News Briefs: Medicare to pay for ED observation

The long-awaited proposed rule on payment for the emergency department (ED) observation services from the Centers for Medicare & Medicaid Services (CMS) has been published, and you probably will be pleasantly surprised at the outcome. "The [CMS] ruling was in our favor," announces Sandra Sieck, RN, director of cardiovascular development at Providence Hospital in Mobile, AL. "Now we can provide better patient care without financial restraints."

The rule proposes to create a new payment group for observation services for patients with chest pain, asthma, and congestive heart failure. The proposed ruling was published in the Aug. 24, 2001, Federal Register. The final rule became effective Jan. 1, 2002.

Raymond D. Bahr, MD, FACP, FACC, president of the Baltimore-based Society for Chest Pain Centers and Providers, reports that the group got CMS’s attention by building a consensus among a dozen groups, including the Irving, TX-based American College of Emergency Physicians. "At an early stage, we were able to engage [CMS] administrators who wrote the previous outpatient regulation," says Bahr, who is also medical director of The Paul Dudley White Coronary Care System at St. Agnes HealthCare, also in Baltimore. "We made them aware of the medical advances which have taken place in the care of patients with acute coronary syndrome."

He gives the example of current chest pain evaluation in the ED, which includes an "attack" approach for patients with acute myocardial infarction (AMI), but also an observation period to assess other patients. "This approach provided evidence for reduction in a number of missed AMI patients being sent home, as well as a significant reduction in the number of inappropriate admissions to the hospital," he adds.

This system of risk stratification was included in the new American College of Cardiology/ American Heart Association guidelines for patients being evaluated with unstable angina and non-ST- segment elevation myocardial infarction, he notes.1 To use this approach effectively, EDs needed to have appropriate reimbursement, Bahr urges.

Although observation centers have been declining due to lack of reimbursement, he expects that to change. "With the proper reimbursement, we expect to see a renewed interest in observation services that will result in exponential growth of chest pain centers." Bahr predicts that the number of chest pain centers, currently 1,300, will double over the next year or two.


  1. ACC/AHA Guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive summary and recommendations. J Am Coll Cardiol 2000; 36:970-1,062.