Impact of Healthcare Proposals on EM

From the EDPMA Alert:

Medicare and Medicaid: Highlighted below are some of the health care proposals contained in the budget outline that could impact emergency physicians:

Physician Payments.  The budget “supports” comprehensive (albeit fiscally responsible) reforms to the physician payment formula that reward high-quality care, not volume.  The budget outline does not go into further detail, or cost, regarding physician payment reform.  However, it is important to note how the budget outline treats the Medicare physician payment issue.  As you know, physicians face a 20% reduction under the fee schedule in 2010 and additional years of negative updates.  The budget outline assumes that this reduction will be averted by Congress (as has occurred several times in previous years).  Typically, a president’s budget incorporates current law when determining the financial state of affairs.  However, President Obama has chosen to incorporate current “policy,” rather than current law.  Current policy, under Obama’s budget, is that Congress will fix the Medicare physician fee schedule and avert the 20% cut.  If Congress adopts the budget’s approach, legislating an overhaul of the Medicare physician fee schedule (as opposed to annual band-aids) will no longer be prohibitively expensive for Congress to enact.

Medicaid Payments.  The use of National Correct Coding Initiative (NCCI) edits would be used to ensure appropriate Medicaid payments.  This proposal would save $175 million over five years and $620 million over ten.

Health Information Technology (HIT).  The budget would continue HIT adoption efforts by focusing on computerizing health records.  This proposal does not contain a cost estimate.

In recent years, much of what was in the President’s budget submission was ignored by Congress.  With Democrats in control of the White House and both the House and Senate, we expect Democratic leadership to work more closely with the Administration.  Congressional leadership has not revealed their budget strategy.  Thus, we do not have clear signals on how the budget process and health care reform will move forward, or whether “reconciliation measures” will be utilized.

“Weekend Effect” for GI Bleeding

From MedPage Today:

Patients with gastrointestinal bleeding who are admitted to the hospital on weekends have higher mortality rates than weekday patients, researchers here said.

The “weekend effect” is well-documented in the literature, suggesting worse outcomes for patients admitted to hospital on weekends. The problem has been partially attributed to reduced hospital staffing and access to intensive treatments and procedures during that time.