Hospitals have been grappling with ways to redirect these patients from their glutted EDs to physicians’ offices, but often they have little success, says Jay Mason, CEO and founder of MyHealthDIRECT, an ED software company. Here Mr. Mason cites six problems in trying to redirect ED patients to physicians’ offices and suggests how to fix them.
1. Finding clinics that would want to treat ED patients. “Many hospital executives assume that local physicians wouldn’t want patients from an ED,” Mr. Mason says. “Actually, there are a lot of physicians who would be happy to treat a few low-paying patients. These physicians view it as a community service.” Federally qualified health centers and rural clinics, in particular, are open to the idea of treating Medicaid patients because they get higher Medicaid reimbursements than private physicians, though usually not enough to cover costs.
2. Many physicians want to limit numbers of ED patients. While FQHCs welcome any patient who comes through their doors, many private physicians can choose which patients to see. Mr. Mason thinks they would accept some ED patients if they could control just how many they receive.
“The independent physician says, ‘I’m willing to treat my fair share but I don’t want to be dumped on,’ ” Mr. Mason says. To meet this need, hospitals should agree to specific numbers of referrals going to each physician. ED personnel could then record assignments to each physician on spreadsheets or use more sophisticated software that is quick and easy to use.
3. Meeting EMTALA requirements. Many hospitals that send their ED patients to outside physicians have fallen under federal enforcement scrutiny for possibly violating the Emergency Medical Treatment and Active Labor Act. EMTALA requires EDs to stabilize all patients who walk through their doors. Mr. Mason says there have been several high-profile patient-dumping cases. Enforcement agencies often scrutinize EDs requiring patients to leave the premises after the appointment has been made. To avoid EMTALA scrutiny, he says personnel should document that the patient agreed to the appointment and that the appointment was made. Then patients should be allowed to stay as long as they wish.
4. Booking appointments drains ED staff time. “Emergency department staff can be on the phone 15 or 20 minutes to set up an appointment at a clinic,” Mr. Mason says. The answer? “Split up the task of getting patients scheduled,” he says. The responsibility of making appointments should be spread across the staff, he says. For example, triage nurses can schedule appointments when the patient does not need to be treated. And when the patient is treated and needs to be seen again for appointments such as cast-removal, the discharge planner could make the appointment.
5. Many booked patients are no-shows. Even when ED personnel help schedule an appointment, typically only about 5 percent of the patients show up at the physician’s office for the appointment. To guard against no-shows, ED personnel should have a face-to-face discussion with the patient. “You need to be aware of patients’ needs,” Mr. Mason says. “Make things easy for them.” Personnel should make sure the patient could easily get to the physician’s office for the appointment, talk to someone who knows their language and not face conditions that conflict with religious or ethnic beliefs.
6. Difficulties booking after hours. Many patients come to the ED after hours, precisely when many private physicians’ offices are closed and cannot take appointments. There is now software, including Mr. Mason’s own product, that allows EDs to book after-hours appointments by logging onto a secure website, opening an up-to-date appointment book for each physician’s office and making an appointment. These online sites also reduce ED staff time in making an appointment.
Learn more about MyHealthDIRECT.
