ER death rate drops by half over 15-year period -AND- Obama calls for revisiting the public option

CAL/AAEM News Service at
Mon Jul 25 10:05:15 PDT 2016



July 7, 2016


ER death rate drops by half over 15-year period 



SSlpLR3lZM0hDVjFTdExXRDFzcDdHdHl6bz0ifQ%3D%3D> Fierce Healthcare



By Paige Minemyer


Emergency department deaths dropped by nearly 50 percent between 1997 and
2011, according to a study published in Health Affairs, and the research
team points to advances in palliative care, prehospital and emergency care
as factors for the decline.


Researchers analyzed emergency room visit data from the National Hospital
Ambulatory Medical Care Survey, including all ED visits by adults over the
15-year study period. The data was divided further by race, age, sex,
insurance status, geographic location and other factors, according to the
study. The team studied more than 365,000 observations, representing more
than 1.3 billion ED visits in the United States.


Over the course of the study's 15-year data period, deaths in the ER
decreased by 48 percent. In comparison, there was no significant change in
inpatient hospital mortality between 2005 and 2011, according to the study.


In 62 percent of the visits involving patient deaths, the patients were in
cardiac arrest, unconscious or dead upon arrival, according to the study.
More than 8 percent of patients who died in the ED reported shortness of
breath as their primary symptom, and more than 5 percent of those who died
came to the ER to treat an injury.


The study team writes that further studies will be needed to pinpoint
exactly why deaths in the ED have dropped so significantly, but they listed
to several possible explanations for the decrease, including:


*  Patients are surviving in the ED, but die after being admitted to the
hospital. The team points to the lack of a notable decrease in inpatient
deaths as evidence of this possible trend. 

*  Palliative care is gaining an increasing role in medicine, including the
ED. Because of this, patients are more likely to die in a hospice center or
under hospice care at home, the team writes. They noted that between 1989
and 2007, the number of home deaths increased by more than 50 percent,
leading to a reduction in hospital deaths by more than 20 percent. 

*  "Do Not Resuscitate" orders may terminate care before patients reach the
hospital. The team suggested that this may be especially true of cardiac
arrest patients, who are now more likely to be declared dead before reaching
the hospital than at the ED. 

*  Substantial strides have been made in treating life-threatening
conditions like stroke, trauma and sepsis, including more effective
therapies and enhanced training in critical care.

The research team included Hemal Kanzaria, M.D., assistant professor of
clinical emergency medicine at University of California San Francisco
(UCSF); Marc Probst, assistant professor of emergency medicine at the Icahn
School of Medicine at Mount Sinai in New York; and Renee Hsia, M.D.,
professor of emergency medicine at UCSF. 




July 12, 2016


Obama calls for revisiting the public option



mpaign=financedaily> Modern Healthcare



By Associated Press


President Barack Obama is laying out a blueprint for addressing unsolved
problems with his signature health law, including a renewed call for a
"public option" to let Americans buy insurance from the government.


Obama's assessment of the Affordable Care Act comes in an eight-page article
in the Journal of the American Medical Association, a peer-reviewed
publication. The article debuted Monday on the journal's website, and Obama
plans to echo the themes in public events and speeches in the coming weeks.


Replete with academic-style citations, the article is largely a
self-congratulatory look at what Obama sees as the accomplishments of his
law: millions of Americans who have gained coverage, slower growth in
overall health costs and better coordination of care to improve quality.


Yet it's also a memo for Democrat Hillary Clinton on how she can build on
his legacy if elected president. Obama's latest ideas are likely to be
dismissed by Republicans, who remain committed to repealing the health care
law. In polls, "Obamacare" continues to divide the public.


Despite progress under his administration, "too many Americans still strain
to pay for their physician visits and prescriptions, cover their deductibles
or pay their monthly insurance bills," Obama wrote. Others struggle to
navigate the "bewildering" health system. Too many still lack insurance
coverage, he added.


Obama urged lawmakers to "revisit" the public plan, especially in areas of
the country where there is little or no competition among private insurers
participating in and state-run marketplaces created by the


Many experts consider that at least three insurers are needed for a
competitive market. But many small towns and rural areas have only one
option. The problem is growing, as some commercial insurers scale back their
participation in the health law's markets, and more than a dozen nonprofit
insurance co-ops have collapsed.


Kristie Canegallo, White House deputy chief of staff, said Obama will keep
making his case for a public option to voters, but he doesn't plan to send
the Republican-run Congress new legislation to implement it.


"This Congress is not going to act on a proposal like that," Canegallo said.


During hard-fought negotiations in Congress before Obama signed the law in
2010, liberals pushed vehemently for a public option, in which Americans
could opt for a government-run plan similar to Medicare. It was scuttled to
secure enough votes from moderate Democrats to pass the bill.


Now, Obama aims to influence the debate about health care in the
presidential election.


A public health insurance option would stop well-short of the government-run
system that Vermont Sen. Bernie Sanders turned into a rallying cry. But some
liberals believe it could be a steppingstone. Clinton has said if elected
she'd work with interested governors to implement state-based versions of
the public option.


Republican Donald Trump has said he'd end "Obamacare" and replace it with
something better, though he's been vague on the specifics. A recent
nonpartisan analysis found that the plan Trump has outlined would make 18
million people uninsured.


In a counterpoint to Obama's article published Monday by the same medical
journal, a conservative policy expert called for an overhaul of the health
care law.


Stuart Butler of the Brookings Institution think tank did not advocate
repeal, but said the system is too complicated for many consumers, and
subsidies for moderate-income families are inadequate. Butler said states
should take advantage of a provision in the law that would allow them to
redesign coverage starting in 2017.


"Core parts of the ACA need to be reassessed and revised," wrote Butler.


The health care law has been the major driver in reducing the nation's
uninsured rate to about 9 percent, a historic low. It provides subsidized
private health insurance to people without workplace coverage across the
country, and offers a Medicaid expansion that states can use to cover more
low-income residents.


In the article, Obama repeatedly blamed "hyperpartisanship" for preventing
more progress, pointing out that the 19 states that have refused to expand
Medicaid under his law haven't done as well reducing the number of uninsured
residents. He urged more of those mostly GOP-run states to accept the
Medicaid expansion.


Obama also urged lawmakers to make the subsidies for private health
insurance more generous. And citing the high cost of prescriptions, he
called for new legislation to force drug companies to disclose more
information about their production costs, as well as to give the government
authority to negotiate prices for some high-priced medications.


Those proposals basically align with ideas that Clinton has already put




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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