Viewpoints: The Future Of The ER Involves More Than Just Technology; Paying For Care That Is Not Needed

Stat: Looking Beyond Technology To Shape The Future Of Emergency Medicine
Not long ago, I attended a lecture given by a highly regarded emergency physician. His talk, “The Future of Emergency Medicine,” focused on how advances in telemedicine will transform emergency care. The following week, as I walked down a corridor at the back of my hospital, I passed seven telemedicine robots, each with a hastily scrawled “Out of Order” note taped to its screen. That captured my uneasy feelings about how interacting with a patient via internet video link would work in the poor neighborhoods served by my emergency department. (Harrison Alter, 9/27)

JAMA Forum: The High Costs Of Unnecessary Care
In a recent study published in PLOS One, researchers surveyed physicians across the United States to ask about their perspectives on unnecessary medical care. These physicians reported that more than 20% of overall medical care was not needed. This included about a quarter of tests, more than a fifth of prescriptions, and more than a 10th of procedures. (Aaron Carroll, 9/27)

Stat: 3 Hurdles To Bringing Medical Devices To The U.S. Market
Medical devices have historically been viewed as having faster and lower-cost paths to market than their pharmacological counterparts: the average cost to develop high-risk, novel medical devices is estimated to be $94 million. After all, device engineers can leverage lower-cost animal models further into development than their pharmaceutical colleagues, the human clinical trials necessary for FDA approval are often smaller in scale, and, in some cases, expenses can be defrayed by revenue generated outside the United States in markets with faster regulatory pathways. Yet, despite these advantages, the FDA approved only 39 novel devices last year through its premarket approval process. Why is it so hard to bring a medical device to market in the U.S.? (Shantanu Gaur, 9/27)

JAMA: Admitting Elderly Patients To The Intensive Care Unit—Is It The Right Decision?
One of the most important decisions that a physician makes is whether to admit a patient to the intensive care unit (ICU). ... ICU care is also one of the most expensive, intensive, and intrusive endeavors in health care. Although patients admitted to the ICU account for approximately one-quarter of hospitalized patients, they account for half of total hospital expenditures in the United States .... Furthermore, ICU care can be unnecessary, harmful, or futile. Importantly, the provision of ICU services is increasing. ... An important question is whether this growth in ICU services and beds is necessary to meet the demands of an expanding population of critically ill patients or whether ICU beds are being oversupplied and subsequently are being filled with patients who might be cared for in less-intense settings at lower cost with similar or better outcome. (Derek C. Angus, 9/27)

Sacramento Bee: Record STD Rates Show Need For More Talk About Sex
In all, more than 2 million Americans were diagnosed last year with a sexually transmitted disease – including chlamydia, the most common. And while the hardest hit states were mostly in the Deep South, where stigmas around sex education and sexual health in general are strongest, some of the biggest statistical surprises were in tolerant, health-conscious California. (9/27)