Regionalizing Emergency Care Workshop Summary (2010) / Chapter Skim
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6 Financing
Pages 83-94
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From page 83... ...
These hospitals also tend to be providers of essential community services, including Level I trauma care, burn care, and other emergency department care, and they also play an important role in local disaster preparedness efforts. Financially, she said, these institutions are "very fragile." Their profit margins are only about one-third to one-half of those of the other hospitals in the country.
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From page 84... ...
, described HCA as an investor-owned heath care company with 163 hospitals, 109 surgery centers, and almost 400 physician practices. Most of the hospitals are community hospitals, although they have one regional burn center, three Level I trauma centers, and three critical access hospitals.
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From page 85... ...
Englebright said that five years ago, local hospital CEOs tended to view the ED "an important community service, but a financial loss leader." Now they tend to see things differently. The company has found that "all of our important service lines have a significant number of their patients come through the ED." With the exception of neonatal and rehab, "every single service line has a significant portion of their patients coming through the ED, including urology and ENT (ear, nose, and throat)
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From page 86... ...
These changes would produce downstream savings that could be used to help pay for medical dispatch, the regional call centers, and system surge capacity. Instituting treat-and-release protocols would also help ensure that patients are treated in the setting most appropriate to their case.
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From page 87... ...
imperative." Teter observed that we have come a long way in 40 years, but there are still sizable gaps in the trauma care system. On the American Trauma Society website there are maps that show which areas of the country do and do not have access to a trauma center within 60 minutes through air or ground transportation.
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From page 88... ...
They have worked with the cardiovascular society and clinical providers and have been successful at moving those groups into the "northeast quadrant," where they provide the highest sustained quality, based on clinical database metrics. UnitedHealth Group has also just created a premium designation program, where providers can be reimbursed more for providing care that may increase front-end costs but is likely to significantly reduce unnecessary downstream services.
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From page 89... ...
problems. David Boyd, administrator of the EMS Act of 1973, said back then the federal government had tried many different approaches to try to decrease the flow of patients into emergency departments -- public relations spots on TV, focus groups, and so forth.
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From page 90... ...
. in improving people's behaviors as they consider utilizing emergency services." Triaging Patients Through the 9-1-1 System Richard Hunt of the Centers for Disease Control and Prevention (CDC)
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From page 91... ...
Disincentives for Integration Alex Valadka, a neurosurgeon from Texas, said that when patients arrive at a facility in an integrated health care system, the clinicians are able to access that patient's records and history and do not waste a lot of time repeating workups or ordering medications for which there is a
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From page 92... ...
Bundling Payments to Regions Stephen Epstein, an emergency physician from Boston, also inquired how we might be able to use financing methods to reduce duplication of services. In Boston, he said, there are five Level I trauma centers in a city that probably requires only two.
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From page 93... ...
For example, neurosurgeons want to take some of their elective cases to the local trauma hospital, which is not as highly regarded and does not have all the toys as one of the larger facilities, because that hospital has a better operating room, better nursing care in the ICUs (intensive care units) , and better follow-up care, so it's better for the patients.
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From page 94... ...
REGIONALIZING EMERGENCY CARE the patients will be seen more quickly, the triage is more efficient, and the overall care is better. Valadka acknowledged that "toys" also matter to patients.
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