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I’m very torn about healthcare reform. As a business owner smack dab at the epicenter of the effects of healthcare reform, it’s a very timely boon to our business. As a taxpayer, although I think a lot of the reforms are necessary, I’m very skeptical about how we go about implementing and paying for it. And in many ways, I think so much more could have been done.
Good for business, but good for patients?
For Picis, healthcare reform and its companion legislation, the ARRA HITECH stimulus money, are going to spur tremendous growth opportunities. Today, the 32 million people that will soon be insured will end up going to the hospital emergency room for care under the EMTALA law (where hospitals aren’t allowed to turn away ER patients). The only problem is the hospital ends up footing the bill, putting pressure on their margins and reducing their ability to invest capital in IT and other systems. After covering 4 million more lives here in Massachusetts, we actually saw ER visits go up by 7 percent. Why? We didn’t add any more primary care doctors, and these newly insured patients swelled the offices of the existing general practitioner population to the point where 56 percent are no longer taking new patients. So where do these patient go? You guessed it – back to the ER, but for an entirely different reason. They’re not going to the hospital to get the only free care they can get – they’ve now got insurance – they’re going because they can’t find a doctor to see them in the ambulatory setting.
One of the most important issues this year for emergency medicine physicians — audits — seems to be slipping by without a lot of notice. How is cost containment going to impact emergency physicians? Well, it could put us “up on a RAC,” for starters.
Recovery Audit Contractor (RAC) programs that examine physician documentation for signs that an admission was not justified have “corrected” $1.03 billion in “improper payments” by Medicare in Florida, California and New York. In other words, if you (the physician) have not documented how sick the patient is and how long you intend to treat them, your hospital could be denied the admission, have to pay fines and a third-party auditor could be reimbursed a percentage for finding the problem.
