Hospital Closings and Patient Visits Prepared by: Brian T. Kloss, DO, JD, PA-C SUNY Upstate Medical University Department of Emergency Medicine

Increase in the number of patients in the ED Significant reduction in the number of EDs Closure of 200,000 inpatient beds Difficulty in reimbursement for hospitals and physicians Overcrowding and Boarding have grown as a result The Issue

The Vicious Cycle Existing ED Patient Visits and Acuity Increase Reimbursement For Services Decreases Annually Hospitals and EDs are Forced to Close

ED Visits on the Rise Since 1973

Emergency Departments on the Decline Since 1995

American Hospital Association Facts* Annual ED visits from 1990 to 2000 increased 16% from 92M to 106.9M Approximately 500 hospital closures during the same time From alone, 797 Emergency Departments have closed * Accessed December 2, 2009.

Who Pays to Keep the ED Open? CDC 2002 Data

What are the Root Causes? Demand for services increased Reimbursement rates under threat –Never occur, Never pay events by CMS –Disconnect between CMS fees and cost of care –Private insurances use CMS fees as benchmark Currently, both Medicare and Medicaid pay less than the cost of care provided to beneficiaries.* * AHA Fact Sheet: The Fragile State of Hospital Finances: Accessed December 2, 2009.

Root Causes Continued Pursuing reimbursement from insurers adds to hospital operating expenses and strains hospital budgets. EMTALA created a federal mandate that requires EDs to provide medical treatment and stabilization without compensation.* * Accessed December 2, 2009

Root Causes Continued Outpatient surgical centers have reduced hospital income –Owner-providers to treat select patients –Lower-paying patients are cared for at the hospital. Urgent Care Clinics causing similar problems –Insured are able to get care –Uninsured referred on to the hospital

Proposed Solutions Improved systems of care to streamline care and cut costs Stabilize and improve reimbursement models Address the unfunded EMTALA mandate Reform Disproportionate Share Hospital (DSH) payments