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Thursday, January 29, 2015

By Alissa Katz


For victims of sexual assault, getting a bill from the ED evaluation is a stark reminder of a traumatic experience they would rather forget, one that many advocates say needlessly creates impediments to healing.


Many states have assistance programs that cover at least part of the ED visit, if not all of it, but others complain that their policies are unfair to victims. The latest to criticize its protocols, the Louisiana Department of Health and Hospitals, has proposed legislation “to ban medical providers from billing victims for treatment,” according to an Oct. 20 Associated Press article. The law seeks permission for hospitals to bill the state's Crime Victim's Reparation Board directly, a practice currently prohibited.


The federal Violence Against Women Act (VAWA), passed in 1994 and updated in 2013, prohibits sexual assault survivors from being billed for the forensic collection of evidence, including copays, and regardless of the national mandate to comply with VAWA, it’s still up to individual states how to handle the ED charges, which potentially leaves patients more confused than assured. States have had to comply with VAWA since 2009, a mandate that requires the exam to include an assessment of physical trauma, determination of penetration or force, an interview with the patient, and a collection of evidence. (“The Violence Against Women Act of 1994; More often than not, however, these requirements aren’t fully covered through state funding, which varies by state and sometimes by county.


Illinois’ law, the Sexual Assault Survivors Emergency Treatment Act, covers the cost of emergency care for sexual assault survivors, including the rape kit examination, any injury treatment, preventive treatment for HIV, STDs, and pregnancy, and any other care an individual may need. Other states with reimbursement programs, like Oregon, don’t cover the full scope of care that Illinois does, however.


“It depends on whether or not they have injuries that go beyond the basic examination collection of evidence,” said Rebecca Shaw, the compensation program manager for the Oregon Crime Victims’ Compensation Program. The Crime Victims’ Services Division in the Oregon Department of Justice established a Sexual Assault Victims' Emergency Medical Response (SAVE) Fund, which makes medical exams available to every victim of sexual assault in the state regardless of ability to pay. Funding originally came from punitive damages in civil cases; now the program is financed through donations.


Oregon and Illinois are two of only six states with a sexual assault reimbursement program, according to a 2012 AEquitas study. The same study found that 32 states, including the District of Columbia and the Virgin Islands, reimburse hospitals through victim compensation programs. Six states are funded by the county where the offense occurred, six require the law enforcement agency requesting the exam to cover the costs, five states bill the victim’s insurance first (in Pennsylvania, only with a victim’s consent), and six states handle it through different means, like in Maryland, where funding comes from the Department of Health and Mental Hygiene, and Missouri, where the expenses are covered by the Department of Public Safety and the Department of Health and Senior Services. (


Iowa, one of the 29 states with a victim compensation program — the Iowa Attorney General’s Crime Victim Assistance Division — pays for all sexual assault exams through its Sexual Abuse Examination (SAE) Program. Fees for the examiner and the agency are established and detailed separately, and, unlike many states, Iowa does not require victims to file a police report for the exam to be covered.


“The SAE program pays for the initial visit and unlimited follow-up visits for the purpose of testing/prevention of diseases. The rules prohibit medical providers from billing the sexual abuse victim for the cost of the exam. The patient’s insurance cannot be billed unless the patient gives permission to bill the insurance carrier,” according to the Iowa Department of Health’s protocol for adult forensic and medical examination. (“Sexual Assault: A Protocol for Adult Forensic and Medical Examination,” Iowa Department of Public Health, December 2012;


Every state has funding available, though the amounts and for which treatments vary, but the real issue is that many hospitals don’t know protocol and bill patients instead. Sarah Layden, the director of advocacy services at Rape Victim Advocates in Chicago, said one of the primary issues with survivors being billed, regardless of state statutes, is a lack of training and education.


“One of the thoughts that I have is that of the treatment protocols that I see reviewed and approved, I’ve never seen one include their billing process. So, I think that they’re focusing on the treatment, which is great. I have some concerns on some of the things I see in some of these treatment protocols that there [are] blatant errors. I think honestly it’s a compliance issue and a review issue of the treatment protocols. I think hospitals should be required to have to submit that as part of their treatment protocol. I know it’s not necessarily related to treatment, but have an addendum or something like that where they’re actually showing this is our billing process and this is the way that we’re insuring it.


“I think it’s really enforcement and compliance issues as [they] relates to how these bills keep sneaking up in survivors’ mailboxes. I don’t think that it’s intentional [or] that hospitals aren’t paying attention to it by any means. I just think it’s a lack of training and a lack of education.”


Ms. Layden said hospitals would make it a priority to see that billing is done correctly, however, if the law clearly creates an enforcement mechanism and possible fines for not doing so.


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Wednesday, January 28, 2015

A young mother battling Stevens-Johnson syndrome finally left intensive care after months of healing from a reaction to a friend’s prescription that caused her to “burn” from the inside out, according to ABC News.


Yassmeen Castanada, 19, spent 52 days in the University of California, Irvine's burn unit after she was diagnosed. More than 90 percent of Ms. Castanada's body is still affected, according to California’s local ABC affiliate.


When she wasn’t feeling well on Thanksgiving, the young mother took a pill that her friend had left over from a previous illness. Soon, her eyes, nose, and throat began to burn, and she was rushed to the emergency department, according to the young woman’s mother.


Patients with Stevens-Johnson syndrome don't really have burns, said Joshua Zeichner, MD, the director of cosmetic and clinical research at the Mount Sinai Hospital in Manhattan, but the skin barrier function is compromised. Inflammation and blistering occur on the outer layer of skin, leaving the patient vulnerable to infection, unable to properly balance electrolytes, and unable to stay hydrated.


Dr. Zeichner said the syndrome is often most correlated with antibiotics, but there’s no certain way to predict this type of reaction. He also warned that patients should report any reactions following new prescriptions and, if necessary, go to the ED.


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Tuesday, January 27, 2015

The U.S. Department of Health and Human Services said it would fundamentally reform how it pays providers for treating Medicare patients in the coming years.


“Today, for the first time, we are setting clear goals — and establishing a clear timeline — for moving from volume to value in Medicare payments. We will use benchmarks and metrics to measure our progress; and hold ourselves accountable for reaching our goals,” said HHS Secretary Sylvia Mathews Burwell in an official announcement.


The announcement outlined two goals:

·         For 30 percent of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide and to do it by 2016.

·         For virtually all Medicare fee-for-service payments to be tied to quality and value (at least 85 percent in 2016 and 90 percent in 2018).


To move forward with the goals, the HHS announced the creation of a Health Care Payment Learning & Action Network to facilitate the public-private sector partnership, and they plan to hold the first meeting in March.


The announcement marks the Obama administration’s biggest effort yet to shape how physicians are compensated across the health care system, according to a Washington Post article.





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Monday, January 26, 2015

Researchers at Vanderbilt University designed a patient survey to assess what interferes with acute heart failure patients’ ability to care for themselves. The survey was published online in Annals of Emergency Medicine. (


The survey also includes patient responses that explain several nonmedical issues that limit patients’ ability to care for themselves. Thirty-one acute heart failure patients who visited the emergency department took the survey, and each averaged 15 different self-care barriers, including comorbidities, physical disability, feeling frustrated, memory and attention deficits, and lack of control. Thirty-three of the 47 different barriers were reported by at least one-quarter of all patients. Weather, physical obstacles, and a food culture incompatible with dietary restrictions were also frequently mentioned as barriers.



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Friday, January 23, 2015

Online services like ER Express and InQuicker are enabling patients to schedule ED trips on their computers or smartphones.


Booking is as easy as going to a website, entering a zip code and type of care needed, and checking available times. And when an ED is backed up, patients with reservations are alerted through a text message to come later.


ER Express, an Atlanta startup, books reservations for more than 150 EDs and urgent care centers in nearly 30 states. It served more than 40,000 patients in 2014, up 300 percent from 2013. InQuicker was founded by Tyler Kiley, the son of an ED nurse and hospital administrator. He said he’d seen lots of unnecessary waiting, so he created software for online check-ins. InQuicker now serves 224 hospital EDs, 517 doctor practices, 126 urgent care centers, and some other medical providers. The Nashville company scheduled 302,000 appointments in 2014, up more than 80 percent from 2013, and its revenue was $7 million.


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