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‘Trauma Centers’ Huge Fees to Treat Minor Injuries and Send Home

The care was ordinary. A hospital in Modesto, California, treated a 30-year-old man for shoulder and back pain after a car accident. He went home in less than three hours.

The bill was extraordinary. Sutter Health Memorial Medical Center charged $ 44,914 including an $ 8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists and usually associated with the most severely injured patients.

The case, buried in the records of a 2017 trial, is a rare example of a courtroom challenge to something billing consultants say is increasingly common at U.S. hospitals.

Tens of thousands of times a year, hospitals charge enormously expensive trauma alert fees for injuries so minor the patient is never admitted.

In Florida alone, where the number of trauma centers has exploded, hospitals charged such fees more than 13,000 times in 2019 even though the patient went home the same day, according to a KHN analysis of state data provided by Etienne Pracht, an economist at the University of South Florida. Those cases accounted for more than a quarter of all the state’s trauma team activations that year and were more than double the number of similar cases in 2014, according to an all-payer database of hospital claims kept by Florida’s Agency for Health Care Administration.

While false alarms are to be expected, such frequent charges for little if any treatment suggest some hospitals see the alerts as much as a money spigot as a clinical emergency tool, claims consultants say.

“Some hospitals are using it as a revenue generator,” Tami Rockholt, a registered nurse and medical claims consultant who appeared as an expert witness in the Sutter Health car-accident trial, said in an interview. “It’s being taken advantage of” and such cases are “way more numerous” than a few years ago, she said.

Hospitals can charge trauma activation fees when a crack squad of doctors and nurses assembles after an ambulance crew says it’s approaching with a patient who needs trauma care. The idea is that life-threatening injuries need immediate attention and that designated trauma centers should be able to recoup the cost of having a team ready — even if it never swings into action.

Those fees, which can exceed $ 50,000 per patient, are billed on top of what hospitals charge for emergency medical care.

“We do see quite a bit of non-appropriate trauma charges — more than you’d see five years ago,” said Pat Palmer, co-founder of Beacon Healthcare Costs Illuminated, which analyzes thousands of bills for insurers and patients. Recently “we saw a trauma activation fee where the patient walked into the ER” and walked out soon afterward, she said.

The portion of Florida trauma activation cases without an admission rose from 22% in 2012 to 27% last year, according to the data. At one Florida facility, Broward Health Medical Center, there were 1,285 trauma activation cases in 2019 with no admission — almost equal to the number that led to admissions.



Broward Health Medical Center in Fort Lauderdale, Florida.

“Trauma alerts are activated by EMS [first responders with emergency medical services], not hospitals, and we respond accordingly when EMS activates a trauma alert from the field,” said Jennifer Smith, a Broward Health spokesperson.

Florida regulations allow hospitals themselves to declare an “in-hospital trauma alert” for “patients not identified as a trauma alert” in the field, according to standards published by the Florida Department of Health.

At some hospitals, few patients whose cases generate trauma alerts are treated and released the same day.

At Regions Hospital, a Level I trauma center in St. Paul, Minnesota, patients who are not admitted after a trauma team alert are “very rare” — 42 of 828 cases last year, or about 5%, said Dr. Michael McGonigal, the center’s director, who blogs at “The Trauma Pro.”

“If you’re charging an activation fee for all these people who go home, ultimately that’s going to be a red flag” for Medicare and insurers, he said.

In the Sutter case in Modesto, the patient sued a driver who struck his vehicle, seeking damages from the driver and her insurer. Patient “looks good,” an emergency doctor wrote in the records, which were part of the trial evidence. He prescribed Tylenol with hydrocodone for pain.

“If someone is not going to bleed out, or their heart is not going to stop, or they’re not going to quit breathing in the next 30 minutes, they probably do not need a trauma team,” Rockholt said in her testimony.

Like other California hospitals with trauma center designations, Sutter Health Memorial Medical Center follows “county-designated criteria” for calling an activation, said Sutter spokesperson Liz Madison: “The goal is to remain in position to address trauma cases at all times — even in the events where a patient is determined healthy enough to be treated and released on the same day.”



Sutter Health Memorial Medical Center in Modesto, California.

Trauma centers regularly review and revise their rules for trauma team activation, said Dr. Martin Schreiber, trauma chief at Oregon Health & Science University and board chair at the Trauma Center Association of America, an industry group.

“It is not my impression that trauma centers are using activations to make money,” he said. “Activating patients unnecessarily is not considered acceptable in the trauma community.”

Hospitals began billing trauma team fees to insurers of all kinds after Medicare authorized them starting in 2008 for cases in which hospitals are notified of severe injuries before a patient arrives. Instead of leaving trauma team alerts to the paramedics, hospitals often call trauma activations themselves based on information from the field, trauma surgeons say.

Reimbursement for trauma activations is complicated. Insurers don’t always pay a hospital’s trauma fee. Under rules established by Medicare and a committee of insurers and health care providers, emergency departments must give 30 minutes of critical care after a trauma alert to be paid for activating the team. For inpatients, the trauma team fee is sometimes folded into other charges, billing consultants say.

But, on the whole, the increase in the size and frequency of trauma team activation fees, including those for non-admitted patients, has helped turn trauma operations, often formerly a financial drain, into profit centers. In recent years, hundreds of hospitals have sought trauma center designation, which is necessary to bill a trauma activation fee.

“There must have been a consultant that ran around the country and said, ‘Hey hospitals, why don’t you start charging this, because you can,'” said Marc Chapman, founder of Chapman Consulting, which challenges large hospital bills for auto insurers and other payers. “In many of those cases, the patients are never admitted.”

The national number of Level I and Level II trauma centers, able to treat the most badly hurt patients, grew from 305 in 2008 to 567 last year, according to the American College of Surgeons. Hundreds of other hospitals have Level III or Level IV trauma centers, which can treat less severe injuries and also bill for trauma team activation, although often at lower rates.



Emergency surgeons say they walk a narrow path between being too cautious and activating a team unnecessarily (known as “overtriage”) and endangering patients by failing to call a team when severe injuries are not obvious.

Often “we don’t know if patients are seriously injured in the field,” said Dr. Craig Newgard, a professor of emergency medicine at Oregon Health & Science University. “The EMS providers are using the best information they have.”

Too many badly hurt patients still don’t get the care they need from trauma centers and teams, Newgard argues.

“We’re trying to do the greatest good for the greatest number of people from a system perspective, recognizing that it’s basically impossible to get triage right every time,” he said. “You’re going to take some patients to major trauma centers who don’t really end up having serious injury. And it’s going to be a bit more expensive. But the trade-off is optimizing survival.”

At Oregon Health & Science, 24% of patients treated under trauma alerts over 12 months ending this spring were not admitted, Schreiber said.

“If this number gets much lower, you could put patients who need activation at risk if they are not activated,” he said.

On the other hand, rising numbers of trauma centers and fees boost health care costs. The charges are passed on through higher insurance premiums and expenses paid not just by health insurers but also auto insurers, who often are first in line to pay for the care of a crash victim.

Audits are uncommon and often the system is geared to paying claims with little or no scrutiny, billing specialists say. Legal challenges like the one in the Sutter case are extremely rare.

“Most of these insurers, especially auto insurance, do not look at the bill,” said Beth Morgan, CEO of Medical Bill Detectives, a consulting firm that helps insurers challenge hospital charges. “They automatically pay it.”

And trauma activation charges also can hit patients directly.

“Sometimes the insurance companies will not pay for them. So people could get stuck with that bill,” Morgan said.

A few years ago, Zuckerberg San Francisco General Hospital charged a $ 15,666 trauma response fee to the family of a toddler who had fallen off a hotel bed. He was fine. Treatment was a bottle of formula and a nap. The hospital waived the fee after KHN and Vox wrote about it.

Trauma alert fatigue can add up to a nonfinancial cost for the trauma team itself, McGonigal said.

“Every time that pager goes off, you’re peeling a lot of people away from their jobs only to see [patients] go home an hour or two later,” he said.

“Some trauma centers are running into problems because they run themselves ragged. And there is probably unneeded expense in all the resources that are needed to evaluate and manage those patients.”

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This post originally posted here Medscape Medical News

A new drug could help treat perinatal depression

Until recently, treatment for perinatal depression—an umbrella term that refers to all depressive disorders related to pregnancy and childbirth—was exactly the same as for other depressive disorders. And Matthews says that the conflation of the two kept some people from seeking care. “Mental health and maternal mental health are two different diagnoses,” she says. “And this is where women struggle—we don’t want the Prozacs, we don’t want the heavy drugs without that diagnosis.”

As part of the movement towards treating perinatal depression as its own distinct issue, a new breed of fast-acting antidepressants is popping up. Positive results from a phase III trial of one such option, zuranolone, were published in June, showing that medication might offer at least some hope to those suffering during or after pregnancy.

“I think we’re finally at the point where we might be entering this new frontier of treating postpartum depression, and breaking from the past where we treat it like any disorder,” says Kristina Deligiannidis, who studies and treats reproductive psychiatry at the Feinstein Institutes for Medical Research, and is the lead author on the study. (Deligiannidis disclosed funding from the drug manufacturer, Sage, including grants for the study and private consulting fees.)

Zuranolone is a sister compound to another antidepressant, brexanolone, approved in 2019 to treat postpartum depression. Both are distinct from existing antidepressants in that they take effect within days, instead of weeks. And so far, patients have not reported suicidal ideation as a side effect, a major risk of existing drugs. But brexanolone is delivered by a multi-hour IV drip, while zuranolone is given as a series of daily pills.

In June, zuranolone’s manufacturer released top-line results from another phase III trial that used the drug to treat major depressive disorder. (The results haven’t gone through peer review.) Those results found some initial efficacy that waned over time, at least by one measure of depressive symptoms. But six weeks into the trial, there was no significant difference between those who’d received the placebo and those who’d received zuranolone. By another measure, zuranolone never made any difference. (After the trial concluded, however, blood analysis suggested that some participants hadn’t been taking their medication, which could explain the lack of results. Other trials for depression are ongoing.)

The postpartum trial was much less ambiguous. The drug was effective on multiple measures of depression, and the effect was consistent for six weeks after beginning treatment. In a press release, the company said that it would “discuss next steps” with the FDA.

More importantly for the purposes of patients, says Deligiannidis, at the end of the study, 53 percent of people who took zuranolone were in remission, versus 30 percent who’d taken the placebo.

That may be, at least in part, due to the difference between the broader major depressive disorder and the much more specific perinatal depression.

Although the language of psychiatry refers to major depressive disorder as a single diagnosis, its causes aren’t well-understood. It’s likely that those causes—social, neurological, genetic, and their overlaps—vary from person to person, just as symptoms do, and there are many different “depressions” that fall under the banner of “major depressive disorder.”

By contrast, Deligiannidis says, the triggers for perinatal depression are better understood, and are largely distinct. “I wonder if [perinatal depression] is a more pure subtype overall, in contrast to major depressive disorder in men and women across their lifetimes.”

[Related: Exercise really does seem to help with depression]

“The data so far is that women who develop perinatal depression or postpartum depression have an altered sensitivity to stress during these phases of reproductive hormone variability,” Deligiannidis says. That stress response seems to come from the interaction between a specific neuroreceptor, GABA, and reproductive hormones, but it’s shaped by genetics, previous trauma, or chronic stress. People who develop some form of perinatal depression seem to have GABA systems that aren’t able to adapt to changes in hormones and general stress either during or after pregnancy.

Researchers know that zuranolone, which is closely related to some of those key sex hormones, modulates some GABA receptors, which likely impacts how the entire brain responds to stress. “We know that it’s capable of changing brain function very quickly,” Deligiannidis says, “but that’s kind of the end of what we know.” But it may have something to do with why zuranolone seems to work for perinatal depression.

This lack of clarity isn’t entirely surprising in the field of antidepressants; despite decades of use, it’s still not clear why exactly selective serotonin reuptake inhibitors, an incredibly common class of antidepressant, alleviate some people’s symptoms and not others.

But even with zuranolone, perinatal depression remains a problem for about 13 percent of people who become pregnant.  Matthews says that was clear as she talked to people she knew about her experience—everywhere she turned, she found friends who could relate to what she described.  Those conversations led naturally into advocacy: she leads an organization that connects women, and especially women of color (who she describes as both under and overdiagnosed) with mental health resources around childbirth.”It affects everyone in their birthing experience, but there’s just not an alignment with conversations around maternal mental health,” she says. “There’s never been anything out there specific to this mental health condition.”

Philip Kiefer

Philip Kiefercovers ecology, the climate, public health, and more from New Orleans. His work has also appeared in Outside, National Geographic, and Sierra.

Author: Sara Chodosh
Read more here >>> Science – Popular Science

Michael Jackson girlfriend Stephanie Mills on ‘compassionate’ star and his favourite treat

Before Michael Jackson became a global superstar in the 1980s he enjoyed a brief relationship with Broadway star Stephanie Mills. Mills was renowned for playing Dorothy Gale in the 1975 stage show The Wiz – an adaptation of The Wonderful Wizard of Oz. Jackson later went on to star in the film version of the show which was released in 1978. During an interview Mills revealed how he acted while they were together.

Mill said in 2016: “I loved Michael!

“We dated for about a year and a half back in the day. He was the sweetest, most compassionate, most loving person. Very soft-spoken and very humble.” (Via Closer)

The seven-time Tony Award-winning singer went on to out one of Jackson’s guilty pleasures.

She revealed: “He loved to laugh, and he loved Famous Amos chocolate chip cookies.”

READ MORE: Michael Jackson gifted Princess Diana three AMAZING presents

Mills continued: “We used to ride up Ventura Boulevard [in LA] and he’d want me to go and get them!

“He saw me in The Wiz all the time, and I went to the set [of The Wiz film] a couple times.”

While talking to The Breakfast Club radio station, Mills explained she and Jackson “were very young” when they were together.

Presley and Jackson eventually got married in 1994.

After their wedding, they appeared on The Oprah Winfrey Show to discuss their love.

During the expose interview, the couple were asked if they had sex.

An irritated Presley replied: “Do we have sex? Yes, yes, yes!”

The daughter of Elvis Presley was clearly frustrated by the doubt surrounding their marriage.

She said: “Did we marry out of convenience? Why wouldn’t we have a lot in common?”

The couple split just two years later in 1996.

SOURCE

Author: Callum Crumlish
Read more here >>> Daily Express

macOS Monterey release: Treat your MacBook to these new features before everyone else

This is beta software and is not by any means the finished article.

In fact, that’s the whole point of Apple making it available early as it means you’ll be tasked with reporting any bugs, incompatibilities, or glitches found in the early software.

This gives the US firm plenty of time to iron out issues before millions of people attempt to download on launch day.

Because it’s not the final build, Apple advises that users should not download the macOS beta on their primary Mac. Instead, to avoid any laptop-crashing nightmares when you really need to use your PC, the software should be installed on a secondary MacBook or iMac.

If you happen to have a spare MacBook under the bed then you can check out some of the best five features here.

Author: David Snelling
This post originally appeared on Daily Express :: Tech

Can a simple pill treat COVID? A new initiative from the NIH wants to find one

Click here to see all of PopSci’s COVID-19 coverage.

Vaccines have been crucial to quelling the COVID-19 pandemic—and that’s an understatement. The billions of dollars put into Operation Warp Speed, along with other investments made by private pharmaceutical companies, to develop the vaccines will continue to save lives as cases of COVID-19 lower. 

But the crux of vaccines’ effectiveness is that the innoculations prevent people from getting a bad infection to begin with. There are far fewer viable medications available that successfully treat COVID-19 once the disease develops. A new initiative from the National Institutes of Health (NIH) aims to fill that gap by developing better antiviral drugs—not just for COVID-19, but for future pandemics as well. 

On Thursday, the Biden Administration announced that it would invest $ 3 billion, taken from the American Rescue Plan, for COVID-19 antiviral development strategy. 

“New antivirals that prevent serious COVID-19 illness and death, especially oral drugs that could be taken at home early in the course of disease, would be powerful tools for battling the pandemic and saving lives,” said Dr. Anthony Fauci, chief medical adviser to the President and the National Institutes of Allergy and Infectious Diseases Director, in a statement from the NIH about the announcement. 

A major part of the plan will be to, as the release puts it, “accelerate and expand” efforts to test new drug candidates for COVID-19. Another portion of the plan’s funds, $ 1.2 billion, will focus on other antiviral drug therapies not just for COVID-19 but for other severe viral infections as well. 

The research and money invested so far in antiviral drug development has largely fallen short. Even the one FDA-approved drug to treat COVID-19, remdesivir, hasn’t achieved significant success. Crucially, the drug needs to be taken early on in the course of the disease for it to work effectively. That’s hard, though, given the drug must be given intravenously—it’s not something you can pick up from your local pharmacy. 

[Read more: What we know about the Delta and Kappa COVID variants]

Similarly, monoclonal antibodies, like those made by Regeneron, must also be administered through an IV andWhat we know about the Delta and Kappa COVID variants are most successful if given early. A better therapy would be one that treats COVID early on in the disease via a pill, but little funding has gone into the development of drugs like these. That’s what this new initiative is aimed at exploring. 

For example, The New York Times points out two drug candidates, AT-527 and PF-07321332, developed by Atea Pharmaceuticals and Pfizer, respectively. AT-527 was originally developed for hepatitis C and some preliminary studies suggested it might help people with COVID-19. The other, PF-07321332, began as a potential treatment for SARS, which Pfizer later modified to prevent COVID. Researchers at Pfizer are currently working on adapting the drug from its current IV formulation to a pill-form, which takes time and money invested into clinical trials. It’s this kind of drug development that the recent investment could push forward.

As the current pandemic has shown, fighting a viral epidemic requires more than just effective vaccines. For one, vaccines will never be 100 percent effective, even in those with healthy immune systems. They also take time to develop, even at warp speed. Having drugs, especially in accessible pill formulations that can easily be accessed with a doctor’s prescription, will be key to continuing to combat COVID-19—and future viral pandemics as well.

Claire Maldarelli

Author: Claire Maldarelli
This post originally appeared on Science – Popular Science

How to treat sunburn – 5 DIY remedies to soothe your sunburn

Sunburn is an inflammatory reaction to ultraviolet (UV) radiation damage to the skin’s outer layers. At the heart of it all is melanin, a pigment that gives your skin its colour and defends against the sun’s strong rays. Melanin works by darkening your unprotected sun-exposed skin, and the amount your body produces is determined by genetics – which explains why some people burn and others tan. But both are signs of cell damage to the skin, and sunburns can range from mild to full-blown blistering.

How to treat sunburn

Baking soda and oats

Baking soda is, basically, a miracle cure for anything and everything, and it turns out sunburn is no different.

Throw a few heaped teaspoons of baking soda into a bathtub of cool water and soak in it for about 20 minutes, which helps to minimise sun damage.

Adding a cup of oats to the bath also soothes irritation and helps the skin retain its natural moisture.

But don’t scrub your skin either in the bath or when you’re out, and dab yourself with a soft, dry towel rather than rubbing.

READ MORE: Fatty liver disease: Nosebleeds are a sign

Chamomile tea

Chamomile tea isn’t just good for soothing a stressed mind or unwinding after a long day – it’s excellent for sunburned skin.

Brew the tea as you normally would and let it fully cool down, you can pop it in the fridge to speed this up.

When it’s ready, soak a washcloth in the tea and apply it all over the affected areas.

However, if you’re allergic to pollen then don’t use this treatment as it could cause an allergic reaction within the skin.

Cucumbers and tomatoes

They aren’t just a salad staple – both tomatoes and cucumbers help relieve discomfort and inflammation.

Rub chilled slices of cucumber on your skin burn to relieve the pain, and once they heat up, flip it over and use the cooler side.

You can also apply tomato slices to soothe a bad burn, but eating them helps protect you against future burning too.

Studies have shown that eating tomatoes helps protect you against UV rays.

Author:
This post originally appeared on Daily Express :: Health Feed
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Fatty liver disease: Diabetes risk increased due to insulin resistance – how to treat?

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver disorders worldwide. It is associated with clinical states such as obesity, insulin resistance, and type 2 diabetes, and covers a wide range of liver changes, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), liver cirrhosis, and hepatocellular carcinoma. What is the link between fatty liver disease and insulin resistance and how can you improve it?

In a study published in the US National Library of Medicine National Institutes of Health, non-alcoholic fatty liver disease and insulin resistance was analysed.

The study noted: “Metabolic disorders, such as lipid accumulation, insulin resistance, and inflammation, have been implicated in the pathogenesis of NAFLD, but the underlying mechanisms, including those that drive disease progression, are not fully understood. 

“Insulin resistance and excessive fatty acids in the circulation lead to simple hepatic steatosis.

“We previously showed that insulin resistance promoted the progression from simple fatty liver to non-alcoholic steatohepatitis.

“Insulin resistance is pivotal for the progression of NAFLD. It has been shown that NAFLD is closely associated with insulin resistance, as 70 to 80 percent of obese and diabetic patients have NAFLD.”

How to improve insulin resistance for a healthier liver

UK researchers looked at weight loss and also at certain biomarkers, or indications of fatty liver, such as levels of a liver enzyme known as ALT (alanine aminotransferase).

What they found is that in people who did not attempt to lose weight or tried with a standard weight loss diet were not very successful but those who participated in a more intensive program showed greater weight change and with it, improvement in their liver status.

Exactly how the weight loss improves liver health is not known for sure, the researchers say.

It could be that by improving control of blood sugar levels and reducing problems of insulin resistance may explain the positive changes in liver function, says study leader Dr Dimitrios Koutoukidis, a researcher at the University of Oxford.

Diagnosis

Most people with fatty liver disease don’t have symptoms, and that’s true even if it has developed into NASH, said Health Harvard.

The site added: “Only occasionally do people feel run-down, or they have an achy feeling in the upper right side of the abdomen, where the liver is located. So, more often than not, fatty liver disease and NASH are discovered incidentally, starting with higher-than-normal levels of liver enzymes on a routine blood test. 

“Some researchers have developed formulas that use a simple blood test and measurements of various hormones, inflammatory factors, and liver enzymes to arrive at a diagnosis, but this work is at a preliminary stage.”

This article originally appeared on Daily Express :: Health Feed
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James Martin shares easy Welsh rarebit recipe for an Easter weekend treat

Welsh rarebit is essentially cheese on toast but with added flavour – a perfect snack or lunchtime meal to eat on the Easter weekend.

Penny from Bingley in Yorkshire called in to James’ show today to tell the chef about her struggles with cooking rarebit, saying that she “cannot keep the cheese on top of the bread”.

James, as always, had all the answers and showed Penny how he would make the delicious dish.

First, the chef pointed out the ingredients needed for Welsh rarebit, which are cheddar cheese, English mustard, tabasco, Worcestershire sauce, flour, egg, and milk.

READ MORE: Cleaning: Mrs Hinch fans share ‘excellent’ 89p tip

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Arthritis: Cannabidiol could treat joint pain and other symptoms in humans and dogs

CBD treatment is rapidly increasing in popularity due to anecdotal evidence suggesting it’s an effective pain relief tool, hence the investigation.

Lab studies have already shown that CBD can reduce inflammatory markers within human and rat cells.

Thus, in investigating the matter further, the researchers turned towards the next test subject – dogs.

The trial

There were 20 domesticated dogs involved in the trial, who were seen at the Sunset Animal Hospital in Houston, Texas.

READ MORE: Arthritis symptoms – five ‘completely different’ signs

This included whether they observed changes in the animals’ level of pain.

In addition, the dogs’ cell blood count and blood indicators of liver and kidney functions were evaluated before and after the four weeks of treatment.

“We found encouraging results,” Dr Halpert said. “Nine of the 10 dogs on CBD showed benefits, which remained for two weeks after the treatment stopped.”

This suggests that CBD – the non-addictive product derived from hemp (cannabis) – can significantly improve quality of life for dogs and their owners.

The pain, discomfort and stiffness is caused by the cartilage within a joint becoming damaged.

Damaged cartilage is less smooth, and can cause the bones within the joint to rub together, leading to pain and more damage.

If you’re concerned, a visit to the vet can confirm if your dog is suffering from arthritis.

Should arthritis be confirmed, the vet will offer a variety of treatments, such as anti-inflammatory drugs.