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Care of uninsured putting EDs at risk
Increasing numbers of uninsured patients and limited Medicaid reimbursements are placing a third of the nation’s emergency departments (EDs) at risk of closing or eliminating emergency services, according to a recent report from the Centers for Disease Control and Prevention. The report, which can be found at www.cdc.gov, identifies more than one-third (36%) of the EDs in the study as carrying a high safety-net burden, which is defined as serving at least 30% Medicaid-eligible patients, 30% uninsured, or having a total of 40% of patients falling into either category.
The analysis also finds that public funding does not offset this high safety-net burden. "Inadequate public and private funding for emergency services is threatening the ability of emergency departments to provide care to all regardless of ability to pay and has already contributed to the closure of more than 1,000 emergency departments across the country," said J. Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP).
In an ACEP report regarding the uninsured, meanwhile, nearly three-quarters of emergency physicians say the number of uninsured patients they treat has increased in the past year, and eight in 10 expect the number to grow higher in the coming year. Nearly three in five emergency physicians surveyed ranked providing health coverage to all Americans the nation’s most important health care goal, the survey found. A summary of the findings can be found at www.covertheuninsuredweek.org.
Uninsured impact hospitals’ bad debt
Growth in the number of uninsured and underinsured Americans is contributing to rising bad-debt expense for hospitals, and the situation likely is to continue, according to a recent report by Moody’s Investors Service. "Lack of insurance as well as higher copays are leading more people to avoid hospitals unless absolutely necessary," the rating agency said. "When they eventually do have to be hospitalized, they require more care and incur higher costs than they would have otherwise."
The trend was cited in a new Moody’s report on the credit outlook for investor-owned health care companies. The agency said both for-profit and not-for-profit hospitals are experiencing the rise in bad debt expenses, which could lead to lower cash flow from operations and credit ratings.
An analysis by researchers with the Commonwealth Fund, meanwhile, indicates that adults under 30 comprise 30% of the nonelderly uninsured. Young adults ages 19-29 comprise just 17% of the population, but 30% of the under-65 uninsured, the study found. That report, which can be found at www.cmwf.org, says that nearly two in five college graduates and one-half of high school graduates who do not attend college will endure a period without health insurance in the first year after graduation.
The researchers say policy-makers could extend coverage to more uninsured young adults by extending eligibility for private family coverage to age 23, and ensuring that colleges and universities require and offer coverage to their students. The study notes that young adults are a relatively low-cost population to insure, and that keeping them in insurance pools may lower the average costs of group coverage.
Get help on-line for move to EMR
The Foundation for eHealth Initiative has launched an on-line repository of information on health information exchange designed to help health care organizations moving from paper-based record keeping to electronic medical records. The Community Learning Network, as it is called, includes articles and community profiles addressing the financial, clinical, and legal aspects of on-line health information exchange and the adoption of electronic-based records. The target audience includes hospitals, clinicians, payers, and other health care organizations.
The foundation is a council of health care leaders with the stated purpose of improving the quality, safety and efficiency of health care through information and information technology. The learning network can be found at http://ccbh.ehealthinitiative.org/.
Tool helps evaluate disaster drill planning
A tool to help hospitals evaluate their disaster training drills is available free to hospitals from the federal Health and Human Services Department’s Agency for Healthcare Research and Quality (AHRQ). The tool, developed by the Evidence-Based Practice Center at Johns Hopkins University, helps hospitals identify their strengths and weaknesses during a disaster drill and improve their ability to meet required emergency management plans. Areas assessed include pre-drill planning, incident command, decontamination, triage, and treatment. The tool also includes checklists to help hospitals tailor drills to specific health threats, such as biological or radiation incidents, and a spreadsheet to track and compare drill performance among hospital units or hospitals.
The resource, Evaluation of Hospital Disaster Drills: A Module-Based Approach, is available from the agency as a notebook with accompanying CD-ROM. Call (800) 358-9295 and reference AHRQ Publication No. 04-0032. It also can be downloaded on-line at www.ahrq.gov/research/hospdrills/hospdrill.htm.