Jun 29, 2010

Need And Use For Air Ambulance Service Is On The Rise

Despite the debate between providers and various authorities, demand for air ambulances is rising. Before hiring an air medical transport, patients and their families should make sure that the operators are licensed and bonded, that the life support systems and other medical equipment meet all requirements and that pilots and medical personnel have the experience necessary to provide for safe transport.

While it has its origins in the wartime transport of injured soldiers, air ambulance services have come to be used by medical facilities everywhere. Thousands of aircraft engage in aeromedical transport, from short-range, rotary-winged flights to more extensive journeys aboard small fixed-wing jets. Air ambulances are available for emergency and non-emergency use, and the costs can be quite high. Services range from basic medical monitoring to airborne surgical facilities. While all agree that safety and uniformity are of paramount importance, the industry lacks the regulation necessary to create equitability between all interested parties. Still, demand for this service is not going away, so regulatory change is inevitable.

An air ambulance has two basic functions: to provide fast transport from the scene of an accident to the appropriate medical facilities in an emergency situation; and to provide timely, sometimes long-distance shuttling of patients from one facility to another. Helicopters provide a more mobile, short-range solution in an emergency. Fixed-wing aircraft, such as private jets, are more suited to long-range trips. However, aircraft in both cases can be outfitted with a variety of life support systems and trained medical staff.

Private medical transport via small jets typically starts with a base fee in addition to the expense of trained staff and mileage. It is not uncommon for an intercontinental medical transport to cost $50,000 or more, although domestic flights are generally much less expensive. Depending on a patient’s insurance coverage, air evacuation might be included but only in emergencies and over limited distances. Fixed-wing medical transport specializes in long-distance movement of patients, most commonly in non-emergency situations.

Onboard medical personnel must be trained and certified according to the requirements of their profession, as well as in operational procedures and in-flight safety. While regulation generally eludes the industry, aeromedical service providers must hold an Operations Specifications Part 135 certificate authorizing them to operate an air ambulance.

The Uniform Fixed-wing Air Ambulance Regulation Project has been attempting to create a cohesive set of rules that coordinates the actions of federal and state health regulators, as well as the FAA, with regards to these medical transporters. But for now, those seeking to utilize these services for themselves or loved ones should look into safety records and customer testimonials before a final decision is made about which service to book.

Original article can be found at: http://tinyurl.com/38e3b6v

Jun 16, 2010

Woman shoots self to get surgery

Woman shoots self to get surgery

Desperate and uninsured, Kathy Myers hoped wound would lead to shoulder repair she couldn't afford

By DEBRA HAIGHT - H-P Correspondent
Published: Saturday, June 12, 2010 1:08 PM EDT
NILES - A woman suffering from severe shoulder pain and without any health insurance shot herself in the upper arm Thursday so she could get emergency room care.

Police said the incident happened around 4 p.m. at a home in the 1500 block of Michigan Street on the city's southeast side. Niles police found 41-year-old Kathy Myers suffering from a gunshot wound.

City firefighters and SMCAS ambulance staff tended to her wound, and she was taken to Lakeland Hospital in Niles, where she was treated and released a few hours later.

The bullet, from a .25-caliber handgun, entered her upper arm and exited a few inches lower on her arm.

She told WNDU-TV that she couldn't see a specialist about her lingering shoulder pain because she couldn't afford health insurance.

"If it's not a threatening situation then they won't do anything about it," she said. "So I thought I would give them a life-threatening situation.

"I really didn't accomplish what I hoped it would accomplish," Myers told WSBT-TV. "I was really hoping it would hit an artery or bone so they would do the surgery and fix me. I have no suicide wish. My life sucks right now, but I want to live."

Paul Smallmon, the father of Myers' friend, spoke with The Herald-Palladium Friday evening. Myers lives in the Smallmons' home.

"She had a shoulder injury from about a month ago and was trying to get some help for that," Smallmon said. "She went about it the wrong way."

It was the Smallmons' gun that she reportedly used to shoot herself.

The WNDU story said Myers had been injured when she tried to restrain her bigger dog after it lunged at her Chihuahuas.

Smallmon said Myers had her shoulder injury checked out by doctors, who said she didn't have any broken bones but likely a torn or stretched ligament. They gave her pain pills, which he said hadn't taken away all the pain.

"She was in so much pain, she went out of her head," he said about Myers shooting herself. "She was at her wit's end."

Smallmon said Myers had been out of work as an asbestos remover for close to a year, had run out of unemployment benefits and didn't have any health insurance.

He said she had tried to get work recently in order to get some health insurance but couldn't work because of her shoulder injury.

By Friday evening people had come forward to try to help Myers get the medical attention she needs for her shoulder injury.

Smallmon said the gunshot wound was minor and not causing her much pain, if any, in comparison with the pain from the shoulder injury.

As for the possibility of criminal charges being filed against Myers for shooting herself, he said, "We're hoping nothing happens."

Niles Police Capt. Jim Millin said Friday that the information was turned over to the Berrien County prosecutor Friday as a routine matter. He said it would be up to the prosecutor whether charges are filed.

Millin said possible charges would be discharge of a firearm in the city, which is a local ordinance violation, or careless or reckless discharge of a firearm.

Original article can be found at:

Jun 13, 2010

Is The ED still for "Emergencies"?

Below is a commentary I posted on an online bulletin board a few days ago.  The original poster was discussing the fact that yet another hospital system has gone public with their "ER Wait Times" (see original article at: http://www.inova.org/emergency-room-wait-times/ )

I think the elephant/rhino/gorilla in the room here is that we need to aknowledge that ED is "not just for emergencies" any more!

As a nation and a culture, we have shifted the mindset to "Now" care regardless if it's an ER Wait Times"emergency"or not.

People that are working in emergency medicine or nursing need to realize that this IS the way it IS now - it's not what it WAS before and it's NOT going back to that anytime soon.

If emergency staff find themselves being upset, disgruntled, frustrated, mad etc about "non-emergencies" coming in, they need to either (a) adjust their mindset or (b) find a new line of work because an unhappy employee is an unsatisfied employee and (i) more prone to mistakes (ii) more likely to give bad customer service etc, etc.

What the "secret" is that your admin is NOT telling you, is that they WANT the business.

The PRIMARY role of the ED is that which is mandated by federal law (EMTALA), the SECONDARY role of the ED is an "intake" or "access" point for hospital admissions. Hospital admissions = revenue, which equals profit for the shareholders/stakeholders.

Ah, but the old argument that "all our patients have no insurance"....
...this is only partly true.

The national average is that approximately 30% of your ED patient mix has NO insurance whatsoever. The other 60% has some form of payor status (private, third party, auto, medicare, medicaid). That 60% is what the hospital wants.

And if you think about it, who are you more likely to admit?
a) a medicare patient (someone typically over 65 +/- who has health conditions)
b) an unisured patient (who typically is <45, and has many fewer comorbidities)

Look at your trauma patients.
What is the #1 cause of trauma? ANS: Blunt trauma
What is the #1 cause of blunt trauma? ANS: MVC's
For the most part, what payor status are MVC patients - INSURED (auto liability insurance in MOST states)....This pays big $$$$$

Even if your ED patient doesn't get admitted, think of all the referrals that come out of the ED: referrals for outpatient testing, office visits, specialist consults, procedures etc - if your hospital is networked with the providers of THOSE services, then it's a 2/3 (60%) chance that the pt being referred has insurance and thus the referrals will have about a 60% payor status.

So, you give away 1/3 of your care to capture the 2/3 that are paying...not too shabby.

But wait, there's more....

If your facility is not the "average" and your unisured payor status is greater than 30%, you argue that you're loosing money...
Well, maybe, but that's where state and federal matching money comes in to subsidize uninsured care based on your percentage uninsured.

Also, if your facility is listed as "non-profit", then the tax benefit for writing off "charity care" is even more beneficial to them which helps keep their income taxes reduced even more which means MORE of the 60% payor's money goes into their pockets.

Why am I saying all this...?

When it was the time that I finally realized that the ED was not "the" money-maker, but rather it played a role in the hospital making money - it all became much easier to swallow and understand the bigger picture.

For when you see the big picture, you start to see your role, your department's role in it.