Colorado pays hospitals to CLOSE their freestanding ERs.

[RustedFox]

Colorado offers to pay hospitals to close free-standing ERs - Sentinel Colorado

"We don't want hospitals to have stand-alone ERs, so we are willing to pay to shut them down," said Kim Bimestefer, executive director of Colorado's Department of Health Care Policy & Financing, which oversees the state's Medicaid program

sentinelcolorado.com

If this doesn't say for certain that what was once a truly great field of medicine is now nothing but a fight over who can steal more money, then I don't know what does.

To EVERY medical student who says "EM is the only thing I can see myself doing"....

.... see yourself doing something else. For your own good.

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[Brigade4Radiant]

They want psychiatric facilities now. But I doubt a lot of places will close their freestanding ED.

 

[RustedFox]

"We need improved access to care"

(Opens more ERs)

"You improved access to the wrong care. We need it cheaper. Here; take the money to close it down and make it cheaper."

 

[pkwraith]

If you want to stop your Medicaid population from abusing the ED for their primary care or BS, start charging a copay for ED visit. Not all the other nonsense such as closing down FSEDs when the same patients will more than happy to go to a hospital for the same Medicaid abuse.

 

[sloh]

“Money talks,” Bimestefer said

It certainly does.

 

[GeneralVeers]

If you want to stop your Medicaid population from abusing the ED for their primary care or BS, start charging a copay for ED visit. Not all the other nonsense such as closing down FSEDs when the same patients will more than happy to go to a hospital for the same Medicaid abuse.

The problem is that these people have no money....despite having a car, the latest iphone and nice jewelry. The way to stop Medicaid abuse is to have a mandatory medical screening exam. If they come in for dental pain, you do the mandatory MSE, after which if there's no emergency they have to pay the copay or get kicked out. Failure to document the MSE would result in non-payment to hospitals and doctors.

I'd kick out nearly all of them if I could.

 

[RustedFox]

On top of what Veers said.

The bit in the article... Where in order to qualify to get paid, the hospitals must pick from a list of goals to meet... and the goals are like "screen for housing insecurity", etc.


It's a HOSPITAL, not a social services dept or charity. That's not what hospitals do. That's certainly not what ERs do.

It has become about everything BUT the actual medicine itself.

 

[Brigade4Radiant]

On top of what Veers said.

The bit in the article... Where in order to qualify to get paid, the hospitals must pick from a list of goals to meet... and the goals are like "screen for housing insecurity", etc.


It's a HOSPITAL, not a social services dept or charity. That's not what hospitals do. That's certainly not what ERs do.

It has become about everything BUT the actual medicine itself.

It doesn’t matter. Now the government will try to make things harder to pay healthcare providers. The ER will be linked to social issues as well.

 

[CajunMedic]

The problem is that these people have no money....despite having a car, the latest iphone and nice jewelry. The way to stop Medicaid abuse is to have a mandatory medical screening exam. If they come in for dental pain, you do the mandatory MSE, after which if there's no emergency they have to pay the copay or get kicked out. Failure to document the MSE would result in non-payment to hospitals and doctors.

I'd kick out nearly all of them if I could.

Way back when I was still riding the band-aid wagon in Arkansas, they had started doing that. Our local ED had "Room 0". You got your MSE, and either co-pay or GTFO. Don't think they kept it. I would love to be able to do that for the pregnancy tests, family plan sniffles, etc.

 

[hundreddaysoff]

The problem is that these people have no money....despite having a car, the latest iphone and nice jewelry. The way to stop Medicaid abuse is to have a mandatory medical screening exam. If they come in for dental pain, you do the mandatory MSE, after which if there's no emergency they have to pay the copay or get kicked out. Failure to document the MSE would result in non-payment to hospitals and doctors.

I'd kick out nearly all of them if I could.

One thing I don't understand: Why don't TH/Envision/other CMGs support this mandatory MSE idea if they aren't making any money off Medicaid patients? Back when I worked for TH/HCA, my buddy tried this on various obnoxious patients and seekers, but almost got canned got talked to by mgmt real good for it without a good explanation.

Explanations I can think of:

(1) the CMGs (or, eg, HCA via facility fee) *are* in fact making just a little money off these patients if they get a room and a big workup;

(2) relatedly, it's ultimately more profitable somehow to have big ER census numbers moving through rooms even if most individual Medicaiders fail to turn a profit;

or

(3) they've learned that it's bad PR because disgruntled proles say/post stuff that's not true but sticky like "X hospital suXXorz they wouldnt even give me a room DEY TERK MAH EMTALA!!!1 "

 

[skougess]

One thing I don't understand: Why don't TH/Envision/other CMGs support this mandatory MSE idea if they aren't making any money off Medicaid patients? Back when I worked for TH/HCA, my buddy tried this on various obnoxious patients and seekers, but almost got canned for it without a good explanation.

Explanations I can think of:

(1) the CMGs (or, eg, HCA via facility fee) *are* in fact making just a little money off these patients if they get a room and a big workup;

(2) relatedly, it's ultimately more profitable somehow to have big ER census numbers moving through rooms even if most individual Medicaiders fail to turn a profit;

or

(3) they've learned that it's bad PR because disgruntled proles say/post stuff that's not true but sticky like "X hospital suXXorz they wouldnt even give me a room DEY TERK MAH EMTALA!!!1 "

Is the MSE room actually saving any money? By the time you do the exam and figure out sick vs not sick and write a note (you’re still gonna have to write one for MSE), you might as well just send it in to medicaid for the few pennies it’s worth.

 

[hundreddaysoff]

Is the MSE room actually saving any money? By the time you do the exam and figure out sick vs not sick and write a note (you’re still gonna have to write one for MSE), you might as well just send it in to medicaid for the few pennies it’s worth.

Depending on your ED setup, MSEing certainly saves time and rooms. And therefore during a rush, MSEing appropriately will reduce LWBS (now tracked by the feds yay!) and more importantly free up an RN and room for someone who really needs them.

Eg, at night my current ER only has 6 active beds and often only 3--4 RNs (charge, 2 on rooms, +/- 1 dedicated triage). On the plus side, it's cozy enough that I one-and-done basically *every* patient deserving of an MSE from triage. More fun both for me and the RNs.

Don't get me wrong, my new hospital has 10 times fewer resources than my old HCA hospital, but the process of my job is so much nicer. I have... autonomy, kind of.

 

[turkeyjerky]

Back in the day when 25% of ED patients didn't have insurance, the MSE was a money-saver. Now, with most of these people transitioned to medicaid, it's a money-loser. IL medicaid pays $32 for a 99283. That 4fer of sniffles? Cash money man!

The incremental costs of most of these visits are nil, so why would they want to dissuade them?

 

[emergentmd]

Everyone knows these MSE rooms and go find a clinic will never work. We are a Woke and entitled society that never will take fault. How the Hell can a doc o a MSE, tell someone to go to the UC/PCP? Are we supposed to do this only for Medicaid/uninsured b/c you can't treat insured/uninsured classes differently and hospitals/CMGS would kill us if we sent insured pts away for non emergencies. Imagine being the most efficient MSE doc, your sat scores would plummet. Good luck keeping a job. On top of sending a pt away with anxiety who ends up having an MI 2 wks later now suing you for misdiagnosis.

This MSE crap has been talked about for decades and will never work out b/c it goes against the business model.

No matter if you are a line doc, own a medical business like a FSER you do not have ultimate control over your practice. So best to make as much $$$ as you can and if things goes universal insurance, you can sit back and watch everything go to Hell.

I am at FIRE right now and going to ride this until the wheels fall off.

This closing down FSERs are just dumb. These pts are just going to flood back into the hospital ERs. They know the game and know they can get everything done in a one shop model at a hospital in 2-3 hrs. Medicaid pts don't pay anything anyhow, so why do they care.

 

[hundreddaysoff]

Back in the day when 25% of ED patients didn't have insurance, the MSE was a money-saver. Now, with most of these people transitioned to medicaid, it's a money-loser. IL medicaid pays $32 for a 99283. That 4fer of sniffles? Cash money man!

The incremental costs of most of these visits are nil, so why would they want to dissuade them?

OK, I suspected $omething like thi$ wa$ happening.

The stunted mutant angel on my shoulder now whispers hoarsely into my ear: How is this different from overcoding in many if not most cases?

I guess an OK answer is "Stop worrying, that's the coders' job, not yours?"