Embed Size (px)
DESCRIPTION
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. - PowerPoint PPT Presentation
Citation preview
1CONFIDENTIAL
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
2CONFIDENTIAL
You Never Know Who
Confidential
3CONFIDENTIAL
130,000,000 Emergency Department Patients
That is 356,000 patients/day
4CONFIDENTIAL
130,000,000 ED patients 250 patients per minute
5CONFIDENTIAL
That is 10 MLB Teams Per Minute in Joe Torre’s World
6CONFIDENTIAL
Where is the Value of Emergency Medicine?
7CONFIDENTIAL
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
8CONFIDENTIAL
The Decision to AdmitThe Decision to Discharge
• Inpatient Revenue
• Downstream Revenue
9CONFIDENTIAL
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.
10CONFIDENTIAL
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
11CONFIDENTIAL
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
12CONFIDENTIAL
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!!!
13CONFIDENTIAL
Types of Deals
• Flat Rate:• $ per Visit• $ per RVU
• Procedure-based
14CONFIDENTIAL
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
15CONFIDENTIAL
Here They Are…• 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
15
• 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
16CONFIDENTIAL
“You Never Know Who”
17CONFIDENTIAL
John G. Holstein Director of Business Development
Zotec Partners610-668-6473
[email protected]://www.linkedin.com/in/johngholstein
