Archive for: ED
ED wait times drop slightly; patient satisfaction rises
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.
Consider ED bedside registration
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.”
California bans ‘balance billing’
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
Hospitals see decline in paying patients, rise in nonpaying
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 absorb costs of treating uninsured immigrants
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
MORE RAC TIPS: What patient access managers should watch
Editor’s note: These tips are provided by Tanja M. Twist, director of patient financial services at Methodist Hospital in Arcadia, CA. Twist is the finance chair for the American Association of Healthcare Administrative Management (AAHAM) who has fought Congress on Capitol Hill for better transparency and answers to concerns with RACs on behalf of hospitals.
1. Review your ED admissions. Twist cautions that many admissions from the ER are made because the facility needs to free up ED beds, which can lead to medical necessity problems with the RAC. “Emergency rooms are busy all across the country,” Twist says. “A key component is to make sure you meet the medical necessity criteria for the ER admissions too. The nature of the emergency department beast is things get rushed, but you have to ensure there are protocols in place to watch the ER admissions, too.”
If you do not have a 24/7 ED case coordinator position that monitors admissions, ensure someone like your case manager or you, the patient access manager, comes in first thing in the morning to clean up the admissions, she says.
2. Review your one-day stays. “This is another piece the RACs are focusing on,” Twist says. “Should those patients be observations? I’ve seen admitting orders just say ‘admit.’ You have to make sure that physician orders have an ‘admit to acute or admit to observation’ designation. There could be some type of check box for the physician to clearly indicate his selection. From here, the concern is whether or not the acute admission meets criteria.”
Open door policy: MA hospitals can no longer turn ambulances away
When a hospital’s emergency department is overflowing and ambulances just keep coming, it has become a common practice to divert some of those ambulances to other area hospitals.
However, turning ambulances away is no longer an option for facilities in Massachusetts. The state government has ordered a halt to the practice by January 1. State officials say that while diverting may help some hospitals with overcrowding, the costs usually outweigh the benefits.
According to The Boston Globe, diverting ambulances decreases patient choice, ties up vehicles, and often just shifts the crowding to other hospitals. In addition, not allowing some patients to enter may prevent them from going to the hospital where their medical records are kept.
This change will force hospitals to devise different strategies to keep patients from crowding into hallways in the emergency department.
Source: The Boston Globe
