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Emergency Department Diagnoses: What's New in the First Month of Reform?

By Matt Sartain, MBA

In the countdown to January 2014, there was a lot of speculation (and trepidation) about how newly insured patients might use (or overuse) the emergency department (ED).

Perhaps the most common prediction was an influx of less serious and lower-acuity complaints that could be better handled in primary or urgent care settings (assuming patients had access to one). Such a scenario was supported by the experience of states like Oregon, which has been tracking healthcare utilization of its expanded Medicaid population since 2008.

The prospect of an influx of newly insured patients at the height of flu season actually had some care providers quite worried.

So what actually happened? Well, the January data is in, so let's have our first look at how January 2014 diagnoses, volume and acuity stack up against previous years.

Choosing Wisely: How the Wrong Independent Physician Group Can Cost Your Hospital

By Denise Brown, MD, and Savoy Brummer, MD, FACEP

There are many options for hospitals looking to improve operational performance and physician engagement. Employment models, locums and outsourcing are among the many options available to hospital administrators today.

For those looking to partner with a physician-owned practice to staff an emergency department or hospitalist program, there are many benefits but also many things to consider. One plus is the physician-owners of such groups have a strong incentive to maintain high quality standards that can help hospitals meet the challenges of healthcare reform.

Of course, not all groups are created equal, and choosing the best group to partner with isn't easy. In today's post, two experienced physician-owners discuss common pitfalls and offer advice on how to spot an underperforming group.

Perspectives: Dr. Brown, Dr. Brummer, thanks for joining us. Let's start by talking about some common pain points between hospitals and physician groups. What kinds of things get in the way of that relationship?

Dr. Brummer: Well, first, there's culture. Hospital administrators want to make sure that you have a culture of engagement, a culture of cooperation and communication. But because it's difficult to assess culture when evaluating potential groups, administrators can be lulled into thinking all contract groups are the same and select cost over value hoping that culture follows suit. This rarely happens, and the typical results are negative consequences for patient care, poor quality and operational performance, and a lack of efficiencies that cost even smaller individual hospitals tens of millions of dollars a year.

Reform Realtime: What are the biggest pressures facing your hospital today?

Last week, we heard perspectives from providers around the country on the biggest problems their facing, but now we want to hear from you!

What are you most concerned about at your practice? What issues are you hearing from your providers, nurses, and staff? Take our poll below to share your thoughts. Then come back in two weeks to see the results. Subscribe to the blog in the top-right corner to be notified automatically.

Reform Realtime Video: Problems Facing Hospitals and Providers

The Affordable Care Act has imposed a number of new rules and regulations on hospitals and healthcare providers. In this video, hear from providers across the country talk about the problems they're currently facing. Share your concerns in the comments section below.

Reform Realtime: On the Ground at Hospitals Across the Country

By Joshua Tamayo-Sarver, MD, PhD, FACEP

CEP America is excited to announce the launch of Reform Realtime here on Perspectives. The initiative aims to examine the impact of health exchanges on acute care through:

  • Up-to-the-minute data sharing
  • Expert analysis
  • On-the-ground reports from hospitals and physician leaders
  • And much more

  • The goal of Reform Realtime is to provide you with an in-depth view of trends and changes affecting our industry.

    So how can we do this? That's where our data comes in.

    It's Not too Early to Gear Up for ED CAHPS

    By Tiffany Hackett, MD, MBA, FACEP

    No one plans to spend Saturday afternoon in the ED. This reality hit home when our laughter from lunch with old friends was pierced by the sound of glass shattering. We heard a scream and realized my daughter had just run through a sliding plate-glass door. During this experience, I had a rare opportunity to observe my profession from the patient/family side of things.

    What struck me most is the tightrope that ED providers must walk while providing high-quality, patient-centered care. As a parent, I valued the time the doctors and nurses spent with my child and me. On the other hand, I understood the pressures they were under to move us as quickly as possible through the diagnostic and treatment process. They worked hard to provide a healthy dose of empathy without sacrificing efficiency.

    ED physicians' ability to manage these opposing forces will become even more crucial over the next year or so as Centers for Medicare & Medicaid Services (CMS) rolls out its latest patient satisfaction survey — okay, patient opinion survey — the Emergency Department Consumer Assessment of Healthcare Providers and Systems (ED-CAHPS).

    Want Meaningful Use? Make Technology Meaningful for Doctors.

    By Jason Ruben, MD

    Last fall, as hospitals and healthcare providers scrambled to meet impending EMR "meaningful use" deadlines, regulators were sending some decidedly mixed messages.

    On Nov. 18, 2013, a representative from the Office of the National Coordinator for Healthcare Technology addressed a gathering of the American Medical Informatics Association. She insisted that meaningful use would proceed on schedule.

    "Wish there could be a delay of Stage 2 meaningful use? Don't hold your breath," wrote a reporter from Healthcare IT News, who was covering the story.

    Then, less than one month later on Dec. 6, the Centers for Medicare & Medicaid Services (CMS) announced that it would indeed extend Stage 2 for an additional year and delay the arrival of Stage 3 until 2017.

    Human factors played a pivotal role in CMS' decision. By delaying the program a year, they hoped to create:


    "Ample time for developers to create and distribute certified EHR technology before Stage 3 begins, and incorporate lessons learned about usability and customization."


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