Reimbursement-related pressures on emergency medical care

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Reimbursement-related pressures on emergency medical care

  1. 1. EMERGENCY!!! in the Emergency Department Ashley Killinder, PA-S University of Kentucky, 2008
  2. 2. Objectives… <ul><li>History of Emergency Department (ED) </li></ul><ul><li>Reasons for Overcrowding in the ED </li></ul><ul><li>Solutions to the Problem </li></ul><ul><li>Questions and Answers </li></ul>
  3. 3. History… <ul><li>The first American hospital was established in 1752. </li></ul><ul><ul><li>Patient Care = Free! </li></ul></ul><ul><li>For-profit hospitals in 1900’s </li></ul><ul><ul><li>Patient Care = Expensive! </li></ul></ul>
  4. 4. History… <ul><li>The introductions of Medicare, Medicaid, HMOs, and DRGs in 1970s-80s. </li></ul><ul><ul><li>Patient Care = Free for some, expensive for others. </li></ul></ul><ul><li>National Hospitals 2007 </li></ul><ul><ul><li>Administration Corruption </li></ul></ul><ul><ul><li>Abuse of the System </li></ul></ul><ul><ul><li>Collapse of Infrastructure </li></ul></ul>
  5. 5. Shocking Statistics… <ul><li>90% of Nation’s large hospitals operate Above Capacity </li></ul><ul><li>In the past 10 years, the number of patients seen in the ED has risen 26%, while population has grown only 11%. </li></ul><ul><li>In the past 5 years, the number of Medicaid patients seen in ED risen 23%. </li></ul>
  6. 6. How is the ED compensating? <ul><li>They are not! </li></ul><ul><li>In the past decade, 500 EDs have been closed, 1/3 of those in rural populations. </li></ul><ul><li>There is currently a 114,000 bed shortage in hospitals nationwide. </li></ul><ul><li>The US is currently in a state of Nursing Shortage as large numbers are leaving the medical field. </li></ul>
  7. 7. Why should we care? <ul><li>The Emergency Department is the sole Safety Net healthcare provider in the US. </li></ul><ul><li>Since 1986, Federal Law requires the ED to treat all patients, regardless of the ability to pay. </li></ul><ul><li>Collapse in the ED  Collapse of US healthcare system </li></ul><ul><ul><li> Saturation of patient care outside the hospital. </li></ul></ul>
  8. 8. The Bottom Line <ul><li>The Emergency Department is in a state of Emergency!!! </li></ul><ul><li>Caused by: </li></ul><ul><ul><li>Decreased Bed Availability </li></ul></ul><ul><ul><li>Increased Numbers on Medicaid </li></ul></ul><ul><ul><li>Outflux of Hospital Staff </li></ul></ul>
  9. 9. Methods <ul><li>The information presented today is based on data collected via PubMed . </li></ul><ul><li>The data is construed from 17 core articles, the majority of which were conducted research studies within the past five years. </li></ul>
  10. 10. Define Overcrowding… <ul><li>How crowded is too crowded? </li></ul><ul><ul><li>National ED Overcrowding Study (NEDOCS) </li></ul></ul><ul><ul><li>Trzeciak and Rivers </li></ul></ul><ul><li>Quantitative rather than Subjective </li></ul><ul><ul><li>Putting patient numbers makes more of a statement than personal judgment of overcrowding in the ED </li></ul></ul>
  11. 11. Increased Numbers <ul><li>Which population contributes the most to the overcrowding problem in the ED? </li></ul><ul><ul><li>Uninsured patients ? </li></ul></ul><ul><ul><li>Medicaid patients ? </li></ul></ul><ul><ul><li>BOTH ?! </li></ul></ul>
  12. 12. Increased Numbers: Ethnic, low-income, uninsured populations <ul><li>Communities with higher levels of… </li></ul><ul><ul><li>Low-income </li></ul></ul><ul><ul><li>Racial/ethnic minorities </li></ul></ul><ul><ul><li>Immigrant residents </li></ul></ul><ul><ul><li>Uninsured population </li></ul></ul><ul><li>… were NOT the communities with the highest numbers of ED visits. </li></ul>
  13. 13. Increased Numbers: Influx of Medicaid/SCHIP <ul><li>Populations with highest numbers of ED visits = highest number of Medicaid enrollees. </li></ul><ul><li>The average Medicaid patient has 16 more ED visits than the average uninsured patient. </li></ul>
  14. 14. Who is at Fault? <ul><li>Are Medicaid patients the “Bad Guy”? </li></ul><ul><li>Look out for large cuts in Medicaid/ SCHIP funding </li></ul>
  15. 15. Outflux of Staff <ul><li>Increased patient numbers = increased responsibility </li></ul><ul><li>2004 NEDOCS questionnaire: </li></ul><ul><ul><li>1. Qualify the degree of overcrowding </li></ul></ul><ul><ul><li>2. If the staff felt rushed </li></ul></ul><ul><ul><li>3. Quantify the degree of overcrowding </li></ul></ul><ul><li>Patient : Staff ratio </li></ul><ul><ul><li>Overcrowding = Unsafe!!! </li></ul></ul>
  16. 16. Solutions <ul><li>Donated Care Program </li></ul><ul><ul><li>Local physicians provide pro bono work </li></ul></ul><ul><ul><li>Hospitals contribute $20,000/year toward free community healthcare. </li></ul></ul><ul><li>Employeeing Mid-Level Providers </li></ul><ul><ul><li>Physicians Assistants are cost effective, skilled, and on the rise in the ED. </li></ul></ul><ul><ul><li>47% of EDs use PAs in the ED </li></ul></ul>
  17. 17. Conclusion <ul><li>The ED is in trouble, reflecting a problem on the entire healthcare system. </li></ul><ul><li>Solutions to the problem must be initiated at every level of care. </li></ul><ul><li>Local communities provide hope for restoration. </li></ul><ul><li>Utilization of PAs eases burdens in ED. </li></ul><ul><li>Action must start NOW! </li></ul>
  18. 18. References <ul><li>Barlett DL, Steel JB. Critical condition: how healthcare in America became big business and bad medicine. New York (NY): Doubleday; 2004. </li></ul><ul><li>Brewer C, Kovner CT. Is there another nursing shortage? What the date tells us. Nursing Outlook. 2001 Jan; 49(1):20-26. </li></ul><ul><li>Brewster LR, Felland LE. Emergency department diversions: hospital and community strategies alleviate the crisis. Issue Brief Cent Stud Health Syst Change. 2004 Mar;(78):1-4. </li></ul><ul><li>Congress of the United States. Diagnosis related groups (DRGs) and the medicare program: implications for medical technology – a technical memorandum. Office of Technological Assessment. 1983 Jul: 23-25. </li></ul><ul><li>Cowan RM, Trzeciak S. Clinical review: emergency department overcrowding and the potential impact on the critically ill. Crit Care. 2005 Jun;9(3):291-5. </li></ul><ul><li>Cunningham PJ. Medicaid/SCHIP cuts and hospital emergency department use. Health Aff (Millwood). 2006 Jan-Feb;25(1):237-47. </li></ul><ul><li>Cunningham PJ. What accounts for differences in the use of hospital emergency departments across U.S. communities? Health Aff (Millwood). 2006 Sep-Oct;25(5):324-36. </li></ul><ul><li>Dorsey JL. The health maintenance organization act of 1973 and prepaid group practice plans. Med Care. 1975 Jan;13(1):1-9. </li></ul>
  19. 19. References <ul><li>Eastaugh SR. Overcrowding and fiscal pressures in emergency medicine. Hosp Top. 2002 Winter;80(1):7-11. </li></ul><ul><li>Ganapathy S, Zwemer F. Coping with a crowded ED: An expanded unique role for midlevel providers. Am J Emerg Med. 2003 Mar;21(2):125-128. </li></ul><ul><li>O’Malley AS, Gerland AM, Pham HH, Berenson RA. Rising pressure: hospital emergency departments as barometers of the health care system. Issue Brief Cent Stud Health Syst Change. 2005 Nov;(101):1-4. </li></ul><ul><li>Oswanski MF, Sharma OP, Raj SS. Comparative review of use of physician assistant in a level I trauma center. Am Surg. 2004 Mar;70(3):272-9. </li></ul><ul><li>Taylor EF, Cunningham P, McKenzie K. Community approaches to providing care for the uninsured. Health Aff (Millwood). 2006 May-Jun;25(3):173-82. </li></ul><ul><li>Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003 Sep;20(5):402-5. </li></ul><ul><li>U.S. Department of Health and Human Services. EMTALA: emergency medical treatment and labor act. Center for Medicare and Medicaid Services. 2006 Oct, Available on: http://www.cms.hhs.gov/FACA/07_emtalatag.asp . </li></ul><ul><li>Weiss SJ, Derlet R , Arndahl J , Ernst AA , et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004 Jan;11(1):38-50. </li></ul>
  20. 20. Questions?…

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