Survey: Administrators eager to expand EDs
Volumes haven’t decreased
If you could take one single action to improve your ED, what would it be? If you’re like 83% of respondents to a recent survey, you’d expand your ED or improve its equipment.
That response illustrates that many hospitals put off expanding their EDs because they anticipate that managed care would reduce ED volumes, according to William Schumacher, MD, CEO of The Schumacher, Group, a Lafayette, LA-based national ED management firm that conducted the survey.
Until recently, administrators were reluctant to add beds or units to the ED, Schumacher says. "Their feeling was, why should we they go out and invest money in expanding when managed care will result in reduced utilization in the ED?"
MCOs look bad’
However, ED volumes have not decreased, he notes. "Managed care has tried to alter utilization patterns of patients, but it’s failed miserably. Instead, there have been bad outcomes which have made managed care organizations look bad." Also, prudent layperson legislation makes it very difficult for governmental payers not to pay for emergency services, Schumacher says.
Budget cutbacks have forced sicker patients out into the community without follow-up from home health care, he says. "So EDs are not only going to be seeing more patients, but also sicker ones. All of a sudden, hospitals with 8,000 ED visits that thought that would mean they wouldn’t see increases are now seeing 12,000 patients."
EMTALA closed loopholes
Revised guidelines for the Emergency Medical Treatment and Active Labor Act published by the Health Care Financing Administration in Baltimore have closed loopholes that allowed preauthorization, Schumacher adds. There are several efforts under way to stop discouraging utilization of EDs, so administrators are more likely to consider expansions, he explains.
Use the survey results to raise the issue of possible expansion with your administrator, recommends Randy Pilgrim, MD, regional medical officer for The Schumacher Group and acting medical director of the ED at Biloxi (MS) Regional Medical Center. "It’s a good entree to discussion," he says. "A facility redesign is certainly an attractive and often necessary option, but if capital expenditure is a limiting factor, administrators may be relieved to hear that other less costly options also work well."
Present alternatives for improving ED operations without a full-fledged redesign, Pilgrim suggests. "Administrators may be relieved to hear that they may not need to spend the money on a facility redesign, which may not fix the core issues that affect care."
Focusing on improving care is a better way to attract satisfied patients without incurring a huge capital expense, Pilgrim explains. "Selected cosmetic fixes enhance patient satisfaction, especially when these are combined with improving quality of care and patient flow."
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