The payer industry continues to move toward value-based payment models, and EM continues to face increasing reimbursement challenges and pressures. It has become more important than ever that your patient collection protocols be sharply defined using the best available metrics to legitimately collect the revenue you deserve.
References
- Melville N. ‘Difficult’ patients more likely to be medically misdiagnosed. Medscape. March 16, 2016.
- Wang DE, Tsugawa Y, Figueroa JF, et al. Association between the Centers for Medicare and Medicaid Services hospital star rating and patient outcomes. JAMA Intern Med. 2016;176(6):848-850.
- Kutscher B. Paying patients for saving money. Mod Healthc. 2016;46(15):11.
- Gooch K. Study: satisfied patients more likely to pay medical bills in full. Becker’s Hospital Review. March 16, 2016.
- Dussault N, Pinkovskiy M, Zafar B. Is health insurance good for your financial health. Liberty Street Economics. June 6, 2016.
- Law S. How your health system’s physician group data can leverage your hospital’s success. Becker’s Hospital Review. March 29, 2016.
- Butcher L. Consumer segmentation just hit healthcare. Here’s how it works. Hospitals and Health Networks. March 8, 2016.
- Employer family health premiums rise 4 percent to $17,545 in 2015, extending a decade-long trend of relatively moderate increases. Kaiser Family Foundation. September 22, 2015.
- 2016 Milliman Medical Index. Milliman website. Available at: http://www.milliman.com/mmi/. Accessed June 15, 2016.
Holstein is director of development at Zotec Partners.
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One Response to “How Today’s Paying Emergency Department Patients Are Changing”
August 7, 2016
Myles Riner MDAlthough Medicaid coverage for patients generates more revenue than uninsured patients, Medicaid patients are more likely to use the ED once they have coverage. You have to also consider how many more provider hours are required to provide these additional services, and Medicaid rarely pays enough in most States to cover these costs. Thus the overall effect on hospital and EP group revenues net of costs may be NEGATIVE, especially in areas where Medicaid coverage is not matched by access to primary and urgent care services for Medicaid patients. We hear lots of stories about revenue increases for hospitals when States increase Medicaid coverage, but very little or nothing about the sufficiency of these revenues when it comes to meeting the increased demand on EP services.