Revenue Cycle Institute » ED

EDs can’t sustain care in current economic environment

Patient Access Weekly Advisor — Wed, 05 Aug 2009 18:57:00 +0000

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.

ED physicians request more resources

Case Management Weekly — Mon, 27 Jul 2009 14:42:00 +0000

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

Tip: Identify populations that will benefit from case management

Case Management Weekly — Thu, 16 Jul 2009 04:59:00 +0000

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 CM activities. Alerts can be set up and printed out as case manager worksheets.

Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!

ED wait times drop slightly; patient satisfaction rises

Patient Access Weekly Advisor — Thu, 25 Jun 2009 04:22:00 +0000

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

Patient Access Weekly Advisor — Thu, 15 Jan 2009 16:16:28 +0000

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 [...]

California bans ‘balance billing’

Case Management Weekly — Wed, 14 Jan 2009 21:36:57 +0000

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 [...]

Hospitals see decline in paying patients, rise in nonpaying

Case Management Weekly — Wed, 12 Nov 2008 18:20:33 +0000

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 [...]

Hospitals absorb costs of treating uninsured immigrants

Case Management Weekly — Mon, 20 Oct 2008 15:25:41 +0000

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 [...]

MORE RAC TIPS: What patient access managers should watch

Patient Access Weekly Advisor — Thu, 02 Oct 2008 13:14:21 +0000

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. [...]

Open door policy: MA hospitals can no longer turn ambulances away

Case Management Weekly — Wed, 17 Sep 2008 20:12:43 +0000

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 [...]

NEWS: Urgent-care clinics offer ED alternative

Patient Access Weekly Advisor — Wed, 13 Aug 2008 12:37:00 +0000

Walk-in urgent-care clinics are seeing a growing number of patients in need of emergency care, the Wall Street Journal reports. With increasingly crowded emergency departments and a shortage of primary-care physicians, urgent-care clinics are drawing in more patients, offering shortened wait times and lower fees. Insured patients might pay as little as half the amount of a [...]

Tip: How to avoid EMTALA violations

Compliance Monitor — Wed, 13 Aug 2008 12:07:00 +0000

Enforcement of The Emergency Medical Treatment and Labor Act of 1986 (EMTALA) is often swift and severe when facilities do not comply with its requirements. The three keys to compliance are Consistency in the application of the facility standards as they relate to individuals presenting to the facility for treatment Initiation and utilization of a compliant system regarding any [...]

Q: Who is responsible for billing for ED services when the patient is discharged from an IPF to the ED and returns to the IPF within the same day?

Patient Financial Services Weekly Advisor — Fri, 08 Aug 2008 14:01:00 +0000

Question: Who is responsible for billing for emergency department services when the patient is discharged from an Inpatient Psychiatric Facility (IPF) to the emergency room and returns to the IPF within the same day? Answer: The status of discharge is what determines payment responsibility. Decisions regarding appropriate site of care for Inpatient Psychiatric Facility (IPF) admissions [...]

CMS releases guidance on EMTALA regulations

Compliance Monitor — Wed, 06 Aug 2008 14:42:00 +0000

On July 31, CMS released its final regulations for inpatient prospective payment system (IPPS) final rule for fiscal year (FY) 2009. In the document, CMS gave guidance for hospitals looking to set up community call plans to fulfill their on-call requirements to the Emergency Medical Treatment and Active Labor Act (EMTALA). A community plan would allow [...]