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New Medicaid Demonstration Opportunity to Treat Patients with Mental Illnesses (11/19/2018)  On November 13, 2018, the Centers for Medicare & Medicaid Services (CMS) sent out a letter to State Medicaid directors that included a new demonstration opportunity for states to treat adults and children with serious mental illnesses. Specifically, states can now apply for a Medicaid Section 1115 waiver to receive matching federal funds for short-term residential treatment services in an institution for mental disease (IMD). This policy broadens the ability for states to work around the current “Medicaid IMD exclusion,” which prohibits the use of federal Medicaid funding for care provided to most patients in non-hospital inpatient mental health treatment facilities. Read More

The ‘complete nightmare’ of 2 men who lived in Maine emergency rooms (8/22/2018) Over the past four decades, the state has built up a system of services to prevent these kinds of situations. Court decisions and laws at the state and federal levels have guaranteed adults with intellectual disabilities. But long emergency room stays have become more common in recent years as crucial elements of Maine’s system for serving adults have disappeared or shrunken.  Read More

This E.R. Treats Opioid Addiction on Demand. That’s Very Rare  (8/18/2018) Every year, thousands of people addicted to opioids show up at hospital emergency rooms in withdrawal so agonizing it leaves them moaning and writhing on the floor. Usually, they’re given medicines that help with vomiting or diarrhea and sent on their way, maybe with a few numbers to call about treatment. Some hospital emergency departments are giving people medicine for withdrawal, plugging a hole in a system that too often fails to provide immediate treatment. Read More

To Fight Burnout, Organize (6/20/2018) The clinician who coined the term “burnout” was not a primary care physician buried under paperwork, nor an emergency physician beset by an unwieldy electronic health record. He was Herbert Freudenberger, a psychologist working in a free clinic in 1974.1 Discussing risk factors for burnout, he wrote about personal characteristics (e.g., “that individual who has a need to give”) and about the monotony of a job once it becomes routine. He also pointed to workers in specific settings — “those of us who work in free clinics, therapeutic communities, hot lines, crisis intervention centers, women’s clinics, gay centers, runaway houses” — drawing a connection between burnout and the experience of caring for marginalized patients. In recent years, burnout has become a chief concern among physicians and other front-line care providers. Read More

This E.R. Treats Opioid Addiction on Demand. That’s Very Rare  (8/18/2018) Every year, thousands of people addicted to opioids show up at hospital emergency rooms in withdrawal so agonizing it leaves them moaning and writhing on the floor. Usually, they’re given medicines that help with vomiting or diarrhea and sent on their way, maybe with a few numbers to call about treatment. Some hospital emergency departments are giving people medicine for withdrawal, plugging a hole in a system that too often fails to provide immediate treatment. Read More


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