Is response time the best way to judge ambulance services?

Tom Kimball, described as a Boston-area paramedic who will be  attending medical school this fall posed that question in a Boston Globe opinion piece this weekend. ambulances

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.


#APEC15 Emergency docs gather in Boston for annual meeting

Not sure we can promise fun but we’ll post some reports here.  Click on the image Or  check out #APEC15.







Today and this weekend: Code Black: Documentary by #ED doc at MFA #hospitals

Have not seen this but it looks good. Thursday, Friday and Sat afternoons at the Museum of Fine Arts. From the film’s promo:

In his vivid and thought-provoking filmmaking debut, physician Ryan McGarry gives us unprecedented access to America’s busiest Emergency Department. Amidst real life-and-death situations, McGarry follows a dedicated team of charismatic, young doctors-in-training as they wrestle openly with both their ideals and with the realities of saving lives in a complex and overburdened system. Their training ground and source of inspiration is “C-Booth,” Los Angeles County Hospital’s legendary trauma bay, the birthplace of Emergency Medicine, where “more people have died and more people have been saved than in any other square footage in the United States.” CODE BLACK offers a tense, doctor’s-eye view, right into the heart of the healthcare debate – bringing us face to face with America’s only 24/7 safety net.



State keeps tabs on hospital costs, use

Catching up on hospital news:  

1)     AG fires back at Partners on costs. From the Globe

Last week, Thomas O’Brien, chief of Coakley’s health care division, wrote Partners general counsel Brent Henry, calling portions of the (Partners cost report) erroneous and saying in other respects it essentially agreed with his office’s findings. The attorney general’s report was ”a more thorough reflection of the health care market,” he wrote.

2)    The Globe also reports on how patients are gaming the state’s insurance system.

The number of people who appear to be gaming the state’s health insurance system by purchasing coverage only when they are sick quadrupled from 2006 to 2008, according to a long-awaited report released (pdf) yesterday from the Massachusetts Division of Insurance.

3)    The state Department of Health issued a report this week on inpatient admissions and emergency department trends. Click here for the .pdf or here for the main DPH reports page.

Two points of interest

Most patients chose hospitals located in the same region where they live, however, one-third of patients residing in the Northeast and Southeast went to metro Boston area hospitals for inpatient care.

This supports the notion that many patients bypass less expensive community hospitals in favor of expensive teaching hospitals.

 Emergency department visits increased between 1.5% and 2.4% each year between FY04 and FY08. Several national and local studies indicate that the volume of ED visits are not necessarily expected to decrease as insurance coverage expands. This is due in large part to the fact that the uninsured do not account for a larger share of preventable or avoidable ED visits than the insured and that reliance on the ED may be due to outpatient capacity constraints, which may be exacerbated by increased insurance coverage.

This counters the notion that health care costs will go down because the uninsured are using the ED for primary care.

4) But, take note of this story from the Worcester paper, which relates to both findings:

While Massachusetts has more pediatric sub-specialists per capita than many other states, the doctors are in short supply, even at big institutions like UMass.

Finally, check out my post on Nature Network Boston about the confounding results of a survey on the best academic insitutions for researcher. Not the absence of many Boston biggies.

Health career/EMT training scams

First, the alleged Obama “death panel” has been soundly debunked. See KHN’s morning roundup.

So, no new health care jobs there. But, a lot of people are looking for new careers. I get a lot of spam about training programs for nurses and techs. I imagine some of them are scams. Buyer beware– look for accreditation.

EMT’s skipping their training isn’t exactly the same thing, but it does amount to cutting corners on life or death training. Would you want these guys responding to your 911 call? From the Globe.

The former Hamilton police chief and three other men who allegedly falsified emergency medical training and attempted to cover it up as investigators closed in on them were arraigned this morning in Salem Superior Court.

Walter D. Cullen, the former chief, was charged with two counts of Emergency Medical Services violations, and single counts of procurement fraud and larceny over $250. According to authorities, Cullen, 64, said during an investigation that he had taken required emergency training at the Essex Fire Department in 2006, but the investigation revealed that he was on vacation in Denver and San Diego during that time period and that his son-in-law, Sean Cullen, had actually signed in for him.