The virtues of a stroke center; caring for the newly insured

Mary Washington Hospital

A study published last week in the Journal of the American Medical Association resonates in the Fredericksburg area, because it found that patients who suffer an ischemic stroke–one caused by a blockage–are more likely to survive if they are treated at a designated stroke center.  Mary Washington Hospital has such a center.

Mortality at stroke centers was “modestly” lower than at other hospitals at 1 day, 7 days, 30 days and 1 year after admission, according to the study. Designated centers are better for patients, the study said,  because of the experience of the staff in diagnosing the stroke and in the treatment offered.

Mary Washington was designated as an Advanced Primary Stroke Center by the Joint Commission in 2009. It treats hundreds of stroke patients each year, among the 800,000 people nationwide who suffer stroke.

Lots of new Medicaid patients are on the way, but are there enough doctors to care for them?

A second study from last week, this one  in the New England Journal of Medicine, documents the dilemma Virginia and other states will face  implementing one of the provisions of the new federal health care reform act.  

The Affordable Care Act calls for an expansion of Medicaid eligibility to include all who earn up to 133 percent of the federal poverty level. This will take effect in 2014.

The study assumes that these newly insured people will increase their use of the health care system. It estimates how many people will be joining Medicaid, by state, and then compares it with what it called that state’s “primary care capacity,” basically the number of physicians in general, family, internal, pediatric and obstetric/gynecologic  medicine.

The result was what the authors call the “access-challenge index.” Virginia was 15^th in this ranking of indexes. That means it is among the states that do not have enough primary care doctors to meet the expected surge in demand. Fourteen states are in a worse predicament; 35 states and the District of Columbia are better off.

This imbalance will mean longer waits for everyone, including those with private insurance and Medicare, the study said. “Patients who cannot get timely primary care in health centers or physicians’ offices may spill over into more expensive emergency rooms,” the authors added.

(An abstract of the JAMA study is available here. The NEJM study is available here.)

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