Emergency Medicine Should Expand Role to Care Coordination

From Becker‘s:

The American College of Emergency Physicians’ Delivery System Task Force released a report exploring the role of emergency medicine in future healthcare delivery systems.

The report, “Strategies for Emergency Medicine,” discusses ways emergency medicine can aid healthcare organizations in new models of care.

The task force made several recommendations for emergency medicine to expand its current role of treating urgent and emergent cases, managing capacity and other responsibilities, to create a more integrated, coordinated healthcare system.

Some recommendations include the following:

•    Share information with primary care providers and specialists.
•    Coordinate care for high-cost users.
•    Collect regionalized data for surveillance and development of evidence-based care protocols.
•    Enhance professional alliances.
•    Re-engage with the American College of Physicians, American Academy of Family Physicians and others.
•    Make technology alliances.
•    Regionalize patient care resources (mobile technology, telemedicine).
•    Implement practical solutions for transitions of care.
•    Develop cost-effective alternatives to hospital admission.
•    Develop cost-effective utilization strategies.

Heart Attacks Twice as Deadly for Women

From MedPage Today:

A heart attack is more likely to kill a woman than a man, perhaps because women are more likely to delay seeking treatment for myocardial infarction symptoms

ERs accused of overbilling in expanded whistleblower suit

From Fierce Healthcare:

Adventist Health System is finding itself in even more legal hot water. The whistleblower suit accusing seven of its Florida hospitals of overbilling Medicare for radiology services now includes alleged overbilling in the hospitals’ emergency departments, the Orlando Sentinel reported.

In the original complaint filed in July 2010, a coding and reimbursement compliance officer said she routinely saw billing code modifiers and electronic bill presentation misused in ways that would boost reimbursements, overbilling the government for tens of millions of dollars for more than 10 years.

In the new complaint, a second whistleblower claims similar billing issues took place in the EDs between 2001 and 2008, in which the hospitals allegedly submitted false, duplicate or padded medical claims.

OIG Targets ED Physicians for Fraudulent E&M Coding Using Incomplete Claims Data

From Dr. Myles Riner’s The Fickle Finger:

The saddest aspect of this distortion is that, as a result, the emergency physicians who work in EDs that employ NPPs to care for a large percentage of Medicare and Medicaid patients are being targeted for investigation of possible fraud and abuse, when in fact the actual overall cost of the care of all these patients is likely to be LOWER than average, because Medicare and Medicaid pay 15% less for services provided by NPPs!  Talk about a miscarriage of justice.