February 25, 2021

Gatekeepers of the ED

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A true gatekeeping process for ED admissions does not always exist. The decision to admit a patient from the emergency department (ED) to a hospital bed is one of the most expensive healthcare decisions. As payers continue to decrease payments for hospitalizations and as more diagnoses move to the outpatient…
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Readmissions affect 18.2 percent of Medicare beneficiaries. Hospitals already suffering from the financial hemorrhage of the COVID-19 pandemic will be hit again by the readmission penalty. More than 2,500, or 83 percent of hospitals in the U.S., will receive reduced Medicare funding for the 2021 fiscal year because of their…
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The pandemic is driving a shortage of hospital beds. Patients presenting to hospitals via the emergency department due to an inability to care for themselves (or other’s ability to care for them) is not new. But the COVID-19 pandemic has added a slew of new concerns and obstacles for hospitals…
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Health systems are grappling with custodial/social admissions from the ED.   In my last article, I discussed how emergency departments (EDs) across the country are grappling with patients presenting without the ability to care for themselves, or others who are unable to care for them, leading to a custodial admission…
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Should hospitals combine two admissions into one? In the absence of CMS guidance, hospitals are urged to do the right thing.  Last week I wrote a confessional for RACmonitor eNews, Hospital Admissions: Combining Two into One Doesn’t Add Up, about how I had been advising hospitals incorrectly on billing a…
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Should hospitals combine two admissions into one? In the absence of CMS guidance, hospitals are urged to do the right thing. Today I have a confession to make. For the last five years, I have been lying. Now, don’t get me wrong; I have not been doing it on purpose.…