Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

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In a recently published article in HealthLeaders MediaObservation Status Sparks Legal Firestormthe author (Christopher Chaney) points to the high differential in out-of-pocket costs for Medicare, Medicaid, and even many commercial plan enrollees around the issue of inpatient admission vs. outpatient observation status, and around coverage for subsequent skilled nursing facility (SNF) admission, as a serious bone of contention for all the stakeholders. ‘Firestorm’ might be an understated way to describe the response to these benefit coverage rules.

In a previous post, I discussed the controversy ignited by the Centers for Medicare and Medicaid Services' (CMS’) Two-Midnight Rule, the MAC and RAC audits and recoupment demands that precipitated blowback from hospitals and the complaints from patients that caused members of Congress to push CMS into reconsidering the rules.
10/30/2014 6:31:57 PM | 1 comments
In Part 1 of this series on healthcare reform and healthcare costs, I discussed how implementation of the Affordable Care Act (ACA) has led to unintended consequences that appear to be driving up healthcare costs.
 
To recap: national healthcare spending increased 3.6 percent to $2.89 trillion in 2013 and is expected to increase by as much as 6.5 percent in 2014. By comparison, the United States GDP increased 3.4 percent in 2013. Healthcare spending already accounts for a staggering 17.9 percent of that GDP, which has serious economic implications for our country.
10/28/2014 10:34:08 AM | 0 comments
​A man in traditional African clothing presents to the emergency department (ED) with flulike symptoms and is immediately isolated from triage for suspected Ebola virus disease (EVD). A physician and two nurses don PPE and enter the isolation room while a tech acts as safety monitor. The hospital’s incident command system is activated, and the infectious disease (ID) physician on call contacts the CDC.
 
Two hours later, the CDC finally clears the patient. As it turns out, the man is from Cameroon (several countries away from the epidemic) and therefore not an Ebola risk.
10/23/2014 1:54:46 PM | 1 comments
By Prentice Tom, MD, and Gregg Miller, MD
 
​Many of you reading this blog will take a lead role in your hospital’s Ebola preparedness planning. Currently it seems unlikely that your facility will encounter a patient with a true Ebola virus infection, but it’s certainly possible that you will care for patients who are concerned they might have the disease. In fact, several of our CEP America emergency departments (EDs) have already seen patients concerned they’ve contracted Ebola.  In these cases, having a solid plan in place can alleviate the fears of patients and staff and maintain public faith in the hospital.
 
To this end, CEP America is currently working closely with our hospital partners. With over one hundred sites, we have access to a wide variety of existing protocols as well as up-to-the-minute feedback from medical directors and nurse managers.
 
The conversation will likely continue for a while, but so far four areas of consensus seem to be emerging.
10/20/2014 5:24:15 PM | 1 comments
​Some say consumers have lost trust in our healthcare system. However, a recent antitrust ruling in Idaho may hold the key to regaining some of that confidence — and curbing the unintended consequences of reform.

Challenging Conventional Wisdom

In preparation for healthcare reform and the shift toward value-based reimbursement, hospitals have been scrambling to buy physician groups.
 
Their oft-stated rationale: employing physicians equates to physician integration, which will promote better quality, greater efficiency and less error and waste. Ultimately, this arrangement means better care and lower costs for consumers. It will also allow hospitals to benefit from new value-based reimbursement schemes.
 
Sounds logical, right? Well, Idaho's Federal District Court isn't quite buying it.
10/16/2014 5:56:48 PM | 3 comments
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