MHA's Executive Briefing

ED Physicians Key to Half of Hospital Admissions

Doctors in the emergency department are the major decision makers in nearly half of all hospital admissions, giving them a significant role in controlling healthcare costs, research shows. Read more from HealthLeaders Media here.

More complex care, not fraud, behind higher ER billing, doc argues Read more: More-complex care, not fraud, behind higher ER billing, doc argues

Fraud isn't at the root of a spike in providers' billing for emergency services, a new opinion piece in the New England Journal of Medicine asserts. Rather, the piece's author writes, higher ER billing reflects both increasingly complex care provided in emergency departments over the past decade and more-accurate coding of that care.

Read more from Modern Physician here.

ED: Operational benchmarking statistics by patient volume

Here are data based on comparative utilization and operational statistics collected by the Emergency Department Benchmarking Alliance from 358 participating hospitals, representing over 14 million emergency department visits.

ED metrics available include:

• ED Patients / day 
• Percent with high CPT acuity rate 
• Percent pediatric patients 
• Admission rate 
• Transfer rate 
• EMS arrival rate 
• EMS arrival admission rate 
• Hospital admission through the ED rate 
• Patients per care space 
• ECGs / 100 ED visits 
• X-ray studies / 100 ED visits 
• CT/MRI studies / 100 ED visits 
• LBTC (left before treatment completed) rate 
• Door-to-physician time 
• ED length of stay for admitted patients 
• ED length of stay

These metrics are in five different size categories - from the low-volume emergency departments with under 20,000 annual ED visits up to the high-volume with over 80,000. The findings of this research were that for certain emergency department operational performance measures, bigger (higher volume) is not better.

Congress urged to oppose hospital E/M outpatient payment cap

The American Hospital Association and four other national hospital groups on Sept. 12 urged Congress to oppose any legislative proposals to cap “total" payment for non-emergency department evaluation and management services at the rate paid to physicians for providing the services in their offices. The proposal, which originated with the Medicare Payment Advisory Commission, would reduce hospital payment by at least 71% for 10 of the most common outpatient hospital services.

“Simply put, it is significantly damaging to beneficiaries and the providers on which they rely to enact legislation that will result in such large cuts,” the letter states. In addition to AHA, the letter was signed by the Association of American Medical Colleges, Catholic Health Association of the United States, Federation of American Hospitals, and National Association of Public Hospitals and Health Systems.

Fingertip Injury Points Out Emergency Care Billing Conundrum

A recent case from Dayton, OH highlights the tangled mess of emergency department specialty coverage, federal law, and out-of-network insurance benefits. When these interact, patients, doctors, insurers and hospitals can be left frustrated and perplexed. Here’s a brief summary.

ER measures may hit urban sites unfairly: study

Emergency-department throughput measures endorsed by the National Quality Forum may penalize urban hospitals, according to a study published online in the Annals of Emergency Medicine. Learn more from Modern Healthcare here.

Slideshow: Emergency Departments Focus on Flow

ontributing forces, from the primary care shortage to the rise in the uninsured, are adding to overcrowded emergency departments and deep concerns about patient safety. Hospital leaders, uncertain about their systems' preparedness, as well as how healthcare reform will further affect the flow of patients, are strategizing to reduce congestion, cut wait times, and improve care coordination.

As health systems try to improve their EDs, healthcare leaders are watching the financial framework with caution. About 80% say they expect their ED revenue margins will worsen as a result of healthcare reform and 78% say their reimbursement also will get worse.

View the data from the most recent HealthLeaders Media Intelligence Report, Volume, Flow, and Safety Issues in the ED, in this slideshow.

Why do adults go to the ER instead of other outpatient or office-based care sites?

A study was conducted by the National Center for Health Statistics [NCHS] to better understand why people go to hospital emergency rooms instead of less costly outpatient facilities or office-based sites for care. In 2011 NCHS interviewed adults aged 18-64 who had visited an ER within the previous 12 months but had not been subsequently admitted to the hospital.

The top reasons given for the ER visits are here.

Bill would expand emergency coverage for veterans

Rep. Peter DeFazio (D-OR) recently introduced the VA Enrollment Act (H.R. 4246), American Hospital Association-supported legislation that would expand Department of Veterans Affairs' coverage for emergency care provided in non-VA facilities. The Veterans' Millennium Health Care and Benefits Act of 2001 currently restricts coverage to veterans who are uninsured or enrolled in the VA health care system and have received VA care in the last 24 months.

The legislation would broaden eligibility to all veterans eligible for VA health care, so long as they enroll within 30 days after they are released from the hospital. "This would provide an important expansion of coverage until the [Patient Protection and Affordable Care Act] becomes fully effective and individuals are required to secure minimum essential health insurance coverage," AHA told DeFazio in a letter of support for the bill.

Is it really an emergency?

While hospitals are required by EMTALA to take care of all comers, leaders at Presbyterian Healthcare Services in New Mexico have been testing an innovative strategy for dealing with nonemergencies in the ED—they screen patients for more serious problems before sending them on their way to a primary care appointment arranged by the hospital.

Read the full article from H&HN Daily.