University of Michigan

Common assumptions about uninsured ED users are false, says study

Anne Zieger — Thu, 23 Oct 2008 09:37:56 -0400

Half of the six most common assumptions about emergency department use by uninsured patients are false, and what's more, the remaining three are supported by fact, but are equally true for both insured and uninsured patients, according to new research appearing in the Journal of the American Medical Association.

Perhaps the most common assumption about uninsured patients--that they frequently come to the ED for non-urgent care--actually isn't supported by current research, according to study lead author Manya Newton, M.P.H., M.S. of the University of Michigan. According to her data, non-urgent visits by uninsured patients climbed from 11 percent to 16.7 percent from 1997 through 2005. However, that was just a bit larger increase than the four-percentage-point climb in such visits, the authors noted, citing the National Hospital Ambulatory Medical Care Survey.

Data suggests that uninsured patients are less likely to be admitted than those with insurance, but this could be because physicians have a higher threshold for admitting the uninsured, researchers suggest.

Another common assumption, that uninsured patients are to blame for ED overcrowding, is not clearly supported by existing data, researchers said. Of about 115 million annual ED visits, just 17 percent are made by uninsured patients. Since this is similar to the proportion of uninsured vs. insured patients overall, this suggests that neither group uses the ED disproportionately, the study concluded.

To learn more about common (and possibly inaccurate) assumptions about the uninsured in EDs:
- read this MedPageToday piece

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Study: ED patients not clear on doctors' instructions

Anne Zieger — Thu, 17 Jul 2008 12:58:06 -0400

A new study appearing in the current Annals of Emergency Medicine suggests that most patients passing through hospital emergency departments don't understand their doctors' instructions. The study, which was conducted by University of Michigan researchers, found that over 78 percent of patients interviewed failed to grasp key information about their care and future needs. To find out whether patients had understood the essentials of their ED visit, the researchers interviewed 140 patients, leaving out those with poor English and those who were diagnosed with alcohol intoxication or abuse in their study.

Among that confused 78 percent, diagnosis and cause of illness accounted for 15 percent, treatment in the ED for 29 percent, how to address their problem at home, 34 percent, and what symptoms should require a return to the ED, 22 percent. Of the 78 percent who had failed to completely understand their visit, a striking 80 percent thought they'd understood everything--an even scarier stat given that such patients are unlikely to demand additional information.

To learn more about the study:
- read this Wall Street Journal blog item

Related Articles:
Trend: ED 'super users' generating big expenses
Hospitals working to avoid non-emergency ED care
Study: ED crowding affects care
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Survey: ED overcrowding getting worse

Michigan mulls new $160M proton beam cancer centers

Abby Christopher — Tue, 24 Jun 2008 13:23:42 -0400

While some communities wonder if they can afford to build just one proton beam cancer center, providers have proposed roughly five such centers in Michigan. Final rulings on state certificate of need applications later this year will determine just how many centers may be approved.

Two rival providers--William Beaumont Hospitals and a cancer treatment consortium established by the University of Michigan--originally planned to jointly fund a single center and applied for a certificate of need to get state approval of the plan. Last week, Michigan Governor Jennifer Granholm changed all that when she vetoed the now former partners' Certificate of Need application that had already won approval from the Michigan CON Commission. In her veto letter to the commission, Granholm stated that a single collaborative approach could violate antitrust laws under the federal Sherman Act and that the U.S. Department of Justice had raised similar concerns.

Each of the former partners plans to re-apply for a separate certificate of need approval. In fact, Beaumont Hospitals has already re-applied, having teamed with Indiana-based ProCure Treatment Centers to build its new for-profit proton beam cancer center. The University of Michigan Health Center's proton beam consortium has only filed a letter of intent, and plans to make a presentation to the state to make its case for the center in early September. The state is expected to rule on the Beaumont application by July 1. Other providers have also submitted applications that the state is expected to rule on by the end of July and the end of September.

State business and labor leaders worry that two or more multi-million dollar cancer treatment centers could drive up health care costs for employers and individuals. Many oncologists, cancer centers, carriers and policymakers around the country also are evaluating the pros and cons of making such high-ticket investments. Proton beam therapy is a relatively new alternative to aggressive cancer treatments such as chemotherapy and more established uses of radiation. Each facility can cost as much as $200 million.

For more information:
- check out the article at Crain's Detroit Business