UnitedHealth Group and MEDPAC both reported on the state of emergency departments last week. Last week, emergency departments (EDs) got some serious national attention. First, UnitedHealth Group released a study examining costs associated with freestanding emergency departments (FSEDs), and second, there was a call for the Centers for Medicare &…
Emergency departments (EDs) have been a hot-button topic in the battles over “surprise” billing.  Certainly, many patients use EDs inappropriately. We’ve all read and heard about uninsured patients, patients with no primary care provider, patients who simply abuse the fact that EDs are always open, patients with complaints that are…
Recent issues in Oklahoma, Nebraska portend a growing crisis. The news coming out of Oklahoma was grim: Pauls Valley Regional Medical Center couldn’t keep its doors open, despite a GoFundMe campaign, as well as a reported solicitation from country music star Toby Keith. And in September, Latimer County General Hospital,…
Length of stay does not correlate directly with costs. I am sure many of you have heard me rant about observation rates before. I’m sure at least half of you have been told that your observation rate is too high and that you need to fix it. “You’re above the…
Condition 44 is one of three perplexing issues reviewed by the author.  Last week was a boring regulatory week, other than the continuing talk about the proposed changes to evaluation and management (E&M) coding. That continues to dominate discussions, with ongoing negativity by the physician community. Without new regulatory controversy,…
Multiple visits to observation patients may soon be payable but…  When one looks at the current payment structure for observation medicine from the physician viewpoint, it makes no sense. Although observation patients are not as sick as inpatients, the amount of time and number of daily visits needed to care…
Many hospitals have found that putting SIBRs into place is incredibly challenging. The Case Management Society of America’s (CMSA’s) 28th Annual Conference and Expo recently took place in Chicago, and I was fortunate enough to be a part of it. Attracting professionals represented within CMSA’s strategic mission – collaborators across…
Better ED quality measures, and, ultimately, greater patient satisfaction are among benefits cited. The placement of registered nurse (RN) case managers in the emergency department, with a focus on determining appropriate admission status and making status recommendations to admitting physicians, has proven to be very successful at Waukesha Memorial Hospital…
If a patient does not have liability for a particular expense, the insurer is similarly absolved of responsibility. The June 14 issue of RACmonitor focused in part on Anthem’s policy regarding coverage of ED services. The relevant article suggested that insured patients should not face responsibility for emergency room bills.…
Observation is a service, not a status. As we have all seen in recent events on television, choice of words matters. That’s particularly true in the utilization review world. And one word that matters an awful lot is “observation.” I am sure you have all heard this a million times…
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