Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

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Going back to the Truman administration, after every failure to enact healthcare reform at the federal level, it has taken another 15-20 years before there is enough political will to try again.  Regardless of how one feels about the ACA, I don't know anyone who thinks we can wait that long to fix a system that is so expensive and so dysfunctional.

I was not surprised that SCOTUS did not invalidate the entire ACA, but had expected the individual mandate and perhaps some of the other private insurance reforms to fall, based on the fairly negative comments about the Commerce Clause defense by a majority of the justices during the hearings in March.  However, to the extent that emergency physicians provide more uncompensated care than any other specialty to tens of millions of uninsured Americans every year because of EMTALA, any credible attempt to expand access to coverage is a positive for EDs and many of their patients in every community.

It will be hard to know how the ruling impacts emergency medicine (EM) until the results of the election in November define control of both houses of Congress and the White House.

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7/16/2012 6:06:17 PM | 1 comments

Which Hospital-Based Physician Specialty Will Wield the Mightiest Pen In the Future?

So what are the implications of more prevalent revenue sharing between hospital based physician practices? Here is one example: It has been widely quoted that hospitalist physicians require a subsidy of up to $130,000 per physician in a hospitalist practice. This happens because hospitalists typically see high numbers of unassigned – and often un- or under-insured – patients. Hospitals, which are now responsible for this subsidy, find value in the better patient care and lower lengths of stay from physicians dedicated only to inpatient medicine.

For the same reasons, many emergency physicians, as well as anesthesiology and radiology physician earnings can be subsidized by hospitals where they work, due to insufficient revenue generated from patient encounters. The actual amount of the subsidy, while varying widely, can be significant, although it is thought to be less than hospitalists receive on a per physician basis.

The point is that hospitals would like to reduce the subsidy to physicians to the smallest amount possible. 

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7/11/2012 10:04:18 PM | 0 comments

Studies indicate that by 2050, the number of older people will increase by 135% above today’s level, and those 85 and over will increase by 350%. A growing aging population is sure to increase the demand for medical care. Innovative health care services can help moderate this impact, but require an investment elsewhere in the healthcare system.

For 30 years Adult Day Health Care (ADHC) services provided a cost-effective way to address the needs of our aging population. By providing daytime health support and social engagement for seniors and adults with disabilities ADHC services are able to monitor health and help them maintain independence. With this comes decreased emergency rooms visits and hospital stays as well as preventing premature placement in nursing homes, all of which cost much more than the amount needed to run ADHC. My organization, SteppingStone Health, provides daily services that include healthcare services such as nursing and social work, therapies such as physical and speech therapy, nutritional lunches, transportation, and activities such as exercise and art therapy.

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7/10/2012 4:49:08 PM | 0 comments

Most of the press has been focusing on the individual mandate. What a victory for Obama! Yet the Medicaid decision could be a much bigger issue than the one regarding the individual mandate. The Supreme Court has ruled that the Federal government cannot coerce the states into expanding their Medicaid programs to cover all people (not just the elderly, blind, pregnant women, and children) below a certain income level by threatening to withhold existing Federal funds as it would violate the Spending Clause of the U.S. Constitution and exceeded Federal authority to encourage states to regulate. This would have been a big stick. Now states are free to do as they choose and several have already said they don't have the money to increase Medicaid enrollees.

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7/3/2012 10:50:24 PM | 0 comments

Now It’s All About Leverage

Bundled payments will be a game changer for every hospital-based physician specialty in the future. This brings to mind the age old analogy of three wolves and one lamb discussing what’s for dinner. It takes little imagination to realize that “leverage” will be perhaps the most important factor in determining who is on the menu, and who gets the biggest portion of the bundled payments for specific patient care episodes proposed by Medicare. 

As fee for service evolves to fee for value, the relative leverage of each hospital-based physician specialty will be crucial. Alignment with other specialists at the same hospital will also be an important factor in physician future reimbursement. Fortunately at least for emergency physicians, it appears that they will not be included in bundled payments for the foreseeable future. This does not diminish however the need to prepare for it appears to be an inevitable payment methodology that will include all physicians across the Acute Care Continuum in the future.

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7/3/2012 5:57:10 PM | 1 comments
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