Acute Care

Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.


Nurse Managers Discuss the Impact of Reform

With Joanne Barnett, RN, MSN, and Curt Cabral, RN, JD

Nurses are a key part of the acute care team who play a crucial role in redesigning healthcare delivery. This week, Reform Realtime is pleased to welcome Joanne Barnett, Director of Adult Inpatient and Emergency Services at Pomerado Hospital in Poway, Calif., and Curt Cabral, Clinical Director of Emergency Services at Natividad Medical Center in Salinas, Calif., to talk about the changes taking places at their hospitals and the role nurses play in improvement efforts.

Hip Fracture Team Reduces Complications and Length of Stay

By Jeffrey Frank, MD, MBA; Doug Lange, MD; Rick May, MD; Peter Rowe, MD; Reid Rubsamen, MD; Ryan Green, MD; Eric Fulkerson, MD; Catherine Hurt, MD; Teri DeLaMontanya, RN; and Barbara Harris, RN

Reducing complications (and ultimately morbidity and mortality) among hip fracture patients is a crucial quality goal for many hospitals. Here's how John Muir Medical Center – Walnut Creek (Calif.) achieved excellent outcomes for hip fracture patients using a unique interprofessional approach.

The following post is adapted from a poster presented at CEP America's 2013 conference.

What's Driving the Physician Employment Trend?

By Gary Li, MD, FACEP

These days, we do not really need to be reminded that the landscape of healthcare is changing rapidly. One clear trend is toward the increasing employment of physicians. This includes employment by hospitals, hospital health systems, medical groups, and other entities.

Merritt Hawkins, a national physician recruitment and consulting firm, recently released its 2014 recruitment survey. The results are astounding — less than 10 percent of recruiting searches from April 2013 through March of 2014 were for independent practice positions, such as solo practice or partnerships. (Contrast that with 2004, when 45 percent of job openings were in independent practices.) Of the remaining 90 percent of searches, a large majority were for employed positions.

What accounts for this trend? It seems there are both healthcare-specific and cultural forces at work. I think these are most conveniently divided into hospital/health system and physician categories.

First, let's look at the hospital side. In an environment of decreasing reimbursement and increasing regulation, hospitals and health systems are under immense pressure to improve operational efficiency, quality and service. They see employment as one pathway to improve physician alignment, which is imperative to reaching these goals. They also see physician employment as an effective means to ensure physician involvement and leadership in team-based care. And in the face of intense competition, they are aggressively trying to increase market share — and they need physicians and their practices to do so.

Analysis Suggests New Exchange Patients Are Sicker in the ED

By Joshua Tamayo-Sarver, MD, PhD, FACEP

sick-patient-from-flu.jpgIt's halfway through 2014, and the Reform Realtime data set has matured considerably. This means we're now able to make more meaningful comparisons by controlling for factors like month, year, hospital and geographic location. We're also able to more confidently identify patients covered by state and federal health exchanges.

Being a numbers guy, I'm really excited about this. I've been really curious about the impact of reform on ED volumes (which appear to be rising) and reimbursement (which we all hope will rise).

But as often happens with data, once I started running ours through computer models, I found something unexpected, but equally interesting:

Patients covered through state and federal health exchanges were more likely to present to the ED with high-acuity conditions.

In fact, their overall acuity (on a 5-point scale) was 4.10 versus 3.98 for the non-exchange population. These numbers hold even when controlling for factors like gender and age.

Yes Virginia, There Is Pediatric Emergency Department Critical Care


By Jim Strafford, CEDC, MCS-P

In a 2013 Acute Care Continuum Blog post at Perspectives, we discussed the issue of pediatric ED providers undervaluing their services through incomplete documentation and inaccurate use of evaluation and management (E/M) codes.

But lately in our audit practice, we've also noticed that another service, critical care (CC), appears to be underreported by providers working in pediatric EDs.

What exactly is critical care?

Reform Realtime: Why Does it Look like Self-Pay is Rising?

Yesterday, we reported that the number of self-pay patients has been increasing at our emergency departments (EDs) across the country, and we received a lot questions! Namely, if more people are insured, how can that be the case?

Well as it turns out; there are a couple of factors that made it appear that self-pay is rising.

Infographic: The Number of Self-Pay Patients Continues to Grow

In this infographic, see what the data from CEP America's 94 EDs across the country tells us about how the payer mix has shifted after many of the new healthcare reform measures took effect. Following the data from previous months, the number of self-pay patients continues to rise while other payer types remain flat.

Does this match what you're seeing at your practice? Leave your observations in the comments section.

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