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Hospital Emergency Departments Face Host of New Pressures A report released by the Center for Studying Health System Change (funded principally by the Robert Wood Johnson Foundation) this month found 73 percent of EDs nationwide reported inadequate on-call coverage by specialist physicians. This translates into patients being required to wait longer or be transferred to another facility at additional cost – particularly those patients requiring harder-to-find specialists such as an orthopedic surgeon, neurosurgeon, plastic surgeon, trauma surgeon, obstetrician/gynecologist, neurologist, ophthalmologist or dermatologist. The Joint Commission reports 21 percent of patient deaths or permanent injuries related to ED treatment delays are attributed to lack of availability of physician specialists. Hospitals recognize the impact on patients and strive to find creative ways to secure adequate on-call coverage for the ever-growing caseload in their EDs. Total Ohio ED visits in 2006 hit nearly 5.9 million and the rate of ED utilization has grown close to 10 percent since 2003. A lack of on-call physicians to treat an increasing number of patients can mean longer waiting room time for all patients. Without the proper physician available, a patient with a simple fracture may be diverted to another hospital, spending more time and money than necessary for treatment. Adding physicians to hospital staffs or offering additional reimbursement for on-call duty are among the ways hospitals are ensuring optimum care for ED patients. Inadequate reimbursement – both for physician specialists and for hospitals – further jeopardizes on-call coverage and ultimately patients’ health and costs. The number of patients coming through hospital doors is rising, but the number of Medicaid patients is rising even faster at nearly 14 percent; Medicaid patients made 1.5 million visits to the ED in 2006. The state this month unexpectedly revoked a planned increase in the reimbursement hospitals and physicians receive for treating Medicaid patients. An increasing number of Medicaid patients, combined with lower reimbursement for these services, equals a shaky financial position for providers. Physicians have not seen an increase in their reimbursement rate since 2000 and as they suffer increasing financial losses on the Medicaid patients they see, they may stop treating Medicaid patients or look to hospitals for compensation. If reimbursement drops too low and physician offices choose not to accept Medicaid patients, many of these Ohioans will turn to hospital EDs for primary care and add to the growing ED population. Reduced reimbursement for Medicaid patients also lowers the incentive for specialists to accept on-call duty. Physicians historically provided on-call services as a stipulation of hospital admitting privileges at an institution, but as more and more services are offered through outpatient facilities or other non-hospital settings, physicians depend less on hospital privileges. Hospitals continue to explore solutions such as offering stipends for physicians for on-call duty or providing compensation for each uninsured patient a physician treats while on call. According to a 2006 American College of Emergency Physicians, 36 percent of hospitals currently pay at least one type of specialist, most often a general surgeon, to take ED call. Finding the funding for these efforts becomes a greater challenge to hospitals facing lower Medicaid reimbursement. Hospitals receive an average of 92 cents for every dollar of care they provide to Medicaid patients. Multiplied by thousands of patients, this discrepancy means millions of dollars. The Legislative Service Commission (LSC) estimates the inpatient reimbursement update would have brought an additional $36 million to hospitals. OHA estimates that if the reimbursement also applied to managed care rates, hospitals stood to receive a total of more than $106 million in enhanced Medicaid payments over the next two years.1 Though the number of Ohioans visiting their EDs continues to grow and reimbursement is not keeping pace, OHA will continue working with the physician community, legislators and the governor’s office to find solutions that protect patients’ access to care and give emergency departments and specialty physicians relief. 1As estimated by LSC, the inpatient update would have brought an additional $36 million to Ohio hospitals from Jan. 1, 2008, to June 30, 2009, in enhanced fee-for-service payments. According to OHA’s analysis, if the update were also applied to managed care payment rates, Ohio hospitals stood to receive a combined total of over $106 million in enhanced Medicaid payments throughout the biennium.
Total Ohio Hospital
ED Visits by Payer |
