we need hospitals to understand our plight
So speaking as someone that now works on the hospital money side, and I say this with respect, this view is somewhat myopic.
The overwhelming concern coming up at the system level for these cuts is on the inpatient side.
We're talking about people with medicaid having protracted sepsis stays, lucrative joint replacement surgeries, liver transplants, etc....some of these things even with medicaid will run bills nearly half a million dollars across the entire episode of care.
The absolute smallest potatoes to worry about is ED revenue for two reasons:
1) Most (not all!) ED's are contracted. Once you contract something out, outside of patient satisfaction/overt safety/throughput issues hospitals don't care what's going on in the ED. The RN's in the department are funded by the hospital not the EM group. The revenue for the docs is simply not their concern, and expecting it to be is like waiting for that ex you really want back to call you ASAP. She gone, she got other **** to worry about.
And I'm not saying I don't disagree. I fully agree with you. But it's definitely not the view I'm hearing. I haven't heard ED revenue come up even once in these discussions.
2) ED revenue is truly, truly small potatoes by comparison to inpatient revenue. Sure, you could do a procedure and bill 99291 and 99292 but if you're putting that much time into the patient, imagine the IP resources utilized over the next 5-6 days.
This wasn't popular in another topic I mentioned this (soapboxing again, apologies) but it's just a fact most critical care time billed in the ED probably is unwarranted. But it's such a small, small amount by comparison to the charges from the rest of the stay that insurance spends their time fighting LOC and DRG issues. Those administrative challenges to us cost them time and money, but if they win they can eek out 5-20k a pop, which is multiples of the ENTIRE ED BILL. So going after CC billing isn't even worth their administrative time, which is why no one from UHC, Humana, Centene, etc even LOOK at CC billing. The future and AI might get involved, but that's a separate discussion way down the road to auto-deny those.
That ramble ties into my main point, which is ED revenue is so small the "plight" of the ED docs isn't even being discussed at the executive level in our large system. Although that's not entirely heartless--what are we to do? We'll quite possibly lose so much money that subsidizing our ED just isn't a realistic choice.
Also ties into my final point, why I left EM. I grew increasingly concerned that the island of revenue is shrinking, and one of the first groups voted off of it is EM.
My best guess for the future when this passes:
Some smaller places close
larger places just take the hit. Everyone complains, nothing changes.
From an ED specific standpoint, revenue has been shrinking and this will just be another hit to revenue. "it's your problem." EM docs in general don't have much of an alternative, so if your pay goes down another 30-50k/year, what will you do? Everywhere you go, it'll be the same unless you move to a rich area with no medicaid patients.
FWIW, I find revenue work highly rewarding. My specific focus is actually FIGHTING medicaid payors. Our problem is they are ALREADY breaking the law and denying payments/downgrading DRG's for no goddam reason. So even though they currently HAVE the funding, they are STILL refusing to pay in many situations. This was already a five-alarm fire BEFORE this bill, which is almost certainly going to be used as an excuse to deny even more care to people who RETAIN medicaid. It's a goddam mess.
I'm trying to lay out facts as best I can from my situation and discussions with my own leadership. If it comes off as callous I apologize, but we've entered a strictly financial discussion and there just aren't a lot of warm feels in the financial aspect of medicine, just accounts.
TLDR: Healthcare is a burning house. Inpatient activity/finances are the children the parents (C-suite) are rushing in to save. EM is the furniture hoping the parents have time to come back in and get saved, but will probably burn with the house.
/ramble
