Jan 22, 2018 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
Meanwhile, some insurance payers are dropping coverage for certain medical treatments they consider “unnecessary,” leaving hospitals and their medical laboratories to wonder if they will be reimbursed for the tests they perform
Hospital-based medical laboratories and anatomic pathologists are well aware that the emergency department (ED) in their hospital is their single largest customer and that reporting test results within required turn-around times (TATs) is a non-stop battle. Thus, it will not be a surprise to learn that EDs provide nearly half of all hospital-related medical care in the US. That’s what a study by the University of Maryland School of Medicine (UMSOM) reports.
The UMSOM researchers claim their study, which was published in the International Journal for Health Services (IJHS), is the first ever to quantify the contribution EDs make to US healthcare. According to an UMSOM news release, they determined that 47.7% of all hospital-associated medical care between 1996 and 2010 was delivered by EDs.
Results Show EDs Critical to Healthcare Delivery
This a remarkable revelation. “I was stunned by the results,” David Marcozzi, MD, Associate Professor and Assistant Chief Medical Officer for Acute Care, UMSOM Department of Emergency Medicine, told Becker’s Hospital Review. Marcozzi led the study, which involved researchers from Thomas Jefferson University and other academic institutions.
“This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system,” he continued. “Patients seek care in emergency departments for many reasons. The data might suggest that emergency care provides the type of care that individuals actually want or need.”
As Becker’s Hospital Review explained, there were about 130-million visits to hospital EDs as compared to 101-million outpatient visits, and 39-million inpatient visits during 2010, the most recent year analyzed by UMSOM.
Quantifying the EDs Contribution to Healthcare
The researchers studied the role EDs play in caring for Americans, as compared to hospital outpatient and inpatient sectors. They were motivated, in part, by the apparent extra attention healthcare decision-makers pay to inpatient services and costs. As an emergency medicine and population health specialist, Marcozzi (who also works in the UM Medical Center Emergency Department) challenged that focal point.
In the first study to quantify the contribution of emergency department care to overall US healthcare, researchers at the University of Maryland School of Medicine (UMSOM) have found that nearly half of all US hospital-associated medical care is delivered by emergency departments. In this video, David Marcozzi, MD, MHS-CL, FACEP, talks about why this is happening and what the ramifications are for healthcare delivery in the US. Click on image above to view video. (Video and caption copyright: University of Maryland School of Medicine.)
The researchers cited National Center for Health Statistics data suggesting just 12% of ED encounters led to hospitalizations. This seems to counter claims of up to 50% of all healthcare being delivered in EDs. However, the researchers note that EDs also serve the uninsured and poor, many of whom are not admitted to the hospital.
“Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered [medical] homes, managed care resources, and accountable care organizations. The use of EDs has not been given much consideration in these models,” the authors wrote in their paper.
ED Visits Jump Nearly 44% over 14 Years
Researchers analyzed ED patient, outpatient, and inpatient data from these sources:
- National Hospital Ambulatory Medical Care Survey
- National Hospital Discharge Survey
- Electronic data files (sources of patient demographics and medical information) from commercial organizations, state data systems, hospitals, and hospital associations
They discovered that 3.5-billion healthcare encounters occurred over the 14-year period studied (1996 to 2010), representing a 43.7% increase in ED visits during that time.
During that period, ED utilization resulted in:
- 1.6-billion ED visits or 47.7%
- 1.3-billion outpatient visits or 37.6%
- 5.2-million hospital admissions or 14.8%
The UMSOM study also found EDs were increasingly being used by African Americans in the south and west and by Medicaid beneficiaries, Fierce Healthcare reported.
“When considering the isolated ED case mix, Medicaid as a course of payment showed a major increase in its contribution, shifting from 19.4% to 27.5% of all emergency care,” the researchers noted.
What’s needed, according to the study authors, are solutions to address non-urgent conditions often seen in EDs. However, they acknowledge, that the topic has drawn controversy.
Insurers Respond to Trend by Dropping Coverage of ‘Unnecessary’ ED Treatments
Some insurance companies on the hook for increasing ED costs have devised a novel approach to the increased cost—stop paying for it.
A Dark Daily e-briefing recently covered one such “solution” involving letters sent to Anthem Blue Cross and Blue Shield (BCBS) of Georgia members informing them that ED services deemed “unnecessary” by BCBS would no longer be paid. (See Dark Daily, “Anthem Blue Cross Blue Shield of Georgia Drops Coverage for Non-Emergency ER Visits; Medical Laboratories Could See Drop in ER Clinical Lab Test Orders,” July 14, 2017.)
These new guidelines, which created quite a stir in Georgia before they went into effect July 1, 2017, are mirrored at BCBS affiliates in New York, Missouri, and Kentucky, noted sources in the Dark Daily report.
Non-avoidable Healthcare Events and ‘Connecting the Care’
In apparent response to this trend, a study published in the International Journal for Quality in Health Care, found that just 3.3% of ED visits are actually “avoidable.”
“Despite a relentless campaign by the insurance industry to mislead policymakers and the public into believing that many ER visits are avoidable, the facts say otherwise,” stated Becky Parker, MD, President of the American College of Emergency Physicians (ACEP), in a news release.
UMSOM’s Marcozzi says the aim should be to “connect the care” delivered in EDs with other care offered by the healthcare system.
“Restricting EDs to patients classified as having critical illness does not seem a feasible or humanitarian option, as many individuals would not be able to find care elsewhere. In addition, many people do not have the knowledge to determine which symptoms indicate an emergency,” the researchers note.
Clinical Laboratories Can Download the UMSOM Full Study for Future Reference
At this point, it’s not clear how increasing ED costs and decreasing insurance payments will impact medical laboratories and anatomic pathology groups. Nevertheless, the UMSOM study is a good resource. ED volume and test orders will likely increase as more people go to EDs for treatment.
As a special to Dark Daily readers, Sage Publications is granting full access to UMSOM’s study through March 31, 2018. After that date, only the abstract will be available to non-IJHS subscribers. Click here to reach the full study article or place this URL into your browser: http://journals.sagepub.com/stoken/default+domain/JG8RNXfhAf7fuhFRIUIV/full.
—Donna Marie Pocius
Related Information:
Trends in the Contribution of Emergency Departments to the Provision of Hospital-Associated Health Care in the USA
University of Maryland School of Medicine Study Finds That Nearly Half of U.S. Hospital-Associated Medical Care Comes from Emergency Rooms
Nearly 50% of US Medical Care Occurs in EDs
ERs Provide Nearly Half Medical Care in U.S., Study Finds
Avoid Emergency Department Visits: A Starting Point
Only 3.3% of ER Visits Are Avoidable
Anthem Blue Cross Blue Shield of Georgia Drops Coverage for Non-Emergency ER Visits; Medical Laboratories Could See Drop in ER Clinical Lab Test Orders
Jul 10, 2017 | Laboratory News, Laboratory Pathology, Laboratory Testing, Management & Operations
Clinical laboratories and pathology groups that use taxicabs to pick up patient specimens and bring them to the lab now have the option of using Uber and Lyft for this service
For decades, medical laboratories have used taxicabs to have specimens picked up from one location and driven to the lab for testing. This was a way to handle STAT specimens, for example. Now, with the rise in popularity of ride-sharing services such as Uber and Lyft, a burgeoning trend has emerged where people utilize ride-services rather than driving themselves to the emergency room (ER) for medical treatment. Should clinical laboratories use ride-sharing services as well for transporting specimens?
Cost and Choice Two Advantages of Ride-sharing Services
According to the Center for Disease Control and Prevention (CDC), there are 130.4 million visits to ERs each year in the US and approximately 15% of those patients arrive by ambulance. But ambulance rides and EMT services can be costly.
According to howmuchisit.org, a website where visitors can find out how much average consumers paid for products and services around America, a trip to the ER by ambulance can range from $350 to $2,000 or more, depending on location, distance to the ER, and the patient’s insurance company.
Conversely, the cost for the same transportation by Uber or Lyft would typically cost less than $100.
So, price is one advantage ride-sharing services have over traditional ambulance rides. There are others. Patients also can choose which hospital they will be taken to for treatment. This option is generally not available via ambulance. Additionally, passengers know what the price of the trip with Uber or Lyft will be up front. Months can pass before patients receive a bill for a traditional ambulance ride.
But is it a good idea to call up Uber or Lyft instead of dialing 911 in a potentially life-threatening situation when moments count and emergency medical technician (EMT) skills can save lives?
To Uber or Not to Uber? That Is the Question
There are no statistics on the number of people who use ride-sharing services to go to the ER. However, many drivers in a chat room for Uber drivers acknowledged an escalation in the amount of requests for trips to the ER, usually for maladies such as broken bones, bleeding wounds, vomiting, or allergic reactions.
In a STAT article, Francis Piekut, who drives for both Uber and Lyft in Boston, described what he encountered when taking a call to transport a passenger to the ER. “They were burned and wanted to go the emergency room,” he stated. “I don’t know how bad it was, but I knew they were in pain really bad.” He took the individual where they wanted to go, as he would any other fare.
“I didn’t mind it,” Piekut added. “I was already there, and I know the ambulance costs a lot.”
However, other drivers in the chat room indicated they had or would refuse such service requests due to:
- Liability issues;
- Fear of getting blood or vomit in their car;
- Knowing that they could not speed through the streets like an ambulance during an emergency; and
- Apprehension about being stuck with a dead body if the passenger perished on the way to the ER.
Officially, Uber and Lyft recommend that people call 911 in the event of an emergency. In an ABC News article, Uber stated: “We’re grateful our service has helped people get to where they’re going when they need it most. However, it’s important to note that Uber is not a substitute for law enforcement or medical professionals. In the event of any medical emergency, we encourage people to call 911.”
The screen shot above taken from an NBC News TODAY video shows that some Uber drivers feel they are not required or prepared to substitute for an actual ride in an ambulance or EMT van. Click on the link above to watch the full video report. (Photo copyright: NBC News TODAY.)
Nevertheless, some emergency departments are looking at ride-sharing services to reduce their workload. Officials in Washington DC are researching the use of such services for “non-emergency, low-acuity” calls. These types of calls were responsible for nearly half of the city’s 911 calls in 2015, STAT reported.
“In our research, we found that many of these calls did not require an ambulance,” Doug Buchanan, Chief Communications Officer for the District of Columbia Fire and Emergency Medical Services (DC FEMS), noted in the STAT article. He believes it would be beneficial if people with non-emergencies used ride-hailing services instead of an ambulance. “We would love our residents to take that initiative,” he stated.
Baltimore ER physician Mark Plaster, MD, believes there should be multiple transportation options available to patients to accommodate different types and intensities of injuries.
“I would hope that no one who needed truly urgent medical attention would take an Uber,” Plaster urged in the STAT article. “If you need medical care en route, a private car is a bad idea, because you won’t have the personnel or equipment to treat you.”
Nevertheless, Plaster can see some merit in using ride-sharing services to get to the ER.
“Rideshares don’t take ambulances out of service, and not everybody coming into the ER is in a dire situation,” he stated in the STAT article. “And the ambulance can be expensive.”
Clinical Laboratories Use Taxis to Transport Specimens
Ride-sharing services were originally established to improve on the cost and availability of taxicab services. Apparently, their faster service versus a traditional taxicab also makes them a desirable option for some individuals who need to get to an ER. But before you call Uber or Lyft to go to the ER, know that they are not prepared for true emergencies and your life could be on the line.
Clinical laboratories and pathology groups, on the other hand, have been using taxicabs for the delivery of lab specimens for decades. It is likely, then, that services like Uber and Lyft will soon be used for the transportation of lab test specimens, as well, and will continue to be utilized into the future.
—JP Schlingman
Related Information:
For a Trip to the ER, Some Are Opting for Uber over an Ambulance
Expert Warns: Take Ambulance Instead of Uber or Lyft to ER
Why Many People Are Turning to Uber over Ambulances in Emergencies
Why I Used Uber Instead of an Ambulance
Why some people are calling Uber instead of an ambulance to get to the ER
Uber to the ER?
$164 Per Mile: Surprise Ambulance Bills Are a Growing Problem and Difficult to Avoid
Lyft Plans to Expand to 100 More US Cities in 2017
Lyft vs. Uber: Just How Dominant Is Uber In the Ridesharing Business?
Nov 13, 2013 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Scribe-assisted physicians say their productivity is back to normal after plummeting with connection to an EHR and have time to spare
One unintended consequence of the federal program to encourage hospitals and physicians to adopt and use electronic health record (EHRS) systems is the creation of a new category of healthcare worker. Today, a growing number of hospitals and medical groups are hiring medical scribes.
Medical scribes are trained individuals who document physician-patient encounters in real-time while a physician is examining the patient. Dark Daily was one of the first to call attention to this new healthcare profession. Medical scribes got their start several years ago working in emergency rooms (ER) to help increase ER physician productivity [See Dark Daily: Adoption of EMRs Creates Demand for New Healthcare Job of ‘Scribes’].
Now, thanks in part to $15.5 billion in federal funding under the American Recovery and Reinvestment Act of 2009, medical scribes are assisting physicians outside the ER. They can be found with doctors making hospital rounds and in medical practices, entering patient medical data into EHRs while physicians are examining or interacting with patients, noted a report published in Modern Healthcare. (more…)
Sep 7, 2011 | Laboratory News, Laboratory Operations, Laboratory Pathology
Clinical laboratory managers are often part of the ER’s process improvement team
Hospital emergency rooms (ER) across the country are intensifying their focus on improving patient safety and reducing errors. The cost of malpractice lawsuits filed after errors in emergency rooms is a major reason why growing numbers of hospitals are initiating formal programs to identify and eliminate the source of errors and wrong care provided to patients.
It probably won’t surprise most pathologists and clinical laboratory managers to learn that diagnostic errors are one significant source of malpractice claims that result from care provided by hospital emergency rooms, which can often be chaotic and overcrowded. Recently, The Wall Street Journal reported that a large percentage of medical errors in hospitals—and the resulting malpractice suits—occur because of mistakes in the emergency room. Studies of closed claims show that 37% to 55% of the malpractice suits are attributable to diagnostic errors. (more…)
