Reimbursement for Emergency Department Electrocardiography and Radiograph Interpretations: What Is It Worth for the Emergency Physician

From Western Journal of Emergency Medicine:

Background: Physician reimbursement laws for diagnostic interpretive services require that only those services provided contemporaneously and /or contribute directly to patient care can be billed for. Despite these regulations, cardiologists and radiologists in many hospitals continue to bill for ECG and plain film diagnostic services performed in the emergency department (ED). The reimbursement value of this care, which is disconnected in time and place from the ED patient encounter, is unknown. In a California community ED with a 32,000 annual census, the emergency physicians (EPs) alone, by contract, bill for all ECG readings and plain film interpretations when the radiologists are not available to provide contemporaneous readings.

Objectives: To determine the impact of this billing practice on actual EP reimbursement we undertook an analysis that allows calculation of physician reimbursement from billing data.

Methods: An IRB-approved analysis of 12 months of billing data cleansed of all patient identifiers was undertaken for 2003. From the data we created a descriptive study with itemized breakdown of reimbursement for radiograph and ECG interpretive services (procedures) and the gross resultant physician income.

Results: In 2003 EPs at this hospital treated patients during 32,690 ED visits. Total group income in 2003 for radiographs was $173,555 and $91,025 for ECGs, or $19/EP hour and $6/EP hour respectively. For the average full-time EP, the combined total is $2537/month or $30,444 per annum, per EP. This is $8/ED visit (averaged across all patients).

Conclusion: As EP-reimbursement is challenged by rising malpractice premiums, uninsured patients, HMO contracts, unfunded government mandates and state budgetary shortfalls, EPs are seeking to preserve their patient services and resultant income. They should also be reimbursed for those services and the liability that they incur. The reimbursement value of ECGs and plain film interpretations to the practicing EP is substantial. In the ED studied, it represents $30,444 gross income per full-time EP annually. Plain film interpretation services produce three times the hourly revenue of ECG reading at the hospital studied.

Supply and Demand of Board-certified Emergency Physicians by U.S. State, 2005

From Academic Emergency Medicine:

Objectives: The objective was to estimate the emergency medicine (EM) board-certified emergency physician (EP) workforce supply and demand by U.S. state.

Methods: The 2005 National Emergency Department Inventories-USA provided annual visit volumes for U.S. emergency departments (EDs). We estimated full-time equivalent (FTE) EP demand at each ED by dividing the actual number of visits by the estimated average EP visit volume (3,548 visits/year) and then summing FTEs by state. Our model assumed that at least one EP should be present 24/7 in each ED. The number of EM board-certified EPs per state was provided by the American Board of Medical Specialties (American Board of Emergency Medicine, American Board of Pediatrics) and the American Osteopathic Board of Emergency Medicine. We used U.S. Census Bureau civilian population estimates to calculate EP population density by state.

Results: The supply of EM board-certified EPs was 58% of required FTEs to staff all EDs nationally and ranged from 10% in South Dakota to 104% in Hawai’i (i.e., there were more EPs than the estimated need). Texas and Florida had the largest absolute shortages of EM board-certified EPs (2,069 and 1,146, respectively). The number of EM board-certified EPs per 100,000 U.S. civilian population ranged from 3.6 in South Dakota to 13.8 in Washington, DC. States with a higher population density of EM board-certified EPs had higher percent high school graduates and a lower percent rural population and whites.

Conclusions: The supply and demand of EM board-certified EPs varies by state. Only one state had an adequate supply of EM board-certified EPs to fully staff its EDs.

Retail sites give comparable care for less

From Modern Healthcare:

Retail medical clinics provide similar quality health services at lower costs than physician offices, urgent-care centers or emergency rooms, according to a study of retail clinics in Minnesota.

The study, published in the Annals of Internal Medicine, compared the care received by 2,100 insured patients treated at retail clinics in 2005 and 2006 in Minnesota and patients treated at traditional care centers. The patients had middle-ear infections, sore throats and urinary tract infections, and the quality of care was assessed on 14 standard quality measures, using insurance claims data.

Quality scores were equal or higher for retail clinics, while the costs were 30% to 40% lower than physician offices and urgent-care centers, and 80% lower than hospital ERs, according to the study, conducted by researchers at RAND Corp. and funded by the California HealthCare Foundation.

“These findings provide more evidence that retail clinics are an innovative new way of delivering healthcare,” said lead author Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine and a RAND researcher. A summary of the report is available here. Full access to the report requires subscription or payment