Economy predicted to put more pressure on EDs
Reduced revenues anticipated, slowdown continues
Emergency medicine experts say the lagging economy is putting additional pressure on EDs that are already stretched to the limit, and that ED managers can look forward to even greater demand from patients while financial woes will lead to staff cuts, further exacerbating the situation.
"In the short or long term, it will increase our census; most EDs are seeing substantial growth," says Charles L. Reese IV, MD, FACEP, chair, Department of Emergency Medicine, Christiana Care Health System, Newark, DE. "And to the extent that people are out of jobs, do not have insurance, lose benefits, and get sicker, it's just going to drive our censuses higher in both low- and high-acuity populations." Caral Edelberg, CPC, CCS-P, CHC, of Edelberg Compliance Associates, Baton Rouge, LA, says, "In a nutshell, unless the economy improves, we will see more uninsured patients and higher ED acuity as folks wait longer for care with fewer alternatives for finding it," says "RAC [recovery audit contractor] audits and recoveries mean practices will be paying money back to Medicare and Medicaid while income is down due to patient inability to pay."
All in all, she says, EDs will need to tighten up, improve documentation where possible, assure correct coding and billing, perform internal audits, and self-disclose overpayments before Medicare/Medicaid identify them.
Funds are 'drying up'
Hospitals are being severely affected by recession, says Mike Williams, president of The Abaris Group, a Walnut Creek, CA-based health care consulting firm specializing in emergency services. "Capital markets for hospitals have completely dried up," he says. "I know one CEO who went to 20 lending agencies and they all told him no — and this is one of the richest counties in California and one of the richest hospitals." That means fundraising for more wings or departments is drying up, says Williams, adding, "We will see layoffs."
The American College of Emergency Physicians is equally concerned. In a prepared statement in October 2008, then-president Linda Lawrence, MD, noted, "The emergency department provides an essential health care safety net for everyone, and this role becomes even more important as the country goes through difficult financial times and faces physician shortages. When people lose their jobs or their health insurance, they go without preventive care and necessary medications, and depend on emergency physicians to treat them when their illnesses turn critical."
There is no question that in New York EDs will be heavily affected, says Steven J. Davidson, MD, MBA, FACEP, chairman, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY. "Whatever we get for Medicaid patients, we get from the hospital and the governor is talking about a $15 billion budget gap," he says. "When you work it all through, this is going to translate to perhaps a 10% reduction on the hospital side of things."
Davidson says that translates into a "substantial" impact on the ability to compensate emergency physicians, who, he says, already tend to be compensated at lower levels than other areas of the country because New York is a desirable place to live. "This will have an impact on my capacity, for example, to support my 35 attending ED physicians," says Davidson. But the effects, he adds, are everywhere. "There are going to be layoffs in the hospitals, and certainly the capital resources are going to be affected," he predicts, adding, however, that there will be winners and losers.
The only good news, notes Reese, is that "if I had to pick a job to be secure in, it's us. There's plenty of job security, but it will be a tougher environment for everyone in medicine."
Sources
For more information on how the economy will affect EDs, contact:
- Steven J. Davidson, MD, MBA, FACEP, Chairman, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY. Phone: (718) 283-6030.
- Caral Edelberg, CPC, CCS-P, CHC, Edelberg Compliance Associates, Baton Rouge, LA. Phone: (225) 454-0154. Fax: (225) 612-6904.
- Charles L. Reese IV, MD, FACEP, Chair, Department of Emergency Medicine, Christiana Care Health System, Newark, DE. Phone: (302) 733-1840.
- Mike Williams, President, The Abaris Group, Walnut Creek, CA. Phone: (925) 933-0911. Fax: (925) 946-0911. E-mail: [email protected].
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