Hospital closings and patient visits
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Hospital Closings and Patient Visits. Prepared by: Brian T. Kloss, DO, JD, PA-C SUNY Upstate Medical University Department of Emergency Medicine. The Issue. Increase in the number of patients in the ED Significant reduction in the number of EDs Closure of 200,000 inpatient beds

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Hospital Closings and Patient Visits

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Hospital closings and patient visits

Hospital Closings and Patient Visits

Prepared by:

Brian T. Kloss, DO, JD, PA-C

SUNY Upstate Medical University

Department of Emergency Medicine


The issue

The Issue

  • Increase in the number of patients in the ED

  • Significant reduction in the number of EDs

  • Closure of 200,000 inpatient beds

  • Difficulty in reimbursement for hospitals and physicians

  • Overcrowding and Boarding have grown as a result


The vicious cycle

The Vicious Cycle


Ed visits on the rise since 1973

ED Visits on the Rise Since 1973


Emergency departments on the decline since 1995

Emergency Departments on the Decline Since 1995


American hospital association facts

American Hospital Association Facts*

  • Annual ED visits from 1990 to 2000 increased 16% from 92M to 106.9M

  • Approximately 500 hospital closures during the same time

  • From 1997-2000 alone, 797 Emergency Departments have closed

*http://www.acep.org/pressroom.aspx?id=25214. Accessed December 2, 2009.


Who pays to keep the ed open

Who Pays to Keep the ED Open?

CDC 2002 Data


What are the root causes

What are the Root Causes?

  • Demand for services increased

  • Reimbursement rates under threat

    • Never occur, Never pay events by CMS

    • Disconnect between CMS fees and cost of care

    • Private insurances use CMS fees as benchmark

  • Currently, both Medicare and Medicaid pay less than the cost of care provided to beneficiaries.*

* AHA Fact Sheet: The Fragile State of Hospital Finances: www.aha.org/aha/content/2005/pdf/05fragilehosps.pdf . Accessed December 2, 2009.


Root causes continued

Root Causes Continued

  • Pursuing reimbursement from insurers adds to hospital operating expenses and strains hospital budgets.

  • EMTALA created a federal mandate that requires EDs to provide medical treatment and stabilization without compensation.*

* http://www.kaisernetwork.org/health_cast/uploaded_files/Emtala.pdf. Accessed December 2, 2009


Root causes continued1

Root Causes Continued

  • Outpatient surgical centers have reduced hospital income

    • Owner-providers to treat select patients

    • Lower-paying patients are cared for at the hospital.

  • Urgent Care Clinics causing similar problems

    • Insured are able to get care

    • Uninsured referred on to the hospital


Proposed solutions

Proposed Solutions

  • Improved systems of care to streamline care and cut costs

  • Stabilize and improve reimbursement models

  • Address the unfunded EMTALA mandate

  • Reform Disproportionate Share Hospital (DSH) payments


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