Thursday, October 20, 2016

On Call by Casey Ross

Good morning! I'm back with today's news on hospitals and health care. For more STAT coverage, like us on Facebook, check out our site, or sign up for our other newsletters.

Just in: A troubling sign for cost control

Uh oh.

You know that prediction that by expanding Medicaid, we could reduce trips to the emergency department and cut costs?

Well, new research published in the New England Journal of Medicine suggests it might be a pipe dream.

After Oregon began broadening access to Medicaid through random lottery, emergency department visits jumped 40 percent. And they stayed at that elevated level  through the first two years of the program. While enrollees are using more primary care, they're still visiting the ED at elevated levels.

“If anything, it looks like Medicaid makes people more likely to use both types of care, rather than substitute one for the other,” said Amy Finkelstein, an MIT economics professor who co-authored the study.

The emergency department is by far the most expensive place to get care. Studies estimate that use of EDs for preventable conditions costs about $30 billion annually — a burden shouldered by hospitals, insurers, and taxpayers.

If Oregon’s experience is any guide, that burden will not be getting lighter any time soon.

Who are hospital CEOs backing for president?

Two words: Not Trump.

The CEOs of many major US health systems are either giving to Hillary Clinton, or sitting it out, according to a review of federal election records by my colleague Ike Swetlitz.

Several influential hospital leaders gave the maximum $2,700 individual contribution to Clinton, including Mount Sinai CEO Ken Davis, University of California San Francisco’s Mark Laret, Duke’s A. Eugene Washington, and Northwestern Memorial Healthcare’s Dean Harrison.   

One of the most prolific donors, Tenet Healthcare CEO Trevor Fetter, was most active in the primaries. He gave $100,000 to Jeb Bush’s PAC, Right to Rise, in March 2015. That makes sense, given that Bush was a member of Tenet’s board until he stepped down to run.

Fetter's loyalty to the Republicans apparently hasn't carried over to the general: His most recent contribution was a $2,700 check to Hillary Clinton in August. (Fetter could not be reached for comment.)

A (data-driven) reminder that the best care isn't always close at hand

Healthgrades has a piece of advice for consumers seeking top-quality health care: Get in your car.

In Tampa, for instance, hospitals abound. But to get a knee replacement done at a top-ranked facility, most residents would have to travel more than 25 miles.

Same goes for pacemaker procedures in Omaha and hip replacements in Cleveland: Getting the best care means a 25-mile drive for most patients.

The report concluded that making the trek is worth it — people who get knee replacements at its 5-star hospitals have a 67 percent lower risk of developing complications than those who get it done at 1-star hospitals.

Standard caveat: As always, take all the stars and rankings with a big grain of salt.

Are naturopaths 'primary care physicians?'

The more than 4,000 naturopaths in the US have been organizing and lobbying to enhance their stature. They're pushing to have some of their treatments reimbursed by Medicare and to be designated as "primary care physicians" under state laws.

But they're running into a buzzsaw of criticism from a former naturopath who has now turned against the profession. 

Britt Hermes’ critiques can only be described as scorching; she uses words like "witchcraft" and "quackery" to describe naturopathy, which uses alternative medicine therapies such as herbal remedies, hydrotherapy, acupuncture and homeopathy. Her former colleagues are fighting back.

Read more about the clash from STAT's Megan Thielking.

CEO Chat: A Florida hospitals exec bets big on heart and brain health

There's an ambitious expansion underway at the University of Florida Shands Health System, a network of hospitals and clinics with annual revenue of $1.2 billion. CEO Edward Jimenez is building two specialty hospitals — one focused on brain health and the other on heart and vascular care. He talked to STAT about the goals.

What’s the benefit for patients?

Here’s what’s special about it: The only thing everyone in the heart hospital will know is heart care. You will know that housekeeper and the dietician and the nurses —that’s all they do is take care of heart patients.

What new technologies are you deploying?

We’re excited about the addition of inter-operative MRI. That will allow our brain surgeons to take MRI images of what’s going on while they are doing surgery itself and be able to adjust their course or continue because it’s working. 

How are you addressing the financial challenges of declining federal reimbursements?

We’ve looked at how to improve our outpatient strategy to put [in place] services that can feed patients back to the mother ship. In terms of new margin, we’ve broadened our reach and for the first time started opening urgent care centers... and creating free-standing emergency rooms.

What's been harder — executing a half-million-dollar building project or installing your electronic health records system?

It’s clearly the electronic health record system.


  • Sexually transmitted diseases are on the rise. (STAT
  • 27 million people are still uninsured (Bloomberg)
  • Will better pay for home health workers improve care for seniors? (Kaiser)
  • Gastric bypass linked to increased risk of C. Diff infections (MedPage Today)

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Stay well, and come back tomorrow.


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