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By Dr. Paul Kivela

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This is a list of thoughts and articles that are relevant to emergency medicine healthcare policy and the home of  “EM News You Can Use.”

Medically Sound

With Dr. Paul Kivela

Majority of Americans Favor Childhood Vaccines

  February 5, 2017

Most Americans support requiring the measles, mumps and rubella vaccine for public school children in order to protect public health. They see high preventive health benefits of such vaccines, and low risk of side effects, and they consider the benefits of the vaccine to outweigh the risks.Yet, public concerns about childhood vaccines linger in the… Read More


Should I really discharge that patient from the...

  February 5, 2017

An article published in the February 1, 2017 issue of British Medical Journal looked at unexpected mortality after discharge from an emergency department   This retrospective cohort study, utilized Claims Data from the US Medicare program, and examined unexpected deaths after discharge from an emergency department.  Because they wanted to look at “healthy patients” the analysis… Read More


The California Medi-Cal Challenge

  February 5, 2017

Medi-Cal is significant percentage of the state budget accounting for 24-35% of the budget depending on how you look at the calculations.  This is an issue as Medi-Cal pays most providers less than the cost of the care they provide.  In other words, most physicians in California lose money when they care for a Medi-Cal… Read More


Hemoglobin A1c is probably not the Ideal Quality...

  February 2, 2017

This January 31, 2017 JAMA Viewpoint article examines whether Hemoglobin A1c should be used as an outcome (quality) measure Type 2 diabetes and its complications are one of the most expensive issues facing U.S. healthcare.  An obvious goal is to reduce the number  and scope of diabetic complications which should in return improve diabetic’s quality and likely longevity.  The… Read More


Readmissions After Sepsis: New Quality measure?

  January 23, 2017

A January 22, 2017 JAMA article examined the readmission rate and costs of patients discharged with a diagnosis of sepsis. The study examined the  30-day readmission rates.   Currently, CMS tracks readmissions following index hospitalizations for acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia Although previously unstudied, the authors hypothesized that… Read More


Suicide prevention doesn’t have to come with gun...

  January 23, 2017

The National Shooting Sports Foundation (NSSF) is partnering with a national suicide prevention organization, called the American Foundation for Suicide Prevention.  The subject of suicide is a sensitive one, especially among gun rights advocates. And while many gun owners recognize the problem — that some two-thirds of all firearms deaths are self-inflicted — they are… Read More


Change quality measure from readmission rate to Days...

  January 23, 2017

A Perspective article from The New England Journal of Medicine — Days Spent at Home — A Patient-Centered Goal and Outcome This study suggests we should consider days at home as a quality measure rather then readmissions. Post measures of the quality of health care delivery focus on what health care providers do, not what… Read More


Health Costs

  January 23, 2017

The Kaiser Family Foundation website looks at where the healthcare dollar goes. Apparently $2.3 trillion was spent on healthcare in 2010 Hospital care—31 percent Physician/clinical services—20 percent Retail Rx drugs—10 percent Net cost of health insurance—6 percent Investment—6 percent Other health, residential, and personal care—8 percent Other professional services—7 percent Nursing home care—5 percent Home… Read More


New Medicare data show steep increases in drug...

  January 22, 2017

This article looks at the steep escalation of Pharma drugs The CMS on Wednesday released data on the price history of 5,000 prescription drugs over five years, shedding light on the fastest rising source of healthcare costs in recent years. The drug with the biggest rise in cost per unit in Medicare Part D from… Read More


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