News and Views

The emerging healthcare environment requires expanded patient access while minimizing the cost of care. This is of particular importance for accountable care organizations that are assuming significant risk and must develop more innovative ways to deliver care to drive better outcomes and wring out inefficiencies. Our practice has experienced this struggle on a daily basis as patients, who needed a surgical consult, were frustrated with limited access. Our clinical schedule was filled with non-surgical candidates. This created a paradox where the most specialized health system resources (e.g., surgeon and MRI) were being allocated to a continuum of care that did not result in better care or outcomes, while also increasing physician and patient frustration. The long-standing dilemma was that the wrong patient was often in the wrong clinic leading to an inefficient and circuitous path for the delivery of appropriate care. When evaluating our practice it was clear that we could improve our allocation of available resources with the outcome being happy patients and happy physicians within a healthcare system that was delivering high quality, low cost, appropriate care.

Executive Insight

By Diku Mandavia, MD, FACEP, FRCPC

Yahoo! Health, Day in Health

By Lisa Collier Cool

Dr. Bahner underscores that since the 1980s, emergency ultrasound performed by emergency physicians at the point of care has been recognized as a valuable technology to improve the department.  Employing ultrasound at the bedside, he asserts, can reduce medical errors, provide more efficient real-time diagnosis, and in certain clinical scenarios, supplement or replace more expensive imaging modalities such as CT and reduce patient exposure to ionizing radiation.  This article details how ultrasound can improve procedural success and safety such as invasive procedures like nerve blocks and central venous catheter placement, prevent costly errors and discussed the future of emergency ultrasound which has grown since the American College of Emergency Physicians (ACEP) published its first specialty-specific ultrasound guidelines.

Patient Safety & Quality Healthcare

Diku Mandavia, MD, FACEP, FRCPC, Chief Medical Officer at SonoSite, and clinical associate professor of emergency medicine at the University of Southern California

True Value

David B. Case, MD, clinical associate professor of medicine at Cornell University Weill College of Medicine in New York 

John E. Postley, MD, FACP, assistant clinical professor of medicine at Columbia University.

This article enumerates the benefits and applications of Musculoskeletal Ultrasound and details procedural guidance for join and soft tissue injections and aspirations.  Dr. Goyal also explains that ultrasound technology has been shown to be 6.5 times more sensitive than x-rays for early, accurate diagnosis of small bone erosions in patients with rheumatoid arthritis.  He argues that point of care US can significantly reduce medical errors and offer efficient real-time diagnosis.   US can replace or supplement more expensive imaging technologies such as CT in appropriate clinical scenarios.

Group Practice Journal

Michael Shabot, M.D. FACS, FCCM, FACMI, is chief medical officer, Memorial Hermann Healthcare System, Houston and Adjunct Professor at the University of Texas School of Biomedical Informatics and the University of Texas School of Public Health at Houston.

The authors walk through the rationale, steps taken and results from a re-engineered clinical shoulder injury pathway program focused on rotator cuff tears.  By using the appropriately skilled provider at the right time and through first line use of ultrasound instead of MRI, the program lead to the clinic being able to serve more patients by improving physician efficiency.   The result was exceptional economic and clinical value: the program ultimately provided a 40% decrease in MRIs and a 10% decrease in surgeries. Current reimbursement rates suggest a 75% savings for each patient that receives an ultrasound compared to MRI, and a 90% cost savings for every patient that responds to the physical therapy course of treatment and avoids surgery.