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Hospitals Avoiding Non-Emergency Care

Reducing Emergency Department Workloads and Expenses

[By Staff Writers]

As most Medical Executive-Post readers know, hospitals are under more intense pressure than ever to avoid bad-debt expenses and reduce write-offs. For example, according to one study, total emergency room visits, classified as non-urgent conditions increased from 10 percent 1997 to 14 percent in 2006, according to research by the Center on Studying Health System Change [CSHSC].

Collection Strategies

One collection strategy is to pro-actively ask for payment up-front, or vigorously pursue claims after the bill has been incurred; using either in-house or outsourced collection agencies. Another novel idea is to auction-off patient ARs, as previously mentioned here:

Link: https://healthcarefinancials.wordpress.com/2008/06/09/hospitals-auction-debt/

It’s Called Triage

But, yet another “new-wave” method for Emergency Departments [EDs] is to determine [remember the concept of triage] that patient’s who don’t need costly care, don’t receive it. That’s why, in part, a growing number of hospitals are working to redirect non-urgent care patients away from costly ED care and over to outpatient clinics.

This concept is a derivative of the “onsite / remote step-down units” proposed by our managing-editor Hope Rachel Hetico; RN, MHA, CMP™ several years ago.

Clinical Care Strategies

To address such issues, hospitals are adopting these and other strategies targeting non-urgent patients coming to the ED.

For example, according to FierceHealthFinance, some have shifted nurse practitioners to screen patients, and to set appointments with outpatient caregivers, and primary care doctors for those who need it.

When patients with non-urgent issues return repeatedly, such nurses can help the ED create care plans that set the patient up with medical homes.

In some cases this can change ED patient inflow dramatically; one Miami ED for example, referred an average of 50 patients a day to clinics over 18 months, according to the report.


Of course, we are long-time proponents of the nurse practitioner, and DNP, models.

Stemming the Primary Care Exodus with DNPs.



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6 Responses

  1. New EMTALA On-Call Policies

    Did you know that the Bush administration just proposed letting hospitals with emergency departments cover their physician on-call responsibilities through community plans that coordinate resources of multiple facilities?

    In a Medicare hospital payment rule released in late April, the Centers for Medicare & Medicaid Services [CMS] proposed clarifying its on-call policies under the Emergency Medical Treatment and Labor Act [EMTLA], which is aimed at preventing EDs from “dumping” uninsured or Medicaid patients at public hospitals; according to the American Medical News.

    If CMS finalizes the proposal, a group of hospitals in a particular region would have the option of designating one of the facilities as the on-call site for a specific time period, for a specific service, or both. Individual hospitals with EDs still would be required to give each emergency patient a medical screening examination and to have a plan for how to proceed if a needed on-call physician was not available.

    -Hope Hetico; RN, MHA, CMP™
    Medical Executive-Post


  2. Un-Insured ER Patients?

    According to Tracey Walker, writing in the Nov 4th edition of Managed Healthcare News, despite common perceptions that uninsured adults are primarily responsible for overcrowding in emergency rooms (ERs) – or are using ERs to seek treatment for minor illnesses – a recent study by Robert Wood Johnson Foundation Clinical Scholar Manya Newton MD – of the University of Michigan – finds that this opinion lacks evidence.



  3. Public Health Series: Crowding vs. Access – Effects of Upfront Emergency Room Payments

    According to Robert James Cimasi MHA, AVA, ASA, CMP – in 2011 – approximately 80,000 prospective patients chose to leave emergency rooms without receiving treatment due to a new hospital cost-cutting policy that distinguishes and charges non-emergency patients who utilize emergency departments in lieu of routine healthcare providers, thereby potentially limiting access to healthcare for many individuals.

    Ann Miller RN MHA


  4. Filling a Gap in ER Care

    Patients who show up with complaints that can’t be quickly or conclusively diagnosed are more frequently being shifted to observation units near ERs.




  5. Why Privately Insured Seek Care in Emergency Departments

    Patients’ perception of the severity of their medical problem and who they first contact for help or advice are the factors most associated with whether they seek emergency care, according to a Center for Studying Health System Change (HSC) study based on the National Institute for Health Care Reform’s (NIHCR) 2012 Autoworker Health Care Survey.

    Nearly a quarter of respondents (23%) reported having an urgent medical problem in the three months before the survey, and almost half (44%) of those with an urgent condition ultimately went to an emergency department for treatment. Of people with an urgent problem, nearly half first contacted their regular source of care-typically a primary care clinician-and those patients were less likely to go to emergency departments, the study found.

    Source: Center for Studying Health System Change (HSC)


  6. Program for High-ED Utilizers Decreased ED Visits By 27.9%
    Health Affairs recently published a new study on the effects of a community-based program called Bridges to Care (B2C) on high utilizers of the emergency department. Here are some key findings from the report:
    • 6 months after the B2C intervention, participants had 27.9% fewer ED visits.
    • Primary care visits increased 114% for B2C participants.
    • For patients with mental health comorbitities, ED visits reduced 29.7%.
    • Those with mental health comorbitities had 30% fewer hospitalizations.
    • Patients with mental health comorbitities had 114% more primary care visits. 
    Source: Health Affairs, October 2017


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