2010: The Tipping Point for Emergency Medicine

Hello, Im Randy Howell, Chief Administrative Officer for ECI.
2010 will be a watershed year for ECI and emergency medicine providers across the country. This year, more patients will present to ECI affiliated Emergency Departments with Medicaid coverage than with employer-sponsored or private health insurance.
As usual, Emergency Medicine is on the front lines of emerging trends in healthcare. Emergency medicine providers stand willing to help everyone and anyone that is in need, even as politicians and the media seek to criticize the cost of care.
Over the past three years, the financial class mix for all ECI-affiliated emergency departments has
dramatically changed.

The decreasing insured section includes patients with HMOs, PPOs, Auto Liability, Blue Shield, Workmens comp, and all other types of private insurance. Medicare is the federally funded program and Medicaid is the combined federal and state-funded partnership. The final section of the graph indicates the increasing number of self-pay patients.
If these trends continue in a simple linear fashion, in 2010, Medicaid patients will be the largest financial class presenting in Emergency Departments. This reflects a broader movement from private to public health insurance. The US government estimates that in 2010, for the first time ever, more than 50% of those with health insurance will be publicly insured. This trend is due to an aging population, the rise in Medicaid enrollment, overall job loss and the loss of private insurance.

Despite what is said by politicians and the media, you know that Emergency Medicine is not the source of all evil. In fact, if there were more patients in the emergency department, it would actually reduce the average costs. As Dr. Robert Williams, ECIs co-founder and current Chairman observed in his landmark study for The New England Journal of Medicine, the real COST of treating another patient is extremely low. In simple economic terms, because emergency departments have high fixed costs and require coverage 24 hours a day, seven days a week, additional patients cost very little.

So what if there are more Medicaid patients in 2010? What are the consequences?
•Obviously, Emergency Departments will face continued financial pressures.
•If all other factors remain the same—which they rarely do—the average-revenue generated per patient will decrease.
•Financial stresses will arise as insolvent state Medicaid plans struggle and limit coverage. These struggles will soon reduce eligibility and payments. With the American Reinvestment and Recovery Act of 2009, the Feds provided stopgap financing for a number of these states—this financing will expire in 2010.
•ED volumes will increase as the lower acuity Medicaid patients present for primary care and urgent care needs and as private physician groups refuse to see them.

There are ways that we address these challenges:
•We can prepare for higher patient volumes by utilizing fast-tracks, mid-level coverage and quick registration and triage protocols.
•We can make process improvements that will help us treat higher volumes with the same resources. These improvements will also help maintain quality and retain the loyalty of the paying patient population.
•We can also do things like publish wait times in real time on billboards or the internet. This could allow us to equilibrate our resources
•Due to continued cost shifting, many ED groups will need to request funding from hospitals. Managed care plans will also receive more requests for reimbursement improvement from providers.

As we stand at the tipping point for emergency medicine, ECI remains committed to helping our client partners effectively manage the evolving financial landscape for healthcare.

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