The emergency department as a pathway to admission for poor and high-cost patients

Article Abstract:

In addition to caring for patients with sudden illnesses or trauma, emergency departments provide primary care for other groups of individuals as well. For both trauma and primary care patients, the emergency room leads to admission to the hospital, with important reimbursement and public policy implications. During the past decade, the number of poor and uninsured patients admitted through emergency departments increased disproportionately. These patients are usually sicker and cost more to care for than patients with similar diagnoses who are admitted by their physicians. To determine whether emergency room admissions differ from other admissions, and to evaluate the resulting cost implications, 20,089 patients at 5 different hospitals were interviewed over a 6-month period. DRGSCALE, a system developed by SysteMetrics Inc., was used to judge severity of illness. At all five hospitals, patients admitted through the emergency department required substantially more resources than nonemergency patients, even after adjusting for age, diagnosis related group (DRG), severity of illness, and income. Uninsured persons were 3.1 times more likely, on average, to be admitted to the hospital through the emergency department than those with private health insurance. Single, nonwhite, lower-income patients were more likely to be admitted through the emergency department, and to require more care; however, hospital reimbursement for their care is based on the national Medicare DRG system of fixed payments based only on the admitting diagnosis. For this reason, hospitals with high occupancy rates are likely to limit emergency care, thus limiting access to medical care for the poor and the elderly. DRGSCALE was a strong predictor of length of hospital stay, and is an important addition to the DRG in predicting a patient's use of medical resources. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Emergency medical services, Hospital emergency services, Medicare

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Do the poor cost more? A multihospital study of patients' socioeconomic status and use of hospital resources

Article Abstract:

The concept of the diagnosis-related group (DRG) originated to restrain the growth of medical costs by placing limits on the payments made for diseases within a particular group. Although the method seems to be having the desired effect, at least for Medicare payments, there are indications that undesired effects are taking place as well. There has been a suggestion that hospitals are reticent to provide care for those patients likely to exceed average costs, especially for those of lower socioeconomic status. If the average costs for patients of lower socioeconomic status are indeed higher, then payments based on DRGs will be providing incentives to restrict access to health care. To determine if different patients groups do incur different costs for comparable illnesses, a total of 16,908 patients at five Massachusetts hospitals were interviewed. Only obstetric and psychiatric patients were excluded from the study. On the basis of the interviews, which revealed the patients' incomes, occupations, and education, patients were divided into three social strata. When compared by equivalent age, severity of illness, and DRG, the lowest strata incurred higher charges and spent more time in the hospital than did those in higher strata. The differences were up to 21 percent for length of stay and 13 percent for charges incurred. These results require careful consideration. For hospitals treating substantial numbers of poorer individuals, the absence of supplementary payments for the care of patients requiring more services may put disproportional pressure on these hospitals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Health services administration, Diagnosis related groups

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Error reporting and disclosure systems: Views from hospital leaders

Article Abstract:

The opinions and experiences of hospital leaders with state reporting systems are examined. Most of them expressed substantial concerns about the impact of mandatory, nonconfidential reporting systems on hospital internal reporting, lawsuits, and overall patient safety.

United States, Legal issues & crime, Government regulation (cont), General services, Government regulation, Hospitals, Management dynamics, Legal/Government Regulation, Management, Safety and security measures, Laws, regulations and rules, Patients, Company business management

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