EM Resident PGY4. MD/MBA, UNC Chapel Hill. 
EMRA Director of Health Policy. Views are my own.
In order for us to survive, our cells must produce adenosine triphosphate (ATP) energy by undergoing glycolysis which breaks down glucose to pyruvate. Ideally, pyruvate gets shuttled into aerobic metabolism for oxidative phosphorylation because this is the most efficient and abundant way to produce 32 ATP molecules (1). In oxygen-deprived Read more…
Thought Experiment: Applying an EBM Disease Model to Defensive Medicine But, if a lawyer were to review your chart, how would you defend that decision? We have all had attendings say this to us when we present a plan for a patient, perpetuating the next generation of defensive medical practitioners. Read more…
By Angela Cai, Rushabh Shah, Gururaj Shan As she walked out of her last shift at Kings County Hospital, many of her colleagues and trainees had no idea she was leaving. Even fewer knew the incredible journey she had been on over the last few years which culminated in her Read more…
Emergency departments (EDs) bill more frequently at the highest levels of service than they did in prior years. This trend has generated questions as to whether the apparent rise in case severity is due to real changes in patient care needs or “upcoding” – the practice of coding cases at Read more…
We are excited to announce the reinstatement of the Administration Mini-Fellowship with our meeting last month. The Administration Mini-Fellowship will be a learning and networking group advised by Dr. Ninfa Mehta, SUNY Downstate’s ED Medical Director. At our first meeting we discussed physician leadership & hospital performance from 2 articles: Read more…
In 2015, the Centers for Medicare and Medicaid Services (CMS) adopted SEP-1, a controversial sepsis quality metric drawn from the Surviving Sepsis Campaign (SSC) guidelines. Extensive focus on guideline evidence, covered well elsewhere, leaves out the details surrounding the process of its implementation.1,2 This post will describe the process and Read more…
How much do hospitals spend just to get paid? A new study1 in JAMA estimates that the cost of billing and insurance activities at a large academic health system in Durham, North Carolina ranged from $20 for a primary care visit to $62 for an emergency visit to $215 for Read more…
US health care spending has had a notorious reputation for high spending and low outcomes.1 A new study in November’s JAMA tackles from a high level perspective the question of why the US is such an outlier with its high health care spending. Dieleman et al (2017)2 identified the most Read more…
Avoidable Emergency Department (ED) visits are difficult to define but of vital interest to ED reimbursement and profit. A newly released study1 from UCSF Department of Emergency Medicine estimated “avoidable” visits comprise 3.3% of ED visits. Some have hailed the study as evidence that avoidable ED visits are a “myth,” Read more…