Hospitals seek to control costs by setting standards for care

One group in Delaware looked at high spending on cardiac monitoring for patients who really didn't need it and encouraged doctors to instead use guidelines from the American Heart Association. Costs fell by 70 percent for the monitoring, a study finds.

The Wall Street Journal: Hospitals Cut Costs By Getting Doctors To Stick To Guidelines
A hospital group in Delaware was concerned it was spending too much on cardiac monitoring for patients outside of intensive care who didn't need it. So it changed its computer system to encourage doctors to follow American Heart Association guidelines for using the monitors. The number of patients using the monitors, and the group's daily costs for such monitoring, fell by 70% without any harm to patient care, researchers from Wilmington, Del.-based Christiana Care Health System report in a study in JAMA Internal Medicine (Whalen, 9/22).

NPR: Avoid The Rush! Some ERs Are Taking Appointments
Hospitals around the country are competing for newly-insured patients, and one way to increase patient satisfaction, they figure, might be to reduce the frustratingly long wait times in the ER. To that end, Northridge and its parent company Dignity Health started offering online appointments last summer; since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada (Gorman, 9/23).

Read the Kaiser Health News' earlier, related story The Latest In Medical Convenience: ER Appointments (Gorman and Colliver, 7/3).

Meanwhile, federal officials call on nursing homes to reduce the use of antipsychotic medications -

Modern Healthcare: CMS' Plan To Cut Antipsychotic Use In Nursing Homes Falls Short, Critics Say
Patient-safety advocates say the CMS' new plan to curb the use of antipsychotic medications in nursing home patients with dementia falls short of what's needed to eliminate unnecessary use. Last week, the CMS called for a 25% reduction in use of antipsychotics for this patient population by the end of 2015, and to a total of 30% by the end of 2016 (Rice, 9/22).

And in other marketplace news -

Marketplace: At In-Store Clinics, $4 Checkups For Wal-Mart Workers
You can't buy a lot for $4-;maybe a cup of coffee or muffin. But at about a dozen Walmart stores across the South, $4 will get employees a visit to a nurse practitioner at an in-store clinic. It's part of a new primary care program that Walmart is testing in three states. Eric Klein leads the healthcare team at the national law firm Sheppard Mullin Richter and Hampton. He says Walmart could actually come out ahead in the big picture. ... Klein says if employees go to an on-site clinic owned by Walmart, the company could save money on doctor visits and insurance premiums. Cutting out the middle men could bring down the cost of Walmart's insurance plans (McCammon, 9/23).