California emergency room doctors are fighting to preserve a state fund that compensates them for treating poor, uninsured patients at private hospitals — money that lawmakers want to shift to the federal insurance program in order to help bridge the budget gap. But doctors say the shift would still leave millions uninsured for the next several years, raising questions about who will pick up the tab at already strained emergency rooms. "We can't deny care to anybody. The hospitals that are barely making it through, this is going to make it unsustainable," said Arturo Pelayo, MD, an emergency physician at St. Francis Medical Center in Lynwood, where up to 20% of the nearly 70,000 emergency patients they see each year are covered by the Emergency Medical Services, or "Maddy," fund.
The doctor was angry. Not long after Blue Cross Blue Shield of Massachusetts urged him and other health care providers to keep their costs down, the insurer this month disclosed it had agreed to an $11 million payout for its former chief executive. In a terse voicemail, the physician told Blue Cross: You have a credibility problem. It was the kind of call Andrew Dreyfus expected. Hired as CEO of Blue Cross last fall, Dreyfus has been championing affordability — prodding payers and providers to work together to rein in the price of medical care following years of double-digit insurance premium increases. Then came the uproar over millions of dollars collected by his predecessor, Cleve L. Killingsworth, and headlines about five-figure annual fees paid to board members. Suddenly, the talk about lowering healthcare costs rang hollow. To many, Killingsworth's pay package and the board's fees— which were suspended more than a week ago in an effort to diffuse the public outcry— undercut Dreyfus's call to control healthcare spending. "It's hard to reconcile those two messages,'' he admitted.
An unlikely battlefield in Texas' budget war is a hushed pink-and-blue hospital nursery, where 1- and 2-pound babies bleat like lambs under heating lamps and neonatal nurses use tiny rulers to measure limbs that are no bigger than fingers. State health officials, searching for solutions to Texas' multibillion-dollar budget shortfall, have set their sights on these neonatal intensive care units, or NICUs, which they fear are being overbuilt and overused by hospitals eager to profit from the high-cost care and by doctors who are too quick to offer pregnant mothers elective inductions and Caesarean sections before their babies are full term.
Although nearly 80% of domestic violence victims who report the incidents to police seek healthcare in emergency rooms, as many as 72% are not identified as victims of abuse. Of those who are, very few are offered adequate support. These findings from a new study point to a missed opportunity to intervene and offer help to women who suffer violence at the hands of an intimate partner. Karin V. Rhodes, MD, directs the Division of Emergency Care Policy Research in the department of Emergency Medicine at the University of Pennsylvania School of Medicine. She says "Emergency departments are a safety net for women with health issues of all kinds, but our study shows we're not doing a good enough job of assessing our patients' entire situation."
Urgent care centers, which handle a variety of acute and severe maladies from broken bones to flu and lacerations, are proliferating nationally. The industry has grown to 8,800 urgent care centers nationwide with $13 billion in revenue. They typically require no appointments and charge prices lower than emergency rooms but higher than family doctors. The number of urgent care centers has ebbed and flowed in recent decades and is now enjoying a resurgence, said Sam Steinberg, a Florida-based independent financial consultant for the healthcare industry. The centers, he said, are taking market share. "They're skimming a lot of business from the emergency rooms and from primary care doctors,? he said. ?And they're taking away good business: middle-class people with insurance who can go where they choose to go."
No one expects Landmark Medical Center in Woonsocket, RI, to suddenly shut down. Indeed a massive effort has been under way to assure its survival, in some form. The big question is what form that will be. It's a question made especially difficult by the absence of a statewide health plan. There is no consensus on which services are needed, in which locations, to best serve Rhode Islanders. Instead, the 11 acute-care hospitals compete based on their separate interests. All community hospitals in Rhode Island have been struggling financially. But Landmark is in an especially difficult position, serving many poor and elderly people with a high burden of illness. Half its revenue — an unusually high proportion — comes from the federal Medicare program for the elderly, which pays less than private insurers. Some 16% comes from the state Medicaid program for the poor, which pays even less. And for the minority of patients with private insurance, a state-sponsored study found that Landmark and other independent hospitals collect significantly lower rates than hospitals that are part of groups with clout.