Archive for: ED
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
NEWS: Urgent-care clinics offer ED alternative
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 typical ER visit. Some facilities provide payment plans and discounts.
To read the full story in the Wall Street Journal, click here.
Tip: How to avoid EMTALA violations
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 potential violations of EMTALA
- Most important, knowledge of the EMTALA requirements and training of staff to enable compliance in this complex area
Knowledge of EMTALA requirements is a powerful tool that, if used properly, can provide protection for both the facility providing emergency care to the public and the individual who seeks that care.
- 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 potential violations of EMTALA
- Most important, knowledge of the EMTALA requirements and training of staff to enable compliance in this complex area
This tip was adapted from A Practical Guide to EMTALA Compliance
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?
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 and discharges are made by the attending physician. First, the patient should not be discharged from the IPF when there is a reasonable level of expectation that the patient will return to the IPF within the same day. Nevertheless, if a patient is discharged, any subsequent services they receive are billed by the provider of those services, whether it is an Emergency Room (ER), hospital, etc. If the patient had never been officially discharged from the IPF, the IPF would be responsible for all of the patient’s subsequent charges. While the person is an inpatient of the IPF, the IPF must furnish all necessary covered services to a Medicare beneficiary. Therefore, if the patient has not been discharged, the cost of the ED services is the responsibility of the IPF. See § 412.404(d)(3).
Source: Centers for Medicare & Medicaid Services
CMS releases guidance on EMTALA regulations
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 two or more hospitals to coordinate on-call coverage within a geographic area. Within a given time period the hospitals would designate one facility to offer specific coverage. The other hospitals would transfer patients needing specific care to that facility.
The new regulations require a formal plan that includes all of the following elements:
- A clear delineation of on-call responsibilities for each hospital participating in the plan
- A description of the geographic area covered by the plan
- The signature of an appropriate representative of each participating hospital
- Assurances that local and regional emergency medical system protocols include information on community call arrangements
- A statement reaffirming the obligation of each participating hospital to meet its EMTALA obligations for medical screening and stabilizing treatment with its capacity, and to comply with the EMTALA transfer requirements
- An annual assessment of the plan by the participating hospitals
CMS also stated, in the IPPS Final Rule, that it would not extend the accepting hospital obligation to include the transfer of an inpatient admitted from the emergency department with an unstabilized condition that had been stabilized during the inpatient stay.
To read the IPPS Final Rule for Fiscal Year 2009, click here
Use The EMTALA Survival Kit to train your staff on EMTALA regulations. For more information, visit the HCPro Marketplace.
- A clear delineation of on-call responsibilities for each hospital participating in the plan
- A description of the geographic area covered by the plan
- The signature of an appropriate representative of each participating hospital
- Assurances that local and regional emergency medical system protocols include information on community call arrangements
- A statement reaffirming the obligation of each participating hospital to meet its EMTALA obligations for medical screening and stabilizing treatment with its capacity, and to comply with the EMTALA transfer requirements
- An annual assessment of the plan by the participating hospitals
