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Value in the Emergency Department

Value in the Emergency Department. John G. Holstein, Director- Business Development- Zotec Partners Mark Mackey, MD, Vice Chairman, Clinical Operations University of Illinois at Chicago Hospital Department of Emergency Medicine . You Never Know Who. 130,000,000 Emergency Department Patients.

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Value in the Emergency Department

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  1. Value in the Emergency Department John G. Holstein, Director- Business Development- Zotec Partners Mark Mackey, MD, Vice Chairman, Clinical Operations University of Illinois at Chicago Hospital Department of Emergency Medicine

  2. Confidential You Never Know Who

  3. 130,000,000 Emergency Department Patients That is 356,000 patients/day

  4. 130,000,000 ED patients 250 patients per minute

  5. Thatis 10 MLB Teams Per Minute in Joe Torre’s World

  6. Where is the Value of Emergency Medicine?

  7. Revenue • “We need to get Mrs. Brown to ICU.” • 68% of all hospital admissions* • Each emergency physician contributes $984,575 in revenue** • - James Augustine, MD EDBA • - Jackson Coker Contribution to Operations Percentage of Revenue Calculator

  8. The Decision to AdmitThe Decision to Discharge • Inpatient Revenue • Downstream Revenue

  9. Emergency Medicine Emergency Medicine is the nexus of the care continuum The entire spectrum of human accident, illness and/or infirmity…every day…in every emergency department.

  10. Preserving Revenue through Payer Contracting No Matter What the Landscape • Practice issues • Know the data and your market • Volume and acuity of patients by plan • Current collection, including self-pay? • That’s collection…per patient visit • These are issues today and within ACOs

  11. Highlight Your ED Practice • Expertise unique to your ED • Door-to-doctor times • Door-to-balloon times • Patient satisfaction scores • Communication with their specialists • Pediatric attendings, etc., etc., etc. • *ED observation

  12. Know Your Practice Data • E/M-Visit Codes: 99281 through 99291 • All non-E/M codes; especially high volume • Observation services • Bedside ultrasounds • X-Rays and ECGs • Sedation • Even if you are not billing these today!!!

  13. Types of Deals • Flat Rate: • $ per Visit • $ per RVU • Procedure-based

  14. Emergency Medicine Specific Issues • Preservation of core EM issues • EM is unique in Medicine • Establish this fact in the negotiation • EM has its own identity and issues

  15. Here They Are… • How is the “provider” defined in this contract? • Documentation requirements: Medicare or CPT? • Claim submission parameters: The ED is a special case • Do not allow contract assignment without your review • Term: How long are you willing to live with this deal? • Appeal process and your Medical Director’s involvement • EMTALA • Prudent Layperson Definition of an Emergency • Insistence on plan specificity to avoid silent PPOs • No favored nation clauses in the contract • Be very careful about moonlighting physicians • The special case of payment bundling • Credentialing: You want a delegated process

  16. “You Never Know Who”

  17. John G. Holstein Director of Business Development Zotec Partners 610-668-6473 jholstein@zotecmmp.com http://www.linkedin.com/in/johngholstein

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