Diagnosis, Treatment of Common Outpatient Disorder Adds $238 Million a Year in ER Costs

Released: 5/3/2013 8:35 AM EDT Embargo expired: 5/4/2013 6:30 PM EDT Source Newsroom: Henry Ford Health System
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Newswise SAN DIEGO A relatively common urinary tract disorder that can usually be managed in an outpatient setting is adding an estimated $238 million a year to the cost of emergency room visits in the U.S., according to two new studies from Henry Ford Hospital in Detroit. Hematuria, or blood in the urine, adds a considerable and substantial economic burden on already strained hospital emergency departments, says Khurshid R. Ghani, M.D., of Henry Fords Vattikuti Urology Institute and lead author of the studies. Our findings suggest that hematuria ED visits could be used as a measurable indicator for the quality and type of care in Accountable Care Organizations, Dr. Ghani adds, referring to the health care networks included in the Affordable Care Act, which are intended to reduce costs while linking reimbursement to the quality of care for Medicare patients. Results will be presented May 4 and 6 at the annual meeting of the American Urological Association in San Diego. The studies set out to determine how often hematuria was the primary reason for emergency room visits, how much they cost and what part of that cost involves imaging radiography, ultrasound, CT and MRI scanning and other costly diagnostic tests. Drawing on data from the Nationwide Emergency Department Sample, which contains as many as 30 million records for ED visits to more than 950 U.S. hospitals, the researchers identified 718,914 patient visits from the start of 2006 through the end of 2009 in which hematuria was the primary diagnosis. Among these, 94,978 patients or 13.2 percent underwent an imaging procedure while in the emergency room. The researchers also found that the incidence of imaging for hematuria during the four-year study period rose from 6.56 to 9.39 per 100,000 person years. Further, Dr. Ghani and his colleagues assembled all reimbursement claims for diagnostic imaging related to those visits. They found that emergency department costs for hematuria patients, adjusted for inflation, were estimated at more than $237 million a year. The median charge without diagnostic imaging was $1,138 compared to $4,300 with imaging. Imaging alone was associated with an increase in ED charges of more than $75 million per year, Dr. Ghani says. The researchers also learned that patients were less likely to undergo imaging if they were seen at hospitals outside of metropolitan areas and at hospitals in the Midwest, and if they were covered by Medicaid and Medicare rather than private health insurance. Noting that the Henry Ford study of imaging incidence and costs in hospital emergency departments is a first, Dr. Ghani says, The economic burden is substantial and a cause for concern. Hematuria constitutes a considerable burden on economic resources in the E D, and it will require concerted efforts by all stakeholders to reduce both the use of imaging in diagnosing the disorder in that setting, and the costs associated with it.

Small Pay Increases for Outpatient Departments, ASCs in 2013

By: MARY ELLEN SCHNEIDER, IMNG Medical News

Medicare officials are proposing small payment increases for hospital outpatient departments and ambulatory surgical centers for next year. Under a proposed rule issued on July 6, the Centers for Medicare and Medicaid Services announced that hospital outpatient departments would receive a 2.1% increase, and ambulatory surgical centers (ASCs) would see a 1.3% pay bump. The proposed payment rates would apply to outpatient departments at more than 4,000 hospitals and at about 5,000 ASCs that participate in the Medicare program. The CMS estimates that because of these new payment rates and other policy changes, the Medicare program will spend about $48.1 billion on payments to hospital outpatient departments and another $4.1 billion in payments to ASCs. The proposed rule, which revises the Medicare hospital outpatient prospective payment system and the Medicare ASC payment system, will be published in the Federal Register on July 30. The CMS will accept public comment until Sept. 4. The agency said it plans to release its final rule by Nov. 1. The proposed rule also makes several changes aimed at improving the beneficiary complaint review conducted by Quality Improvement Organizations (QIOs). These organizations exist in all states and territories, and are charged with investigating beneficiary complaints related to the quality of care received from Medicare providers. Under the proposal, the CMS would create a new review process called "immediate advocacy" to investigate oral complaints quickly. This is a significant departure from the previous complaint resolution process, which required beneficiaries to submit written complaints and often took up to 150 days to complete. In the new process, the CMS wrote that through immediate advocacy, some complaints could be resolved on the same day. It would be the ideal process for complaints related to delays in obtaining medical equipment, such as wheelchairs. The immediate advocacy process would be good for providers, the CMS said, because it would reduce the burden of a lengthy review process. The CMS has already been trying the process out, and so far it has been positively received by beneficiaries and providers, they wrote in the proposed rule.