ED fares well on APC increases

ED managers should be pleased with the proposed increases in ambulatory payment classifications (APCs) for fiscal year 2009, says Dennis Beck, MD, FACEP, CEO of Beacon Medical Services in Denver and chair of the quality and performance committee of the American College of Emergency Physicians (ACEP).

"They are pretty decent for EDs," he says.

For example, while the overall Medicare inflation adjustment was 3%, the APC payment rate for Levels 2, 3, and 4 emergency visits are 3.2% higher than the 2008 rate, according to Beck. The rate for Level 1 visits is 5.6% higher than in the previous year. In addition, there was a 4.8% boost in the critical care APC rate, "which is a good thing," he notes.

The one area where reimbursement will drop involves "Type B" EDs, which refers to facilities that provide emergency level services but are not open 24 hours a day, seven days a week. Currently, Medicare pays for emergency visits to those facilities as nonemergency visits to the outpatient department, but it now has data that show most emergency visits in such facilities are more costly than clinic visits but less costly than emergency visits in "Type A" EDs.

"They will get paid less," says Beck. "For example, the 2008 rate for a Level 4 visit was $212.59, while the proposed rate for 2009 is $156.56."

If these proposed changes go through, he predicts, "That may cause some facilities to consider changes, such as whether it is viable to maintain 'Type B' beds."


For more information on the proposed rule contact:

  • Dennis Beck, MD, FACEP, CEO, Beacon Medical Services, Denver. Phone: (303) 306-7783. E-mail: info@beacon-medical.com. Web: www.beacon-medical.com.
  • Dell M. Conyers, Senior Program Director, National Quality Forum, Washington, DC. Phone: (202) 783-1300. Fax: (202) 783-3434.
  • John Moorhead, MD, Professor of Emergency Medicine, Oregon Health & Science University, Portland. Phone: (503) 494-7551.