Patient Satisfaction and the Collections Conundrum

Emergency Strikes

The year was 2001—seems like a distant memory. Expecting our first child, my wife and I were living in Modesto, California, thinking about cradles and nurseries. We were so excited—the little one we’d been expecting was on his way! Excitement quickly changed to deep concern as we learned there were some major complications with the pregnancy and our baby was in serious jeopardy. Life’s pause button was pushed as everything else in the world came to a screeching halt.

An ambulance transport and emergency delivery later, we found ourselves in our new home—the neonatal intensive care unit. For the next four months, we worked with medical teams around the clock to slowly usher our new 1-pound, 4-ounce son, Noah (now 15 years old), into the world.

Financial Domino Effects

This was an incredibly stressful time in our lives. Of all the things that burdened us, one of the most memorable was the nearly $5,000 invoice we received for a specific service. With no clue how we would pay this, I finally worked up the courage to pick up the phone and call the number on the invoice. The provider was demanding immediate payment before sending the bill to collections.

Me? Collections? But I’m the good guy, right? People should be reaching out to care for me. What just happened? After days of multiple information exchanges between me, the billing office and my insurance carrier, we finally figured it out—all charges were to be covered by insurance.

While our care through this time was generally very good, this unexpected charge put a cloud over the provider who lacked the proper information—despite a 120-day inpatient stay. Why did the provider send our bill to collections without contacting us? Where was the disconnect? Does this still happen today?

Fast Forward 15 Years to Smarter Billing and Collections

Sadly, this is not an isolated incident. Everyone knows a person with a similar story. But what if this patient billing story could be different? What if instead of multiple collection agency invoices demanding payment, I had been contacted early in the process? Or better yet, what if everything had occurred behind the scenes between provider and payor?

Technology advancements have narrowed the data gap that created these and other tensions for patients, providers and insurance carriers. Health care providers today can better serve their patients and communities through technology. The systems required to instantly supply insurance information and ensure patient-friendly billing are now available. It’s a matter of awareness and investment. Two key technology strategies are rapidly emerging to make collection letters and calls a thing of the past.

Real-Time Insurance Discovery

Insurance discovery solutions help providers find hidden insurance coverage for patients up front versus after the fact. Especially in emergency or self-pay situations, patients may have coverage the provider doesn’t know about. Finding coverage provides a tremendous boost to patient satisfaction and financial engagement.

For providers, finding and securing coverage early in the encounter helps billing teams circumvent months of patient statement and collection efforts. Operational costs are reduced and payor reimbursement is hastened. Best practices are rapidly emerging on how to incorporate real-time insurance discovery within patient registration and billing workflows.

Payment Likelihood Determinations

Where insurance coverage can’t be found or high deductibles result in exorbitant patient financial responsibilities, checking “payability” becomes crucial. Patients with minimal cash reserves or low propensity to pay can be moved to charity care, Medicaid, or account write-off. Families likely to qualify for financial assistance are also quickly identified by using payment likelihood applications.

Billers and collectors are more efficient and effective without damaging patient relations or community reputation. It is often a smarter long-term decision to write off patient balances in those cases where personal bankruptcy is only one medical bill away.

Proactive financial engagement, insurance discovery and smart collections are in the early stages in healthcare. However, provider organizations that embrace more patient-friendly billing strategies can significantly promote patient satisfaction and long-term community benefits.

Ted Williams has been a featured presenter at regional and national EMS conferences, including the state medical associations, ambulance networks, and technology user group conferences. Williams is a founder of Payor Logic, a national provider of healthcare revenue cycle solutions.

NHTSA and NASEMSO Host Panel on EMS Practices

The National Association of State EMS Officials (NASEMSO) and the National Highway Transportation Safety Administration (NHTSA) hosted a series of meetings for subject matter experts to discuss revisions to the National EMS Scope of Practice model. The experts reviewed the model’s practices, examined education and training procedures, and discussed what certification level, if any, is needed for specific treatments that are now widely-used among EMS professionals. The panel focused on five specific procedures that are commonly practiced: hemorrhage control, Naloxone use, CPAP use, therapeutic hypothermia in cardiac arrest, and pharmacological pain management.

Over the next several months, the panel will continue to examine information and recommend changes to the Scope of Practice model, with final recommendations tentatively set to be submitted in August 2018. For more information, please visit NASEMSO’s website.



HHS to Administer $70 million in Funds to Combat Opioid Crisis

The Department of Health and Human Services (HHS) announced $70 million in grants to help communities and health care professionals combat the ongoing opioid crisis that is ravaging communities across the U.S. The majority of the money will be used to help prevent opioid-induced deaths and to provide treatment for people with opioid use disorders, including $28 million allotted for medication-based treatment. More than 33,000 lives were claimed in 2015 due to opioid overdoses.

$41.7 million of the funding is set to expand resources and training for first responders on how to use emergency treatments, such as Narcan, to help reverse and treat overdoses. In many cases, first responders are often the difference between life and death for opioid users who experience an overdose, so it is imperative health care professionals have access to the needed resources and training to help save lives. The additional funding aims to help paramedics, EMTs and other emergency service personnel gain access to much-needed resources.

“The grants we announce today clearly demonstrate our efforts to meet the opioid crisis with every tool at our disposal,” said Substance Abuse and Mental Health Services Administration Acting Deputy Assistant Secretary Kana Enomoto. “The evidence-based training, medication, and behavioral therapies provided here will save lives and help people with addictions start a path toward reaching their potential.”

In addition to the most recent grants, $485 million in grants were awarded in April to treat and prevent opioid abuse.

To read more about the grants, please visit the HHS web site.

Patient Apologies in EMS

When something goes wrong during an ambulance transport, sometimes the most important thing to do is to apologize to your patient. Join Matthew Streger, Esq. of Keavney Streger for a brief overview of the Dos and Don’ts of saying, “I’m sorry.”

2016 AMBY Best Public Relations Campaign: EMSA, CPR Education Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

EMSA CPR Education Program Awarded a 2016 AMBY for Best Public Relations Campaign

Emergency Medical Services Authority (EMSA) | Tulsa, Oklahoma

amby-congrats-emsaEMSA, the Emergency Medical Services Authority, is Oklahoma’s largest provider of pre-hospital emergency medical care. We provide ambulance service to more than 1.1 million residents in central and northeast Oklahoma. EMSA was established in Tulsa in 1977 and later expanded to include Bixby, Jenks and Sand Springs. EMSA began providing service to Oklahoma City in 1990. EMSA is the ambulance provider in 16 cities across the state. As a public trust authority of the City of Tulsa and City of Oklahoma City governments, EMSA is charged with ensuring the highest quality of emergency medical service at the best possible price. There are several entities that work together in the EMSA system, including the Cities of Oklahoma City and Tulsa, the medical director, and the contracted ambulance provider. EMSA oversees all business aspects including ambulances and other capital equipment, maintaining patient records, billing and more. The medical director conducts routine audits and testing of all medics practicing in the system, writes seamless protocols to ensure the continuity of care between first responders and transport medics, researches new treatment modalities and evaluates complaints. EMSA is committed to training and building awareness about CPR in EMSA’s 16 service areas. The program includes a variety of year-round opportunities to learn Hands-Only CPR(TM), as well as leveraging various opportunities to promote CPR education through traditional earned media, digital advertising, and social media. Also, EMSA medics were part of a national challenge to train as many local citizens as possible in Hands-Only CPR, called World CPR Day.

The CPR Education Program had one ultimate goal which was to increase the number of Oklahoma citizens who can effectively do CPR statewide (mostly Hands-Only CPR). The secondary goal was to connect the message of health care expertise and community involvement with EMSA, as an organization, by providing non-emergency interactions with EMSA medics and promoting CPR-related stories in earned media and digital platforms. Two measurable objectives were identified for the CPR Education Program.

Primary Objective

The first objective was to train more than 2,000 Oklahomans on how to conduct Hands-Only CPR on World CPR Day and 10,000 at the Tulsa State Fair and Oklahoma City State Fair. The second specific objective was to utilize earned media, social media, events and public figures to educate the community that EMSA is their CPR resource for training.

For many years EMSA, along with its 16 partnering first-responder agencies, achieved a heart attack survival rate six times higher than the national average. Recognizing that bystander response times were integrated into this health outcome, EMSA noted an opportunity to magnify and improve these successful numbers. The heart attack survival rate results are based on patients in cardiac arrest who received some form of bystander CPR and were found in a shockable rhythm (an ECG rhythm that is treatable using defibrillation) on first EMS contact.

Secondary Objective

The American Heart Association Research The American Heart Association conducts numerous studies on the impact of bystander CPR. These studies prove that during cardiac arrest a person’s survival chance increases significantly with immediate CPR, that CPR can be taught in a very short amount of time, and that compression-only CPR is effective for saving lives. When paramedics arrive on-scene, a patient who is in cardiac arrest and is found in a shockable rhythm (an ECG rhythm that is treatable using defibrillation) is more likely to survive if they receive some form of bystander CPR. The impact of bystander CPR has improved significantly in the past decade. In 2010, the AMR bystander CPR rate was 21.4 percent and in 2014 it increased to 40.8 percent.

Every five years, EMSA conducts a citizen survey to review the perception of services. The most recent report (2012) shows 80 percent of people who use EMSA have a positive impression. Additionally, the public responds extremely favorably to medics and paramedics; however, most people don’t meet a medic until they’re experiencing a medical emergency. Utilizing this information EMSA expanded its public events to put medics in front of potential patients more regularly — before they experience an emergency. Although the CPR Campaign primarily focuses on health-outcomes related to cardiac arrest, a secondary benefit is providing one-on-one opportunities for the general public to spend with EMSA medics, allowing those without ambulance-experience to see first-hand the caring and compassionate men and women who work at EMSA.

In order to build community awareness around the health impact of knowing CPR, EMSA focused on two general audiences: the first included citizens of EMSA’s service area without Hands-Only CPR training, the second group was the opinion leaders. The opinion leaders with the highest stakes for improving health outcomes on a statewide basis were determined to be elected officials.

EMSA has conducted CPR training throughout the community for decades. EMSA also partners with other CPR-certification agencies to increase access to CPR education. For the past three years, EMSA has organized an annual special event to train a large number of citizens in Hands-Only CPR and also communicate the importance of learning CPR. In addition, EMSA provides stand-by ambulances at the Oklahoma State Tulsa State fair annually; during the fair EMSA utilizes an informational booth space to provide citizens with an opportunity to learn CPR.

The CPR Education Program consisted of three key areas. The first was participation in large-scale events that provide an opportunity for training a large number of people (World CPR Day and the two State Fairs). These larger events would be used as a catalyst. The second area was building awareness that EMSA offers CPR training, both Hands-Only and traditional CPR, to the general public within their service area. The final area was recruiting a prominent Oklahoman to participate in a CPR training in order to maximize attention to the importance of CPR training for all individuals. All of the focus areas, and the message that CPR saves lives, were promoted through traditional earned media, advertising, and social engagement.

Large-Scale Training Events

World CPR Day is organized on a national level by AMR and on a local level by EMSA. Each year the EMSA communications team strategically identifies partnership events and organizations to bring Hands-Only CPR in front of Tulsa and Oklahoma City-area citizens. There are many options annually because the wide audience-base includes all individuals in EMSA’s service area without Hands-Only CPR training. EMSA hosted CPR trainings throughout coverage areas utilizing ongoing events at businesses and organizations, such as the business board meetings. Some trainings were private and others were public events. Utilizing earned media and social media, World CPR Day was heavily promoted and resulted in strong participation. Reviewing the World CPR date and community events we noticed the two largest events that could incorporate CPR training were the Big 12 Baseball tournament and the Dallas Cowboys Mobile Museum. These two events were slated to attract large crowds of active Tulsans ideal for learning Hands-Only CPR. EMSA worked alongside the Tulsa Regional Chamber to coordinate a training site at Fan Fest, the fair-like celebration that runs concurrently during the Big 12 Baseball Tournaments. EMSA also had the Dallas Cowboys mobile museum for their evening sessions at LaFortune Park. In addition to the large public trainings, EMSA hosted smaller CPR trainings throughout our coverage areas utilizing ongoing events at area businesses and organizations, such as the Jenks Chamber of Commerce Board Meeting. The largest private training was at Roosevelt Middle School in Oklahoma City where EMSA trained more than 600 students. The Tulsa and Oklahoma City State Fairs provide easy-access to large groups of Oklahoma residents who are eager to learn CPR in order to save a life. Although the location and interaction opportunities are optimal, medics do use key message points, such as “It’s most likely a loved one’s life you’ll save,” to encourage passers-by to participate in the training. Thousands of individuals learned Hands-Only CPR at the state fairs last year. CPR Training Requests EMSA generally receives 30 requests per year to train small groups on how to perform CPR. These are businesses and organizations, as well as teams and non-profits. During the CPR Education Program, EMSA promoted CPR training through all owned mediums including its website and social channels. After promoting World CPR Day and the importance of learning Hands-Only CPR, EMSA inquiries for trainings increased by almost 25 percent. Most of the new requests came from government officials or civic-related organizations, which are targeted groups because their circle of influence is generally larger than other groups.

Training High-Profile Oklahoman in Hands-Only CPR

EMSA individuals researched prominent Oklahomans to find who fit with EMSA’s mission and goals. We needed individuals that would create a buzz online and in traditional media. After considering various famous individuals we determined that elected officials were the most inclined to be concerned with the overall health and well-being of Oklahomans. We set our goals high, and invited the Governor to learn Hands-Only CPR. Additionally, we sent requests to various local elected officials to offer a CPR class during a City Council meeting. We were pleased that Oklahoma’s Governor Mary Fallin, the Tulsa City Council and Oklahoma City Council accepted our invitations, and in three separate events, they learned the steps to save a life through CPR. The events created a stir in local newspapers and TV while also creating engagement online through our EMSA social channels and other digital news sources. Promotion EMSA promoted World CPR Day, CPR trainings, and the elected-officials training events throughout the year. Additionally, EMSA hosted several in-studio CPR demonstrations at Oklahoma City and Tulsa media stations. Another media component was promoting feature stories on patients that survive because of CPR. The final promotional component was a digital ad campaign that are PSAs about the three C’s of CPR: check, call, and compress.

See measurable outcomes below; additionally review work samples to view social media samples, earned media samples and more.

  • Measurable Objective: train 2,000 attendees how to do Hands-Only CPR on World CPR Day. Result: Trained 2,585 people 1,201 in Tulsa and 1,384 in OKC Measureable Objective: train 10,000 attendees how to do Hands-only CPR at the two Oklahoma State Fairs. Result: Trained more than 10,000 people at the Tulsa State and Oklahoma State Fairs.
  • Measurable Objective: Utilize social media to increase awareness of World CPR Day Result: More than 20,000 unique social media impressions for various social media posts promoting and celebrating World CPR Day.
  • Measurable Objective: Utilize earned media, social media and World CPR Day to educate the community that EMSA is their CPR resource for training.
  • Result: Following World CPR Day EMSA was contacted by several community groups wanting EMSA medics to teach Hands-Only CPR at their monthly meetings. Additionally, EMSA gained a lot of media coverage and social media activity due to the high-visibility leadership participating in Hands-Only CPR.

The overall impact of the ongoing EMSA CPR program continues to increase the number of Oklahoma residents who can perform CPR. This ultimately affects improved health outcomes. Additionally, this campaign provides one-on-one time with medics which produces a familiarity with the ambulance authority that will provide long-term mutually beneficial outcomes.

Congratulations to EMSA for the CPR Education Program’s selection as a 2016 AMBY Winner for Best Public Relations Campaign.


2016 AMBY Best Clinical Outcome: Advanced Medical Transport, Race to the Top Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Advanced Medical Transport’s Ramby-congrats-2016-amtace to the Top Program Awarded the 2016 AMBY for Best Clinical Outcome

Advanced Medical Transport (AMT) | Peoria, IL

Advanced Medical Transport (AMT) developed the Race to the Top Program to provide the communities they serve with some of the top cardiac resuscitation rates in the nation. “By concentrating on eight highly-interdependent elements of a world-class emergency cardiac care and response system, we soldier more forces together and win more battles in the war on sudden cardiac arrest,” said AMT’s Josh Bradshaw.

Even before implementing Race to the Top, AMT’s cardiac arrest resuscitation rates were three times the national average.  However, the leadership team felt that they could push the rates higher through a multifaceted outreach program. The project began in in late 2014, with eight specific, measurable, and actionable objectives:

  • Immediate recognition of sudden cardiac arrest;
  • 911 activation, “First-Care” hands-only CPR, GPS to the rescue (PulsePoint);
  • Access to and utilization of AEDs;
  • Pit crew resuscitation by EMS providers;
  • Deployment of Advanced Practice Paramedics;
  • Advanced biomedical tools;
  • Immediate provider feedback; and
  • Community and caregiver recognition.

AMT began the program with a Return of Spontaneous Circulation rate of 27%, and have now reached 45%, well on the way to their near-60% goal. The national average is just 9%.

In December 2014, AMT became the first downstate Illinois EMS agency to report directly to the Cardiac Arrest Registry to Enhance Survival (CARES), a CDC-approved registry provided by Emory University. CARES participation empowers the AMT team to compare Race to the Top’s results with peer cities in North America. This benchmarking is in and of itself another best practice, and helps to drive ever-better results.

AMT’s key objective was to achieve widespread cultural expectations and awareness that saving lives is a community responsibility. “Saving lives is everyone’s responsibility,” says AMT CEO, Andrew Rand, “by working together we can achieve event better results.”

Congratulations to the entire Advanced Medical Transport Team for Race to the Top’s selection as the 2016 AMBY Winner for Best Clinical Outcome.


MetroWest’s JD Fuiten on Mobile Integrated Health

Metro West Ambulance’s Mobile Integrated Heath Program is a leader in the emerging world of community paramedicine and MIH.  The successes in our programs have been centered on the strong relationships we have built with our health system partners.  This partnership allows Metro West Ambulance MIH paramedics to better participate in the longitudinal care of our patients instead of the focused, episodic care of traditional EMS. We have now positioned ourselves as an integral part of the health care team.  The value of an MIH paramedic continues to expand as the skills, tools and knowledge of the paramedic profession as a whole continues to increase.

As the success of the MIH programs across the country continue to prove their value, we look forward to full recognition by CMS as a valuable patient care service that should be recognized outside of the traditional transport fee for service.

JD Fuiten
CEO, Metro West Ambulance
Director, AAA Board
2015 AAA Distinguished Service Award Winner
Hillsboro, OR

Cataldo Ambulance’s Ron Quaranto on Mobile Integrated Health

As a current mobile integrated health provider, we recognize the values of an MIH program which most importantly provides quality patient care to those in need, often in the comfort of their own homes. This is often done under the direction of the patient’s primary care physician in conjunction with the patient’s healthcare team. This allows for the patient to maintain their quality of life while receiving the medical attention they need—and ultimately reducing the healthcare expenses of hospitalization.

Ron Quaranto
COO, Cataldo Ambulance Service

Savvik: Beat the EpiPen (Epinephrine) Price Surge!

Savvik Buying GroupYou may have seen in the American Ambulance Association’s Digest newsletter that many ambulance services are facing a 400% price increase in the price of  EpiPen epinephrine injections. AAA members are beating the surge through AAA’s partnership with the Savvik Buying Group (formerly the North Central EMS Cooperative). Members, save big on Epi-Pen and Epi-Pen Jr today!

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Epinephrine Auto-Inject Jr

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Spotlight: SSM Health Cardinal Glennon Children’s Hospital STARS Program

The Special Needs Tracking & Awareness Response System (STARS), was founded just over two years ago at SSM Health Cardinal Glennon’s Children’s Hospital in St. Louis, Missouri. The team at Cardinal Glennon realized that they needed to do something to address the growing number of children in the U.S. with special health care needs, many of whom are at a higher risk for repeated ambulance transports.

As an EMT for over 18 years, Patricia Casey, the Missouri Coordinator of the STARS Program, knows how intimidating it can be for a first responder to walk into a home that in many ways may look like a hospital room. Children with special health care needs can require many different types of in home medical equipment that first responders are often not familiar with. The STARS Program aims to make the job of the first responders easier while making children with medical needs and their parents more comfortable with ambulances in case they need to be transported in one.

Cardinal Glennon works with local ambulance districts to enroll children with special medical needs in that district’s STAR Program. Once a child is registered in STARS, they are given a unique patient identification number and a home visit is scheduled with the patient and their family to compile pertinent medical history. Participating ambulance companies then create a book with all of the stars in their area so that their first responders have access to the medical information on the go. If a STAR needs to be transported, their caregiver can relay their STAR number to the dispatcher who will then let the first responders know. First responders can then look up crucial medical information about the STARS patient, so they can be better prepared when they arrive on scene.

Knowing that many medical devices in the homes of the STARS may be foreign to first responders, Cardinal Glennon’s staff provides free necessary trainings all around Missouri and now Illinois. Shelby Cox works as the Team Lead for EMS outreach, and Josh Dugal, RN, is the EMT-P STARS Coordinator for Illinois. Together with Casey, they help keep the program running smoothly. Each participating ambulance company appoints a STARS coordinator on their staff who will make biannual home visits and make sure the STARS medical information is up to date. Cardinal Glennon also sets up regular opportunities for STARS to visit their local first responders. Giving STARS the chance to get familiar with an ambulance and their local first responders prior to a medical emergency has been proven to help out both parties when an emergency occurs.

A paramedic who has responded to STARS calls explains that “the STARS system permitted me to have advanced medical knowledge before I walked through the door. There was no time lost backtracking to learn the patient’s history or baseline in the midst of a chaotic scene”. In addition to helping the first responders, the STARS program has been a huge reassurance to the parents of STARS whose children may often need medical assistance.

To learn more about Cardinal Glennon’s STARS program, visit their website or check them out on Facebook. Also check out Patricia Casey’s Article on the STARS Program which includes testimonials from both parents and first responders who have participated in the program.
Thanks to the entire team at Cardinal Glennon for your great work!

Do you know of other innovative programs being run by ambulance services? Share with the AAA so that we might feature those programs on the AAA Blog as well.

Savvik Discount on Physio-Control

The American Ambulance Association is pleased to announce that AAA members can now save significantly on Physio-Control products through the Savvik Buying Group.

Through Savvik’s partnership with Vizient (formally Novation), the largest acute care GPO in the United States, AAA members now have access to this discounted contract on AED’s, Monitors, and Lucas devices and accessories.

Visit the Savvik site today or contact for details!

“Save Lives, Not Seconds” member editorial

Don’t miss the fantastic member-written editorial, Save lives, not seconds, in Wednesday’s Boston Globe. Submitted by Cataldo Ambulance’s Tom Kimball, it gets to the heart of many issues with using response times as the only performance metric. (Emphasis below is ours.)

Many cities and towns in Massachusetts still judge the performance of their ambulance services using metrics like response times, which can miss the point. An additional two minutes waiting for an ambulance will rarely make a difference for a trauma patient facing emergency surgery that may take hours.

Patient outcome is a more valuable measure of whether a medical service is doing right by people. In many areas of health care these days, it is the gold standard, a key factor in determining how much insurance companies pay service providers. Changing the terms of ambulance companies’ contracts to make good patient outcomes the goal could greatly improve the quality of medical care across the state — and save lives.

Read the full editorial over at the Boston Globe. 

Savvik: New Vendor Buying Programs!

Check out the new contracts and specials from Savvik Buying Group! Savvik, formerly the North Central EMS Corporation (NCEMSC), was founded in 1997 as a nonprofit coop that negotiates best prices on millions of items ranging from fully-loaded ambulances to stretchers to office supplies to boots for individual employees.

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10 Safety Topics that Will Move EMS Forward in 2016

What are your ambulance services’s safety priorities for 2016? AAA member The Center for Patient Safety has just released 10 Safety Topics that Will Move EMS Forward in 2016, a free download covering:

  • Airway Management
  • Behavior Health Encounters
  • Crashes: Ambulance and Helicopter
  • Device Failures
  • Medication Errors
  • Mobile Integrated Healthcare
  • Pediatric Patients
  • Safety Culture
  • Second Victim Intervention
  • Transition of Care

Get your copy today to learn how to ensure safety for your employees and patients.

Download Now

AAA Meets with FDA on New Drug Dispenser Regulations

On October 21, the AAA participated in a meeting with stakeholders and the Food and Drug Administration (FDA) about the need to ensure new regulations don’t discourage the transfer of small quantities of drugs between dispensers, hospitals and first responders among others. Under the Drug Supply Chain Security Act of 2013, starting on November 1, drug dispensers must provide a full transaction history for transactions involving even small transfers of drugs. Since these transactions are often done in paper form, it will be difficult for many drug dispensers to be compliant with the new regulation and may opt to not distribute drugs in small quantities.

The AAA is participating in a coalition to ease initial enforcement on small transactions to help ensure those hospital pharmacies that provide first responders with drugs under a safe harbor agreement or direct cost reimbursement will continue to do so. The coalition of stakeholders including the AAA had sent a letter to the FDA on September 24 requesting the meeting.

Older adults’ frailty varies by region, racial background

“A large-scale survey of older Americans living at home or in assisted living settings found that 15 percent are frail, a diminished state that makes people more vulnerable to falls, chronic disease and disability, while another 45 percent are considered pre-frail, or at heightened risk of becoming physically diminished… Older people in central southern states more than three times as likely to be frail than those in the western states. The researchers also found significant racial differences, with blacks and Hispanics nearly twice as likely to be frail as whites.”

Read the full Johns Hopkins Bloomberg School of Public Health study.

Health Affairs shows “frequent flier” needs taper over time

Last week, Health Affairs published a study on the so-called “super utilizers” of the healthcare system, those who are in and out of emergency rooms with such frequency that their need for readmission is nearly assured.

The researchers found that these folks have an intense need that tapers off over time. Of the 1,682 identified as such, just 28 percent fell into the category after 12 months. Baseline spending decreased from $113,522 per capita to $47,017 the following year when they were enrolled in a program to help them stay on top of their health. The study, performed by the medical center Denver Health, analyzed nearly 5,000 patients and found that 3 percent were accounting for 30 percent of adult charges between May 1, 2011 and April 30, 2013.

Read the full article in the Dallas/Fort Worth Healthcare Daily.

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