Key Notes For The Week
10/27/2017
Nearly half of medical care comes from emergency rooms, study
shows
Nearly half of all medical care in the U.S. is delivered by
emergency departments, according to a new study by researchers at the
University of Maryland School of Medicine. And in recent years, the percentage
of care delivered by emergency departments has grown.
In 2010, the study found there were nearly 130 million emergency
department visits, compared with almost 101 million outpatient visits and
nearly 39 million inpatient visits. Inpatient visits typically involve a
hospital stay, but are planned ahead, as opposed to emergency department
visits, which are generally at least somewhat unexpected.
Over the 14-year period of the study, more than 3.5 billion
healthcare contacts -- emergency department visits, outpatient visits and
hospital admissions -- took place. During that time, emergency care visits
increased by nearly 44 percent. Outpatient visits accounted for nearly 38
percent of contacts, while inpatient care accounted for almost 15 percent of
visits.
Certain groups were significantly more likely to use the
emergency department as their method of healthcare. Black patients were much
more likely to have emergency department visits than patients in other racial
groups; patients in the "other" insurance category, which includes
those without any type of insurance, were significantly more likely to have
emergency department visits than any other group. And patients living in the
South were much more likely to have emergency department visits than patients
living in other areas of the country.
African Americans used emergency departments at a higher rate
than other groups. In 2010, this group used the emergency department almost 54
percent of the time. The rate was even higher for urban African-American
patients, who used emergency care 59 percent of the time that year. Emergency
department use rates in the south and west were 54 percent and 56 percent,
respectively. In the Northeast, use was much lower: 39 percent of all visits.
Certain groups accounted for increasing percentages of overall
emergency room use: blacks, Medicare and Medicaid beneficiaries, residents of
the south and west, and women. The authors said these findings point to
increasing use by vulnerable populations -- no surprise, since socioeconomic
and racial inequality creates barriers to the use of healthcare.
The use of emergency care resources for non-emergency cases has
been controversial, since initial emergency care patients often end up being
seen for non-emergency medical issues. Some experts argue that emergency
departments are covering for deficiencies in inpatient and outpatient
resources, and for a lack of effective prevention strategies, the report said.
This could contribute to the high rate of emergency department use. These
experts contend that emergency room use should be reduced.
Providers
should consider:
· Review and Urge Health Plans to develop
contracts with Urgent Care Centers
· Educate Patients on usage of ER and Urgent
Care
· Consider longer hours on certain days
769 hospitals fined for medical errors,
infections, by CMS
The federal government has cut payments to 769 hospitals with
high rates of patient injuries, for the first time counting the spread of
antibiotic-resistant germs in assessing penalties.
The punishments come in the third year of Medicare penalties for
hospitals with patients most frequently suffering from potentially avoidable
complications, including various types of infections, blood clots, bed sores and
falls. This year the government also examined the prevalence of two types of
bacteria resistant to drugs.
Based on rates of all these complications, the hospitals
identified by federal officials this week will lose 1 percent of all Medicare
payments for a year -- with that time frame beginning this past October.
While the government did not release the dollar amount of the penalties, they
will exceed a million dollars for many larger hospitals. In total, hospitals
will lose about $430 million, 18 percent more than they lost last year,
according to an estimate from the Association of American Medical Colleges.
The reductions apply not only to patient stays but also will
reduce the amount of money hospitals get to teach medical residents and care
for low-income people.
Providers
should consider:
·
This
penalty is being reviewed to extend
further , and apply to Providers
·
Review
DISCHARGE Summary / Orders
·
Consider
working with Case Managers
·
Implement
Discharge Care
·
Require
patient to be seen within 7-10 Days after DISCHARGE
The Centers for Medicare
& Medicaid Services (CMS) is conducting a field test for eight
episode-based cost measures before consideration of their potential use in the
cost performance category of the Merit-based Incentive Payment System (MIPS) of
the Quality Payment Program.
Rehab Services are being Audited
We have created a checklist
that serves as a documentation guide to assist providers and therapists when
responding to requests for medical documentation pertaining to therapy
services. This is only a guide, and it is
ultimately the responsibility of the provider of services to ensure the correct
submission of legible documentation for all dates of service on the
claim(s) in question. Please ensure that the medical records submitted provide
proof that the services were ordered, services were rendered, and that the
documentation provided justifies medical necessity. If classified as a
CORF/ORF, you must provide a coordinated, comprehensive, skilled rehabilitation
program that includes at least the three “core” services listed:
1. Physician's services
2. Physical therapy services
3. Social and/or psychological services
For more information regarding this article or about
our services, please contact:
SILBEN Health Services, Inc
Paul Silverio-Benet
305-975-1171
Our Services:
·
HEDIS
Compliance
·
MACRA-MIPS
Compliance
·
Coding
& Reimbursement
·
Local/State/Federal
Compliance
·
Medicare
and Medicaid Audits
·
Practice
Administrator
·
Provider
Contracting
·
Provider
Credentialing
·
Practice
Analysis
·
HCC- MRA
Compliance
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