Admissions to intensive care units (ICUs) from emergency departments (EDs) rose by nearly 50% between 2002 and 2009, according to a study in the May issue of Academic Emergency Medicine.

The authors of “National Growth in Intensive Care Unit Admissions from Emergency Departments in the United States from 2002 to 2009” add that nonwhites and Medicaid enrollees are over-represented:

“Higher rates of general ED and ICU use in these groups may be a symptom of less access to primary care and preventive services, contributing to both increased use of the ED and increasingly higher severity presentations requiring ICU-level care.”

Researchers used data from the National Hospital Ambulatory Care Survey, a national sample of hospital-based EDs. They looked at 4,267 patients who moved from the ED to the ICU, a sample representing over 14.5 million ED encounters during that time.

“Over the study period, ICU admissions from EDs increased from 2.79 million in 2002/2003 to 4.14 million in 2008/2009, an absolute increase of 48.8% and a mean biennial increase of 14.2%,” the study states. “By comparison, overall ED visits increased a mean of 5.8% per biennial period.”

The most frequent reasons for admission were chest pain, shortness of breath, and abdominal pain. The most frequent diagnoses were chest pain, congestive heart failure, and pneumonia.

“Despite this, the top 10 complaints and diagnoses [made up only] 50% and 35%, respectively, of all ICU admissions. This demonstrates the heterogeneity of critically ill patients cared for in ED settings, further underscoring the need for critical care training in emergency medicine residency and beyond.”

Another issue is that patients admitted to the ICU from the ED also underwent more tests, especially CTs and MRIs “which increased from 16.8% in 2002/2003 to 37.4% in 2008/2009, a 6.9% mean biennial increase.”

Patients making such a transfer spend an average of five hours in the ED, the researchers find.

“This finding may suggest that delays in transfer from ED to ICU may be more dependent upon the availability of ICU beds than the level of resource utilization in the ED.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.