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A recent federal report casts more concern that hospital emergency rooms are having increasing difficulty treating all comers, especially because federal payments and the uninsured don't pay their full cost of care.
"There is a growing concern that EDs will not be able to sustain care for all persons in the current economic environment," according to the report, entitled "Payers of Emergency Department Care, 2006," that was published by the U.S. Agency for Healthcare Research and Quality.
"Between 1993 and 2003, there was a 23% increase in ED visits and a closure of 425 hospital EDs. In addition, a recent Institute of Medicine report notes that EDs have become increasingly overcrowded, overburdened, and underfunded. Yet little is known about who is paying for ED care, what the charges are for the care, and how to potentially relieve this pressure," the report said.
Of all visits to hospital emergency departments in 2006, 41.8% of the care was billed to the federal government–21.6% to Medicaid and 20.2% to Medicare. Another 17.7% were uninsured. An estimated 34.6% was billed to private insurance, and the rest to other private payers.
Read the full story by HealthLeaders Media’s Cheryl Clark.
A recent statement from U.S. Health and Human Services Secretary Kathleen Sebelius seems innocuous enough—many people seeking care in emergency departments are uninsured.
The nation's leading group of emergency physicians immediately took issue with her remarks, however. They chastised her for perpetuating a myth about hospital care and said she is oblivious to a much bigger problem.
In her statement, Sebelius cited statistics from a database managed by the Agency for Health Research and Quality. These statistics reveal that in 2006:
- One in 5 patients seen in emergency department settings was uninsured,
- Low-income patients accounted for almost one-third of patient visits,
- Residents of rural areas comprised one-fifth of emergency room care
Sebelius observed that uninsured patients often cannot afford primary care and must seek care in the ED. ED physicians, including Nick Jouriles, MD, president of the American College of Emergency Physicians, say this statement helps direct resources to managed care instead of emergency departments where they are most needed.
Source: HealthLeaders Media
When it comes to ED case management, it is possible to target certain populations for case management screening to determine involvement. These populations fall under the category of high-risk patients:
- Elderly fall
- Elderly extremity fracture
- Repeat visits for pain (back, abdominal, dental, migraines)
- Failure to thrive, frail elder
- Patients with multiple ED visits within the hospital-defined allotted time frame (e.g., more than two visits/month)
- Patients with readmissions within the time frames set by your facility (e.g., 48-72 hours from ED visit or inpatient admission, 30 days from inpatient admission, etc.)
- Patients with short- or long-term placement needs
- Patients with insurance red flags (e.g., managed care insurance plans, pay-for-performance insurance initiatives, uninsured/self pay)
To target specific populations, set up identifiers in the registration process to alert the case manager to targeted populations that may benefit from case management activities. Alerts can be set up and printed out as case manager worksheets.
Despite a recession and continued crowding, a new study shows that the average wait time in the nation's emergency departments fell by two minutes in 2008 to 4:03. Even with the long waits, Press Ganey's Emergency Department Pulse Report 2009 finds that patient satisfaction rose in 2008, continuing a five-year improvement trend.
Leigh Vinocur, MD, on the emergency physician faculty at the University of Maryland School of Medicine, says she's not surprised that patients leave the ED satisfied.
"First of all, they probably can't get in to see a primary care doctor," says Vinocur, who is also a national spokesperson for the American College of Emergency Physicians. "And when you go to a doctor's office, he decides you could need a CT scan or a neurologist and you're waiting another few weeks for a referral.
"So, even though people are waiting four and five hours in the ER, they have an idea they are going to have a diagnosis when they leave. That doesn't always happen. But we can do a lot of procedures and things while you are there to get closer to the diagnosis," she says.
Read the full story by HealthLeaders Media’s John Commins.
York (ME) Hospital finds bedside registration in the emergency department one of the most effective tools to ensure an accurate and compliant patient claim.
Pat Finnemore, CHAA, who works on the patient access team at the 11-bed ED facility, says bedside registration in the ED:
- Increases efficiency of workload for registrars
- Opens strong lines of communication between clinical and access teams
- Provides convenience for patients who do not want to be shuffled from place to place.
“We have not found this process to be more difficult at all,” Finnemore says. “We have an excellent working relationship with the clinical staff. Patients also like not being shuffled around. They can get in and get comfortable.”
The California Supreme Court recently ruled that physicians can no longer bill patients for emergency room treatments that physicians feel HMOs do not adequately pay.
HMOs and patient advocates celebrate the decision as a way to stop physicians and hospitals from overcharging for emergency services. Physicians say the court has taken away their only leverage against HMOs to receive fair payments, and this ruling may put emergency departments in economic jeopardy.
Regulations require HMOs to pay physicians and hospitals reasonable amounts, but do not specify what constitutes reasonable.
Sources: HealthLeaders Media, Los Angeles Times
As emergency departments are filled to capacity with patients who have no insurance or can’t afford care, fewer patients are visiting the hospital who have the ability to pay.
Because of the worsening economy, patients are opting to postpone nonemergency surgeries such as knee replacement or weight-loss surgery, according to The New York Times. These types of surgeries are normally the most lucrative for hospitals, but patients fear costly copayments or missing work for recovery periods.
Gary Taylor, a Citi investment research analyst, conducted a survey in September of 112 nonprofit hospitals. The results showed inpatient admissions were down overall more than 2%, and about 62% of the hospitals surveyed reported flat or declining admissions.
Decreasing admissions are having a large effect on hospitals’ profitability, which may cause hospital administrators to adopt harsher cost-cutting methods.
Source: The New York Times
Hospitals in New York, Connecticut, and New Jersey are increasingly finding themselves providing uncompensated care to poor, uninsured, and sometimes illegal, immigrants.
These hospitals face a dilemma because they feel it is their ethical obligation to provide care to those who show up at their door, according to The New York Times, but some hospitals report losing up to $10 million a year caring for these types of patients.
Medicaid covers illegal immigrants in emergency situations, but other conditions, which may be debilitating but are not emergencies, are not covered.
Hospital officials say that providing care at the time the patient presents to the hospital, even if it’s not an emergency situation, can save the hospital money by dealing with the health issue before it becomes urgent. In addition, community education about available healthcare resources can prevent patients from coming to the hospital if they are aware of other options.
Sources: HealthLeaders Media, The New York Times
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