Jun 13, 2010

Is The ED still for "Emergencies"?

Below is a commentary I posted on an online bulletin board a few days ago.  The original poster was discussing the fact that yet another hospital system has gone public with their "ER Wait Times" (see original article at: http://www.inova.org/emergency-room-wait-times/ )

I think the elephant/rhino/gorilla in the room here is that we need to aknowledge that ED is "not just for emergencies" any more!

As a nation and a culture, we have shifted the mindset to "Now" care regardless if it's an ER Wait Times"emergency"or not.

People that are working in emergency medicine or nursing need to realize that this IS the way it IS now - it's not what it WAS before and it's NOT going back to that anytime soon.

If emergency staff find themselves being upset, disgruntled, frustrated, mad etc about "non-emergencies" coming in, they need to either (a) adjust their mindset or (b) find a new line of work because an unhappy employee is an unsatisfied employee and (i) more prone to mistakes (ii) more likely to give bad customer service etc, etc.

What the "secret" is that your admin is NOT telling you, is that they WANT the business.

The PRIMARY role of the ED is that which is mandated by federal law (EMTALA), the SECONDARY role of the ED is an "intake" or "access" point for hospital admissions. Hospital admissions = revenue, which equals profit for the shareholders/stakeholders.

Ah, but the old argument that "all our patients have no insurance"....
...this is only partly true.

The national average is that approximately 30% of your ED patient mix has NO insurance whatsoever. The other 60% has some form of payor status (private, third party, auto, medicare, medicaid). That 60% is what the hospital wants.

And if you think about it, who are you more likely to admit?
a) a medicare patient (someone typically over 65 +/- who has health conditions)
b) an unisured patient (who typically is <45, and has many fewer comorbidities)

Look at your trauma patients.
What is the #1 cause of trauma? ANS: Blunt trauma
What is the #1 cause of blunt trauma? ANS: MVC's
For the most part, what payor status are MVC patients - INSURED (auto liability insurance in MOST states)....This pays big $$$$$

Even if your ED patient doesn't get admitted, think of all the referrals that come out of the ED: referrals for outpatient testing, office visits, specialist consults, procedures etc - if your hospital is networked with the providers of THOSE services, then it's a 2/3 (60%) chance that the pt being referred has insurance and thus the referrals will have about a 60% payor status.

So, you give away 1/3 of your care to capture the 2/3 that are paying...not too shabby.

But wait, there's more....

If your facility is not the "average" and your unisured payor status is greater than 30%, you argue that you're loosing money...
Well, maybe, but that's where state and federal matching money comes in to subsidize uninsured care based on your percentage uninsured.

Also, if your facility is listed as "non-profit", then the tax benefit for writing off "charity care" is even more beneficial to them which helps keep their income taxes reduced even more which means MORE of the 60% payor's money goes into their pockets.

Why am I saying all this...?

When it was the time that I finally realized that the ED was not "the" money-maker, but rather it played a role in the hospital making money - it all became much easier to swallow and understand the bigger picture.

For when you see the big picture, you start to see your role, your department's role in it.

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