Critical access hospitals (CAHs) are medical providers located in America’s most isolated regions, serving rural communities that do not otherwise have easily-available access to care. Since the closest alternatives to these hospitals are usually over 35 miles away, they provide an essential resource for Americans living in secluded communities — and therefore receive enhanced funding from the federal government to carry out their work. But according to a Harvard School of Public Health study, death rates at these hospitals are significantly higher than national averages — and are on the rise.

The study found that, while mortality rates in the nation’s other hospitals declined by 0.2 percent per year between 2002 and 2010, “critical access hospital death rates rose about 0.1 percent each year, reaching 13.3 percent in 2010.” Those numbers were also worse than non-CAH rural hospitals, leading head author Dr. Karen Joynt to suggest that a dearth of sophisticated medical technology and the special government treatment that CAHs receive may be contributing to higher death rates:

Joynt and her co-authors, John Orav and Dr. Ashish Jha, also of Harvard, suggested that the hospitals’ care may suffer because they don’t have the latest sophisticated technology or specialists to treat the increasingly elderly and frail rural populations. A previous paper by the trio found that critical access hospitals were less likely to have the ability to perform cardiac catheterizations and to have intensive care units. [...]

She also suggested that the hospitals may have been victims of their lenient treatment by the government. Since hospital officials are not required to evaluate their performances to make reports to Medicare, the government may not realize that facilities could need additional assistance in caring for sicker patients.

“This is 1,000 hospitals, a quarter of the hospitals in the country, that are invisible,” she said. “We’ve created a completely separate system, and in this case it looks like that has not done patients in these hospitals any favors.”

Brock Slabach, an executive at the National Rural Health Association, cautioned against drawing sweeping conclusions from the report. “Mortality is just one small part of the picture of what qualities means,” he said. He said the association’s own research has found that rural hospitals do better in patient satisfaction surveys than do urban hospitals, and that there’s no substantial difference in other measures such as readmissions.

Slabach’s point is important to note — mortality shouldn’t be the only measure of a hospital’s or government program’s effectiveness, particularly for specialized populations in rural areas that have more specified needs than their urban counterparts. Americans living in rural areas have much higher numbers of elderly Americans than urban regions, meaning that mortality rates for rural areas will be skewed upwards to begin with. Furthermore, these populations have more children and are more likely to be poor, uninsured, under-insured, and chronically ill, meaning that preventative and ongoing primary care may ultimately be more important to the locales than more sophisticated secondary or tertiary care.

Still, the study’s findings draw attention to the reality that specialists are hard to come by in these areas. The vast majority of doctors in general — and specialists in particular — are concentrated in cities. But that doesn’t explain why non-CAH rural hospitals are apparently outperforming CAHs. And that suggests there may be something to the study authors’ point about lax reporting standards, which could be leading to a lack of nuance in the way that funding and resources are deployed to these providers.

Robots emitting UV rays can help zap deadly superbugs

This month, the CDC has been sounding the alarm about the rise of a rare, potentially deadly superbug that is resistant to last-resort antibiotics. According to the agency, a recent jump in the recorded incidences of carbapenem-resistant Enterobacteriaceae (CRE) means that health officials need to be on high alert, since the “nightmare bacteria” represents one of the biggest threats to patient safety in hospitals across the country. But even though antibiotics can’t help contain the spread of CRE, another type of advanced technology can: Superbug-killing robots.

As drug-resistant bacteria become an increasing problem for health care settings, hospitals are looking toward innovative prevention methods. Johns Hopkins Hospital in Baltimore began using robots — each about the size of a washing machine — to kill superbugs by first spraying a toxic hydrogen peroxide mist into a sealed hospital room, and then following up with a vapor that makes the air safe for humans to breathe. Thanks to the robot technology, Johns Hopkins recently reported a sharp 64 percent drop in the number of untreatable infections at its hospital.

About 24 other hospitals around the country have their own hydrogen-spraying robots. But that’s not the only way robots can help hospitals stay superbug-free. More than 100 hospitals now use robots that can disinfect hospital rooms in just 10 minutes by emitting powerful beams of ultraviolent light to zap the bacteria. Unfortunately, germ-zapping robots don’t come cheap: The ultraviolent versions can cost as much as $10,000 apiece.

Since robots are about 20 times more effective than the typical hospital sanitation methods, however, that could be a valuable investment. And especially now that CDC officials are warning that CRE represents a particularly troubling threat with a high rate of mortality, hospitals may want to pursue the most advanced technologies available to slow the superbug’s spread. Perhaps most problematically, CRE could help hasten the rise of other drug-resistant diseases, which is already a significant global health problem — but maybe not if the robots get to them first.

Mississippi, one of the poorest states in the nation, is grappling with what to do about its Medicaid program. A deeply red state where the GOP controls both state houses and the governor’s mansion, Mississippi lawmakers are highly skeptical of Obamacare’s optional Medicaid expansion. So, in a last-ditch effort to protect the state’s low-income residents — as well as the fiscal security of the safety net hospitals that serve them — Democrats in the state senate sent Gov. Phil Bryant (R) a letter expressing their wish to introduce legislation that would automatically trigger a Medicaid expansion if Mississippi’s disproportionate share hospitals (DSHs) buckle under the weight of the payment cuts contained in Obamacare. Unfortunately, Bryant’s initial response to the proposal suggests he doesn’t fully understand the dire consequences awaiting his state’s safety net hospitals without an expansion of Medicaid.

For some context: as part of Obamacare’s efforts to make a dent in government health expenditures, the law contained some pretty deep cuts to so-called “DSH payments” — federal reimbursements to safety net hospitals that cater mostly to the poor and uninsured. Such hospitals need these reimbursements since their patients usually can’t afford the full cost of their care, and the DSH payments help make up for their resulting high uncompensated care costs. But Obamacare cuts these payments in half by the year 2019. The reason? When lawmakers first passed the reform law, they were working under the assumption that its Medicaid expansion would be mandatory, and that an influx of newly-insured Americans on Medicaid would reduce the federal government’s need to dole out DSH payments.

Of course, the Supreme Court ultimately rendered the Medicaid expansion optional and left it to states’ individual discretion. That threw a pretty big wrench into the Obama Administration’s plans, and is a large part of the reason the Administration has been begging states to grow their Medicaid pools; it’s also a large part of the reason that GOP governors in highly uninsured states like Arizona and Florida have embraced expansion, giving into pressure from hospital associations warning that they can’t afford to keep treating poor and uninsured Americans in the face of DSH payment cuts. But Bryant is betting that the federal government won’t actually follow through on the DSH cuts because they would violate the Supreme Court’s ruling that states cannot be “punished” for not expanding Medicaid:

“Without disproportionate share payments, many rural hospitals and hospitals that treat a disproportionate share of uninsured Mississippians will close,” Sen. David Blount, D-Jackson, said during a news conference that two dozen Democrats had in the Capitol rotunda. “People will lose jobs and people will lose access to health care, particularly in our rural communities.”

Bryant said in an interview a short time later he doesn’t believe the federal government will eliminate disproportionate share payments.

“We believe that they would be in violation of the United States Supreme Court decision, which said you can’t punish a state for not expanding Medicaid. And they certainly would be punishing us by doing that. So, I don’t think that ought to be a trigger,” Bryant told reporters in an office next to the House chamber, where he’d been having closed-door meetings with Republican lawmakers.

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The CDC is sounding the alarm about a potentially deadly superbug, carbapenem-resistant Enterobacteriaceae (CRE), on the rise in hospitals around the country. After a recent uptick in the recorded cases of the drug-resistant bug, federal health officials released a report urging medical professionals to do their best to prevent CRE from spreading further — but this week, the CDC is upping the ante, warning that the “nightmare bacteria” represents one of the biggest threats to patient safety in our nation’s hospitals.

CRE bacteria are resistant to even last-resort forms of antibiotics. Even though they remain relatively rare, health officials are worried about the dramatic spike over the last decade. The national percentage of CRE cases jumped from 1.2 percent in 2001 to 4.2 percent in 2011 — an increase of about 250 percent. The CDC is warning that, if the medical industry doesn’t find a way to contain the spread of the superbug, it will eventually make its way outside of hospital settings and into the broader community:

“These are nightmare bacteria that present a triple threat,” said Thomas Frieden, director of the Centers for Disease Control and Prevention. “They’re resistant to nearly all antibiotics. They have high mortality rates, killing half of people with serious infections. And they can spread their resistance to other bacteria.”

So far, this particular class of superbug, called carbapenem-resistant Enterobacteriaceae, or CRE, has been found only in hospitals or nursing homes, rather than in the community, Frieden said. But officials sounded the alarm partly because, if the bacteria’s spread isn’t contained soon, even common infections could become untreatable. [...]

These superbugs are “the biggest threat to patient safety in the hospital that we have,” said Costi Sifri, an infectious disease physician and hospital epidemiologist at the University of Virginia Health System. “Unfortunately, it doesn’t seem like anything is slowing their spread.”

People with compromised immune systems, who are either hospitalized for a long time or living in a nursing time, are most at risk for contracting the superbug. About 4 percent of hospitals in the U.S. have had at least one patient with CRE, and that figure rises to 18 percent for long-term, acute-care hospitals — although the CDC points out those numbers could actually be underestimations. There’s no reliable national data on the bacteria because the overwhelming majority of states don’t require hospitals to report any information on their CRE cases, and there’s no federal reporting requirement either.

Even though CRE cases remain rare, the threat of drug-resistant antibiotics is a serious issue with potentially disastrous implications. The CDC’s Friedan pointed out that one of the most troubling things about CRE bugs is the fact that they can transfer their antibiotic resistance to other bacteria — hastening the rise of antibiotic-resistant diseases, which is already a growing global health issue, even further.

The rising cost of medical services is driving up the price of health care throughout the industry. There’s perhaps no better illustration of that phenomenon than hospitals’ emergency departments, since ER trips are the most expensive type of health care delivery. In fact, a new NIH-funded study finds the average cost for an ER visit was over $2,000 — about 40 percent more than most people spend on their rent each month.

The most common reasons that Americans visit an emergency department, like treating sprains or urinary tract infections, can rack up exorbitant charges. But the industry’s wide range in pricing means Americans often have no idea what kind of bill they should expect when they head to the hospital. When factoring in the IQR — the “interquartile range,” which represents the difference between the 25th and 75th percentile of charges — it becomes clear that hospitals end up charging most patients a lot more or a lot less than the average prices for these services (although these numbers don’t account for what insurance plans may end up covering):

And the researchers note that, since they focused on the most common diagnoses, these aren’t even necessarily the most costly ER services out there. If they had set out to figure out how an ER trip could be as expensive as possible for a sick American, that chart would have even higher numbers.

The study’s lead researchers ultimately conclude that Americans need to get more upfront information about ER costs before they land in an emergency department. They recommend better pricing transparency throughout the health care industry — a significant step forward that could help drive down health costs by allowing patients to be more discriminate about which unnecessary and expensive services they’d rather not pay for.

Ultimately, the rising cost of basic medical treatment is putting a big strain on the American families struggling to regain their footing in the wake of the Great Recession. Health costs have skyrocketed at the same time as workers’ wages have stagnated, and more than one in three people are forced to put off the health care they need because they can’t afford it.

The quest to improve patient care, maximize medical efficiency, and curb wasteful spending by digitizing Americans’ patient records, insurers’ claims, and providers’ treatment requests just gained a powerful new ally: “Watson,” IBM’s revolutionary data-mining supercomputer that made national waves when it defeated reigning Jeopardy! champion Ken Jennings at his own game.

American Medical News reports that health insurance giant WellPoint has struck up a deal with IBM and Memorial Sloan-Kettering Cancer Center in New York to use the supercomputer — which has spent its post-Jeopardy days amassing and “learning” massive amounts of data about the American health care, insurance, and public health industries — for two pioneer programs to automatically process, review, and pre-authorize medical claims and treatment requests, as well as a third program dubbed “Interactive Care Insights for Oncology” that will “identify individualized treatment options for cancer patients, starting with lung cancer” in order to advise oncologists on the latest and most effective treatment regimens by incorporating up-to-the minute longitudinal medical studies and cancer data into its suggestions.

In an email to ThinkProgress, Cindy Wakefield, a Regional Director for Public Relations at WellPoint, pointed out that the new technology has the potential to have a big impact on the health care industry. “We believe the IBM Watson technology can improve the efficiency and quality of treatment, potentially eliminating unnecessary testing, enhancing the consistency of actions, and accelerating the time to treatment via expedited decision-making processing,” Wakefield explained. “We are continuing to train Watson, and we are teaching Watson by ‘feeding’ it information such as our medical policies and clinical guidelines.”

Using Watson’s technology to automate claims processes could be a potent catalyst for a more efficient American health care industry — which is often bogged down by poor inter-provider communication, incomplete and non-centralized data, and archaic paper records. The supercomputer could also advise providers on the most efficient and appropriate use of treatments based on each individual medical claim, patients’ specific insurance benefits, and patients’ medical histories by analyzing health care data from across the country.

Interestingly, if Watson concludes that a physician or provider’s treatment request is not the most effective one based on a patient’s history and medical benefits, the computer can register its disagreement — but as Wakefield explained to ThinkProgress, it cannot override the provider’s decision or deny treatment requests. Instead, a human nurse would have to review Watson’s alternative suggestion, and then make a judgment call along with the provider on whether or not to comply with it.

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This week’s issue of Time Magazine takes a deep dive into Americans’ medical bills and the roots of the U.S. health care industry’s rampant inflation — costs that force one in four American seniors into bankruptcy and over one in three Americans to forgo care.

The investigative piece highlights the exorbitant costs of the most commonplace procedures and medications, and how insurance coverage often falls through for Americans who encounter unaffordable out-of-pocket costs due to the rising price of health care technology and services. Furthermore, it is often impossible for patients to ascertain why they are being charged what they are for care — a pricing opacity that is truly unique to the service-centered health care industry. Here are the three biggest takeaways from the Time exposé on the unsustainable foundations of American health care costs — and some ideas for shifting the U.S. medical landscape towards a more equitable system: