The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
In previous posts, Dr. Ellis Weeker and Dr. Gary Li discussed the current state of hospital pricing and the forces that shaped the system we have today. In the third installment of our four-part series on transparency, they turn their attention to the future and the many ways in which this payment system might evolve over the next decade.
So now that the charge master has been unmasked by the Centers for Medicare & Medicaid (CMS) and high profile news stories in Time and The New York Times, will it survive?
No one knows for sure, but we think that there are a number of forces working toward the demise of the charge master and a movement toward greater transparency.
The push for payment reform in US healthcare is getting a great deal of support from every corner, and this will impact compensation for emergency physicians (EPs) just as it will for nearly every specialty. Nearly everyone believes that our fee-for-service (FFS) reimbursement system results in too much care for too little benefit. The perception that preventative and primary healthcare services are undercompensated, and procedural services to rescue failing health are overcompensated, seems to be widely accepted as one of the major reasons why our health system is too expensive and ineffective in producing better health as an outcome.
Personally, I think characterizing FFS as the real villain in this drama is a bit overblown. For-profit health insurance plans, pharmaceutical companies, medical equipment manufacturers, industry lobbyists and advertisers, Wall Street's short-term-goal-driven stockholders and lack of political leadership all play a significant role. However, I think FFS as we currently know it is dying, and capitated multi-specialty medical groups focused on disease prevention are gradually going to push out other, less cost-efficient provider systems. Mostly, physicians in these groups will be salaried. So where does that leave emergency physicians?
California Medicaid Patients Driving ED Visits
As the Affordable Care Act prepares to expand Medicaid coverage, the state of California is reporting that its own Medicaid program, Medi-Cal, drove an increase in emergency department (ED) visits between 2005 and 2010. In a letter to JAMA, researchers from University of California, San Francisco note that overall ED visits in California increased from 5.4 million to 6.1 million annually over this five-year period. Overall, EDs saw a 35 percent increase in Medi-Cal beneficiaries and a 25 percent increase in uninsured patients. The authors suggested that "increasing ED use by Medicaid beneficiaries could reflect decreasing access to primary care" and could have an adverse impact on federal and state healthcare spending.
"It is absolutely critical for the healthcare safety net that MICRA be preserved. It protects our patients and the stability of community health centers to continue to be able to serve the uninsured and economically disadvantaged."
— Jim Mangia, president and CEO, St. John's Well Child and Family Centers (Compton, Calif.)
Each day, thousands of commuters gaze into the eyes of six-week-old Mia Chavez, who died of whooping cough in 2010. "Medical Negligence Kills," reads the Sacramento billboard bearing her picture. "A 38-year-old law says Mia's life was worth only $250,000."
The ad is calculated to pack an emotional punch. Unfortunately, it doesn't tell the whole story.
Anyone working in the healthcare field has heard the buzzwords “big data” and “analytics” with increasing frequency over the last five years. Interest in the topic is fueled by many factors, including accountable care, the Triple Aim and value based purchasing. In the current era of accountable care, a healthcare organization must be data-driven to remain competitive. This realization has prompted the same data bonanza in medicine that several other industries experienced years ago.
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Great article Seth! As a non-clinician, I know that a call-back would mean the
Great article and really a good 'how to do it' in a way that makes sense and
Thanks, Seth, for highlighting the personal gratification that comes from
Rachel, thank you for sharing your unique method of coping that allows you to
Inspiring and thought provoking! Thank you for taking the time to share this