The trusted source for
healthcare information and
How will payers view low-acuity ED patients?
While faster throughput makes financial sense for EDs today, there is some concern that that the type of lower-acuity patient most influenced by advertised wait times may not make financial sense in the future because payers may not be willing to pay for non-emergency care in such an expensive setting, explains David Cummings, RN, CEN, corporate administrator, patient care operations, at Methodist Le Bonheur Healthcare in Memphis, TN.
"Certainly we pride ourselves on a 30-minute guarantee to see a doctor, nurse practitioner, or physicians assistant, but does that, in effect, further clog our ED because we are so efficient that patients would rather come here than go to an urgent care center?" queries Cummings. "That is a struggle we are having, or will be having shortly if payers say they're not going to pay for this."
To get around this dilemma, Cummings suspects that health systems may need to consider solutions like what Methodist Le Bonheur has done with the ED at its children's hospital. "We have an urgent care center just adjacent to the ED, and it sees about 85 patients per day," he says, noting that those patients get billed at the urgent care rate, not the ED rate. "That is something we will probably have to consider at our adult hospitals. Many hospitals are going to have to look at alternate forms of care for those lower-acuity patients who could just as easily be cared for in their PCP's [primary care physician] office."