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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Should the states that have thus far turned up their noses at federal subsidies to expand Medicaid coverage to their citizens under Obamacare be praised for upholding conservative principles and fiscal responsibility or derided for ignoring the needs of their poorest citizens and being penny wise and dollar stupid?
When this issue is discussed in the media, in state legislatures and governor’s mansions, and in public policy discourse, this question is as often framed around the political/electoral ramifications of the policy as it is around ethical or financial considerations.

Frankly, it is hard to get too excited about the fate of the politicians who might win or lose leverage or elections as a consequence of this policy decision. Sadly, these politicians are insulated from the direct consequences of the expansion or contraction of Medicaid — they generally have health insurance coverage and lots of healthcare options. When politicians feel insulated, they tend to make ideological rather than practical decisions and often shoot themselves, and the rest of us, in the foot.

9/25/2014 5:33:40 AM | 0 comments

In 2012, the Centers for Medicare and Medicaid Services (CMS) rolled out its first emergency department (ED) core measure set. This was the start of a new era in which EDs played a key role in helping their organizations meet national quality goals. A high-performing ED was suddenly necessary in order to maintain accreditation, compete for patients and receive full annual update payments under CMS' Hospital Inpatient Quality Reporting (HIQR) program. New ED measures have been added to the program each year.

9/23/2014 5:28:22 AM | 0 comments

As of this week, Perspectives is moving to the CEP America website. In addition to an updated design and user-friendly layout, the new site will provide many benefits for our readers.

9/17/2014 6:08:18 PM | 0 comments

One of the toughest challenges facing any military is how a trained soldier will act when bullets start flying.

Some hunker down, claiming it’s common sense to avoid injury. Of course, this type of rationalizing can also be a way (subconscious or otherwise) to disguise fear. Nor does it accomplish the unit's goals, because inaction and self-preservation aren’t exactly keys to success in battle.

Other soldiers face fear head on. In a 2011 blog post for the Wall Street Journal, reporter Bing West shared his experiences while embedded with a highly effective platoon of Marines in Afghanistan. One of the officers told West about a radio conversation they’d recently interrupted between Taliban leaders and the local militia. The Taliban was chastising the guerillas for running from fights. The locals protested that victory was impossible because the Marines actually ran toward their bullets.

9/11/2014 4:34:10 PM | 1 comments


My pediatrician made house calls. I always knew when I heard the pan of water being placed on the stove that a needle was being sterilized and an injection was coming. He knew that I was a gymnast and that my brother was on the swim team, and frequently asked how we were doing in competition.

What I just described was commonplace in the 1950s and 1960s. To me, those were the "good old days" when the doctor actually knew me. And he was my doctor in the hospital, outside the hospital and even in the emergency room! He called the surgeon, orthopedist or urologist and facilitated the specialized care I needed.

9/9/2014 10:03:35 AM | 0 comments
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