Congressional Advisers Urge Medicare Payments To Many Stand-Alone ERs Be Cut

KHN contributing columnist Michelle Andrews writes the sequence Insuring Your Health, which explores well being care protection and prices.

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This story additionally ran on NPR. This story might be republished without spending a dime (details).

The girl arrived on the emergency division gasping for air, her extreme emphysema inflicting such shortness of breath that the doctor who examined her put her on a ventilator instantly to assist her breathe.

The affected person lived throughout the road from the emergency division in suburban Denver, stated Dr. David Friedenson, who cared for her that day a number of years in the past. The facility wasn’t bodily positioned at a hospital however was affiliated with North Suburban Medical Center a number of miles away.

Free-standing emergency departments have been cropping up in recent times and now quantity greater than 500, in response to the Medicare Payment Advisory Commission (MedPAC), which reviews to Congress. Often touted as extra handy, much less crowded options to hospitals, they usually appeal to suburban walk-in sufferers with good insurance coverage whose medical issues are much less acute than those that go to an emergency room positioned in a hospital.

If a recent MedPAC proposal is adopted, nevertheless, some suppliers predict that these free-standing services might change into scarcer. Propelling the trouble are considerations that MedPAC’s fee for companies at these services is increased than it must be because the sufferers who go to them are typically not as severely injured or in poor health as these at on-campus services.

The proposal would cut back Medicare fee charges by 30 p.c for some companies at hospital-affiliated free-standing emergency departments which are positioned inside 6 miles of an on-campus hospital emergency division.

“There has been a growth in free-standing emergency departments in urban areas that does not seem to be addressing any particular access need for emergency care,” stated James Mathews, govt director of MedPAC. The comfort of a neighborhood emergency division could even induce demand, he stated, calling it an “if you build it, they will come” impact.

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Emergency care is dearer than a go to to a main care physician or pressing care heart, partially as a result of emergency departments must be on standby 24/7, with costly gear and personnel able to deal with critical automobile accidents, gunshot wounds and different trauma circumstances. Even although free-standing emergency departments have decrease standby prices than hospital-based services, they usually obtain the identical Medicare fee for emergency companies. The Medicare “facility fee” payments, which embrace some ancillary lab and imaging companies however not reimbursement to physicians, are designed to assist defray hospitals’ overhead prices.

The proposal would have an effect on solely funds for Medicare beneficiaries. But personal insurers usually take into account Medicare fee insurance policies when setting their guidelines.

According to a MedPAC evaluation of 5 markets — Charlotte, N.C.; Cincinnati; Dallas; Denver; and Jacksonville, Fla. — 75 percent of the free-standing facilities had been positioned inside 6 miles of a hospital with an emergency division. The common drive time to the closest hospital was 10 minutes.

Overall, the variety of outpatient emergency division visits by Medicare beneficiaries elevated 13.6 p.c per capita from 2010 to 2015, in contrast with a three.5 p.c development in doctor visits, according to MedPAC. (The reported knowledge doesn’t distinguish between typical and free-standing emergency facility visits.)

“I think [the MedPAC proposal] is a move in the right direction,” stated Dr. Renee Hsia, a professor of emergency drugs and well being coverage on the University of California-San Francisco who has written about free-standing emergency departments. “We have to understand there are limited resources, and the fixed costs for stand-alone EDs are lower.”

Hospital representatives say the proposal might trigger some free-standing emergency departments to shut their doorways.

“We are deeply concerned that MedPAC’s recommendation has the potential to reduce patient access to care, particularly in vulnerable communities, following a year in which hospital EDs responded to record-setting natural disasters and flu infections,” Joanna Hiatt Kim, vp for fee coverage on the American Hospital Association, stated in an announcement.

Independent free-standing emergency departments that aren’t affiliated with a hospital wouldn’t be affected by the MedPAC proposal. These facilities, which make up a couple of third of all free-standing emergency services, aren’t clinically built-in with a hospital and may’t take part within the Medicare program.

The MedPAC proposal can be included within the group’s report back to Congress in June.

Even although stand-alone emergency services may not routinely deal with sufferers with critical trauma, they’ll present lifesaving care, proponents say.

Friedenson stated that for his emphysema affected person, avoiding the 15- to 20-minute drive to the principle hospital made a vital distinction.

“By stopping at our emergency department, I truly think her life was saved,” he stated.

This story additionally ran on NPR. This story might be republished without spending a dime (details).

Michelle Andrews: @mandrews110

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