Hospitalwide Initiatives Will Increasingly Involve ED

The intensifying focus on ever-rising health care costs is spurring other government initiatives that will soon affect the emergency department. In the past, the Medicare Core Measures program applied only to admitted patients. But that’s expanding for 2011 to include certain outpatient measures, such as median time to ECG, median time to fibrinolysis, and use of abdomen and thorax CT, among others, that involve ED clinical processes.

Those CT measures, and another for lumbar MRI for low back pain, reflect the CMS’s efforts to reduce medically unnecessary resource utilization. One thing is for certain: As the CMS’s hospital quality-improvement programs expand, emergency physicians will be tapped to help their facilities meet new standards. And emergency physicians’ ordering patterns will come into the picture, as hospitals are increasingly pressured to report Core Measure performance.

“Hospitals are on the hook because if they don’t report [on Core Measures], they don’t receive their annual ‘market-basket’ update of 2%. So for hospitals on thin profit margins, it’s a major issue,” Dr. Granovsky said. “That’s why almost all hospitals are now reporting.”

Resource-consumption concerns also figure in another nascent CMS initiative: looking at total costs of care per episode and at the provider level. The CMS has started evaluating total provider-associated care costs for common episodes such as MI, and other quasi-discrete diagnoses are likely to follow.

Finally, emergency physicians and other admitting providers are now charged with documenting certain medical issues that are “present on admission,” such as urinary tract infections and pressure ulcers.

Ultimately, as the CMS scrutinizes 30-day readmission rates, emergency physicians’ roles in both appropriate inpatient length of stay and protracted stays resulting from faulty processes will figure in financial penalties to hospitals. Practically speaking, any effort to make care more efficient and cut unnecessary costs is understandable and even laudable, but there’s no question that these initiatives will affect ED practice patterns, Dr. Granovsky predicted.

“Ultimately, CMS is moving toward paying us [hospitals and physicians] on outcomes, which may soon mean that we’ll get to looking at things like the 30-day outcome and costs of a pneumonia admission,” he said.