At the Becker's Hospital Review Annual Meeting in Chicago on May 11, John G. Holstein, director of Medical Management Professionals, Mark Mackay, MD, vice chairman of clinical operations, department of emergency medicine at University of Illinois at Chicago Hospital, and Richard Jones, senior vice president and CFO at Reading (Pa.) Health System, discussed the rise in emergency department use, and how the ED could be both a revenue generator and a hospital front door.
Mr. Holstein opened the session by giving advice about negotiating with payors with regard to the ED. "Discuss the unique expertise of your emergency department," he said, and if possible, don't make any reference to Medicare. It is also important to keep in mind that in the future your organization may want to walk away from the contract — remember that and plan for it.
The emergency department has the potential to be a hub for care coordination and can be a valuable source of revenue for a healthcare organization. According to Dr. Mackay, emergency department volumes are going up, and most patients are going to the emergency room before they even see a physician when they are sick. The University of Illinois at Chicago Hospital, through a focus group, found that healthcare dollars are not primarily being used for emergency care. In fact, only 2 percent of healthcare dollars is used for emergency care. The hospital has been focusing on improving efficiency and decreasing "left without being seen" cases, which result in significant return on investment, said Dr. Mackay.
According to Mr. Jones, the ED at Reading Health System is truly the hospital's front door as nearly 60 percent of its inpatients come in through the ED. It is one of the busiest EDs in Pennsylvania. He closed the session by talking about the current paradigm shift that is occurring in healthcare, which incudes different types of models moving into the market, such as ACOs and shared risk models.
Mr. Holstein opened the session by giving advice about negotiating with payors with regard to the ED. "Discuss the unique expertise of your emergency department," he said, and if possible, don't make any reference to Medicare. It is also important to keep in mind that in the future your organization may want to walk away from the contract — remember that and plan for it.
The emergency department has the potential to be a hub for care coordination and can be a valuable source of revenue for a healthcare organization. According to Dr. Mackay, emergency department volumes are going up, and most patients are going to the emergency room before they even see a physician when they are sick. The University of Illinois at Chicago Hospital, through a focus group, found that healthcare dollars are not primarily being used for emergency care. In fact, only 2 percent of healthcare dollars is used for emergency care. The hospital has been focusing on improving efficiency and decreasing "left without being seen" cases, which result in significant return on investment, said Dr. Mackay.
According to Mr. Jones, the ED at Reading Health System is truly the hospital's front door as nearly 60 percent of its inpatients come in through the ED. It is one of the busiest EDs in Pennsylvania. He closed the session by talking about the current paradigm shift that is occurring in healthcare, which incudes different types of models moving into the market, such as ACOs and shared risk models.