Updated Jan. 5, 2015
Reimbursing ambulance providers to transport patients to destinations other than emergency departments could save Medicare an estimated $283 million to $560 million a year. If private insurers also reimbursed for alternative destination transports, the savings could be even larger, according to a study by researchers from the University of California, Irvine, and colleagues.
Researchers analyzed a random sample of 5 percent of the roughly 7.1 million ambulance transports resulting from 911 calls by Medicare beneficiaries between 2005 and 2009. Between 12.9 percent and 16.2 percent of Medicare-covered transports were either not emergencies or were for conditions treatable in a primary care setting, the study found. Of patients not admitted to the hospital, about 35 percent had low-acuity diagnoses that could have been treated at less-costly places such as doctor’s officers or urgent care centers.
The study was in the December 2013 issue of Health Affairs.
SCA survival rate stuck at 10 percent
Only about 10 percent of out-of-hospital sudden cardiac arrest victims survive, according to the American Heart Association’s Heart Disease and Stroke Statistics—2014 Update. And at just 5 percent, survival rates for children are even lower. Using data derived from a Resuscitation Outcomes Consortium multi-center clinical trial registry, the 2014 update found:
- More than 1,000 people suffer out-of-hospital SCA daily in the U.S., including about 26 children.
- EMS assesses 424,000 SCAs annually, or about 60 percent of the total number of out-of-hospital SCAs.
- 25 percent of SCA victims treated by EMS have no symptoms before the onset of their arrest.
- Among EMS-treated cases, 23 percent have an initial shockable rhythm of ventricular fibrillation or ventricular tachycardia.
- Blacks and Hispanics have a higher age-adjusted risk of SCA than whites. They also have a lower rate of survival to 30 days post-hospital discharge.
- Prior heart disease (heart attack or heart failure), or a family history of cardiac arrest in a parent, sibling or offspring, is associated with an increased risk of SCA.
- Survival to hospital discharge after EMS-treated non-traumatic SCA with any first recorded rhythm is 10.4 percent.
- Survival after bystander-witnessed VF is 31.7 percent.
- Among people who survive to hospital discharge, five-year survival is better among those who receive angioplasty (78.7 percent vs. 54.4 percent) and among those who receive therapeutic hypothermia (77.5 percent vs. 60 percent).
- Survival rates are higher among those who receive compression-only CPR (10.2 percent) vs. chest compressions and rescue breathing (8.5 percent).
- Each year, EMS responds to SCAs in 9,500 children under the age of 18 and treats 7,700 of them.
- Black athletes aged 17 to 24 are at higher risk of SCA than whites, while male athletes are at higher risk than females.
- Survival to hospital discharge after EMS-treated SCA in children is 5.4 percent. About 7,000 children die annually from SCA.
- Of cardiovascular deaths that occurred in athletes younger than 18, 29 percent occurred in blacks, 54 percent in high school students, and 82 percent with physical exertion during competition or training.
The SCA update was published in the January issue of Circulation. The summary of the report’s findings was prepared by the Sudden Cardiac Arrest Foundation.
Fewer children dying in car crashes
From 2002 through 2011, 9,182 children died in motor vehicle crashes, including 650 in 2011. The good news is that over that same period, the annual death rate fell 43 percent, from 2.2 deaths per 100,000 children in 2002 to 1.2 per 100,000 in 2011.
One in three of the children who died in 2011 weren’t in an age-appropriate restraint such as a car seat, booster seat or seatbelt, according to the study, which appeared in the Feb. 4 Morbidity and Mortality Weekly Report.
Black children were at higher risk of death: 1.5 per 100,000, compared to 1.0 for whites. Black children aged 12 and under were also more likely than whites to be unrestrained at the time of the fatal crash (45 percent compared to 26 percent). Hispanic children were also more likely to be unrestrained than whites (46 percent vs. 26 percent).
Yet usage of car seats and seat belts is increasing, researchers found. From 2002–2003 to 2009–2010, the proportion of unrestrained child deaths decreased by 27 percent for whites, 16 percent for blacks and 14 percent for Hispanics.
Medicaid explansion increases ed visits in Oregon
In 2008, Oregon initiated a limited expansion of a Medicaid program for uninsured, low-income adults, drawing names by lottery. By analyzing ED usage of about 25,000 lottery participants in the 18 months after the lottery was established, researchers found those with Medicaid coverage visited EDs more often—by 0.41 visit annually per person, or 40 percent relative to an average 1.02 visits per person in the control group.
Researchers from the Massachusetts Institute of Technology and colleagues found ED visits increased across a range of conditions, including visits for conditions treatable in primary care settings. The study was in the Jan. 2 issue of Science.
