Emergency department visits are getting more expensive. The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) found that between 2001 and 2010, the proportion of claims for lower reimbursement ED visits decreased while the use of higher-paid codes increased. Unfortunately, the report didn’t examine the cause of the change, but that hasn’t stopped others from speculating. The DOJ has suggested that the use of electronic health records has made it easier for physicians to up-code and inappropriately use more expensive codes. When physicians use EHRs, they select signs and symptoms from an array of check boxes, which the system then uses to arrive at the appropriate code.
The system will alert physicians when more documentation is needed to justify a more severe code. This concurrent review of the physicians’ documentation makes it easier for the physicians to provide additional documentation and use a more complex code. There is concern amongst experts that some facilities have created templates that are designed to facilitate coding encounters at the highest possible level. However, Stephen Pitts, MD, thinks there could be another other, less sinister, reasons for the increase in expensive codes. In short, ED patients are sicker.
Pitts analyzed a sample of Medicare ED discharges from 2001 to 2009. What he found was that the demographics that make up the average Medicare ED patient changed over the decade, most interestingly, the average age of Medicare patients discharged from the ED decreased. In 2006, 38% of Medicare patients discharged from the ED were younger than 65. That may sound like good news, but in fact, patients who are under 65 and on Medicare are typically harder to treat because they are often disabled, poor, or cognitively impaired.
Hospital EDs are also performing more diagnostic tests, such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography. In many cases, ED physicians order such tests to get a more accurate picture of patients who do not have a primary care physician. As the primary care shortage gets worse in the coming years, EDs can expect the trend of sicker patients without a proper medical home to continue.
