New Frontiers for 911
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A Good Day To Advocate for Better Healthcare
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New 911 Capabilities
911 calls to report a cardiac arrest, in Forsyth County North Carolina may soon see a drone carrying an automated external defibrillator, or AED as the first-responder on the scene.
The Forsyth County program is one of a growing number of efforts by public safety and health care organizations across the country to use drones to speed up lifesaving treatment in situations in which every second counts.
More than 356,000 people have a cardiac arrest outside of a hospital setting every year in the United States, according to the American Heart Association. Most people are at home when it happens, and about 90% die because they don't get immediate help from first-responders or bystanders. Every minute that passes without medical intervention decreases the odds of survival by 10%.
A 2017 study found it takes an emergency medical services unit seven minutes, on average, to arrive on the scene following a 911 call, though response times vary considerably by region, and rural wait times can be much longer. Drone-delivered AEDs in the pilot study could reduce the time to treatment by four minutes compared with standard first-responders.
Unlike a heart attack, which occurs when blood flow to the heart is blocked, a cardiac arrest happens when a heart malfunction causes it to stop beating, typically because of an arrhythmia or an electrical problem. Eighty percent of cardiac arrests start as heart attacks. The only way to get the heart restarted is with CPR and a defibrillator.
In Forsyth County, a drone pilot from the sheriff's department will listen in on 911 calls. If there's a suspected cardiac arrest, the pilot can dispatch the drone even before emergency medical services are contacted. The drone, which weighs 22 pounds and can travel 60 mph, will fly to the location and hover 125 feet in the air before lowering an AED to the ground on a winch. The AED provides simple verbal instructions; the 911 dispatcher on the phone can also help a bystander use the AED.
A Swedish study published in The Lancet in 2023 compared the response times between drones and ambulances for suspected cardiac arrest in 58 deployments in an area of about 200,000 people. It found that drones beat the ambulance to the scene two-thirds of the time, by a median of three minutes and 14 seconds.
Other locations in the US are planning to deliver Narcan by drone to help counter the more than 100,000 opioid overdoses yearly. (CBS)
Watch this space!!
Acute Care At Home - Maybe/Maybe Not
In November 2020, with the COVID pandemic severely stressing hospital capacity, CMS implemented the Acute Hospital Care at Home waiver and enabled hospitals and health systems to deliver hospital-level care in patients' homes.
Since the authorization, more than 300 hospitals in 37 states have obtained this payment waiver.
A report from CMS published in JAMA Health Forum looked at more than 11,000 patients who received their hospital care at home and found low rates of emergency returns to the hospital, referrals to skilled nursing facilities, 30-day hospital readmissions, and mortality. A review in Annals of Internal Medicine found patients receiving at-home hospital care who were dually eligible for Medicare and Medicaid or had a disability or dementia, had similar and sometimes even better outcomes than the general hospitalized population.
This is not appropriate for everyone, of course. But it does offer a potentially less stressful environment for those requiring significant acute care.
Without additional congressional action, the waiver and the ability of hospitals to deliver acute hospital care in patients' homes will expire at the end of 2024. It's time to extend the waiver once again and continue to expand access to innovative hospital-at-home care.
It isn’t all roses - there are downsides to this as well. 24/7 monitoring is costly. Sometimes much more medical intervention is needed for someone's safety and continued good health than can be provided in a remote setting.
There is legislation in the Senate to extend the program for another 5 years and collect data to see if it continues to work well, It is S.3756 - At HOME Services Act of 2024.
I’m still reviewing data before I make any recommendation.
New Pharmacy Benefit Manager Business Model
As the Federal Trade Commission (FTC) and Congress turn their attention to the business practices of pharmacy benefit managers (PBMs), companies are springing up to provide alternative ways for employers to manage their drug benefits.
Under the traditional model that has been used by the "Big Three" PBMs -- CVS/Caremark, ExpressScripts, and OptumRx, which together comprise about 80% of the market -- the PBM made its money in several ways, including through rebates -- discounts -- from drug manufacturers, and "spread pricing," in which the PBM charges employers and insurers more for the drug than it pays to the pharmacy. PBMs have also used other tactics, such as charging fees to pharmacies known as "clawbacks," to increase revenue.
But these alternative PBMs operate in a different way -- they charge a flat per-member-per-month fee to employers and then pass along 100% of rebates to them, which they contend is a better deal for their employer customers.
While it seems straight forward this is the marketplace seeking to apply a bandaid to a massive wound.
What fixes the problem of Third Party Administrators standing between you and your healthcare with their had out is Universal Healthcare not more bandaids. (Medpage Today)
Resources
Find My Elected Officials
Contact State and Federal Representatives - phone and email
Healthcare Advocacy (Us) Website
Our Newsletter resources including reproductive healthcare - Healthcare Advocacy Reading List
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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