as of November 2018, up 8% from 8,125 in 2017, according to the Urgent Care Association's annual report. The number of Medicare and Medicaid patients seeking services at urgent-care centers continues to grow, accounting for nearly 27% of all visits in 2018.

    "This acquisition creates more access to the quality healthcare services our community needs, when and where they need them," Erol Akdamar, president of Medical City Healthcare, said in prepared remarks.

    HCA Healthcare reported net income of $3.79 billion on revenue of $46.68 billion in 2018, up from $2.22 billion in net income on revenue of $43.61 billion in 2017.

    Same-facility inpatient admissions increased 2.5% during 2018 while same-facility outpatient surgeries rose 1.8%.

    Outpatient revenue as a percentage of patient revenue remained relatively flat at 38.2%.

    The gap between U.S. hospitals' outpatient and inpatient revenue continued to shrink in 2017, according to the American Hospital Association.

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