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Hospital Patient Transfers with Optional Protocols

Posted on September 4, 2018 I Written By


The following is a guest blog post by General Devices.

Patient Transfers are business. Serious business for all patients involved; transferring hospitals, transport service, agent and – the patient. They hold the balance to patient care, place and time plus the business side of healthcare. If a patient transfer is initiated and the ED/ EMS staff are unable to follow protocols it could result in not only the breaking of federal law, but also impact outcomes and costs. “Inter-hospital transfers can have negative financial (operational, and liability) implications for the patient, transferring and accepting facilities, and the health care system” (Academic Emergency Medicine: Inter-hospital Transfers from U.S. Emergency Departments; 2013). This article will explain:

  • EMTALA and how it will affect your transfer process
  • The different types of transfers
  • How transfer process and workflow can be made simpler, with less risk, using digital protocols.

In 2017, the United States saw 1,391,712 hospital transfers. Faster approved transfers lead to much better outcomes and more lives saved. Transfers can be necessitated by a multitude of reasons which include overcrowding, limited resources, lack of expertise, proper equipment for a specific treatment specializations, and more. A transfer can happen both during initial transport to the hospital or during the patient hospital stay. There are times where an incoming EMS call is immediately deemed transfer necessary, referred to as a diversion. Other times, a patient could be stablizied in the emergency room or during their hospital stay and require a treatment which is better suited for another hospital. Once the need for transfer is confirmed there are certain liabilities and protocols that must be followed.

E M T A L A, the federal law, requires the patient transferred from one hospital to another to be first stabilized and treated. This can include forms that must be completed, pre-transfer stabilization and preparation, as well as communication between the EDs, the transporting staff and transfer centers. EMTALA includes its’ own steps that must be followed during a transfer.

Transfer centers were established in an attempt to better manage the process. The simple fact is, their communication technologies do not allow team collaboration.

How can a configurable mobile telemedicine app help?

During a transfer, timing is one of the most crucial components to ensure effective patient treatment. Having inflexible protocols potentially restrict the ease of transferring a patient when needed. Every hospital, EMS and healthcare environment operate differently and have different needs, which is why a canned set of protocols will not work for everyone. – This is where a configurable mobile telemedicine solution comes in. Whether it’s an intra-hospital, inter-hospital or EMS transfer, a good mobile telemedicine will give you the capabilities you need to ensure the patients best interests. Proper Documentation is a result of a proper MT app and can be used for audit purposes for workflow improvement and investigating the flaws in the patient transfer.

About GD (General Devices)
GD enables smarter patient care by empowering hospitals, EMS, community healthcare, and public safety with the most comprehensive, interactive, configurable, affordable, and integrated FDA listed medical communications and mobile telemedicine solution. The benefits of which are enhanced workflows, minimized risk, reduced costs and improved patient outcomes.

Patient Financial Clearance: Ensuring a Successful Revenue Model in Emergency Medicine

Posted on July 2, 2015 I Written By

The following is a guest blog post by Jordan Levitt serves as a Managing Partner and Founder for PayorLogic.
Jordan Levitt
In emergency medicine, most providers know this to be true: medical triage and rendering healthcare services is often the easy part. Financial clearance and obtaining payment is the challenge. This is particularly relevant in light of the Emergency Medical Treatment & Labor Act (EMTALA) that ensures public access to emergency department (ED) services regardless of one’s ability to pay.

Even with the influx of patients who now have insurance through Medicaid expansion, EDs are still up against many challenges in terms of collecting payments from urgent care encounters. Emergency patients are frequently transient and difficult to manage. And beyond the traditional self-pay patient population, a growing number of emergency patients are now insured under high deductible health plans (HDHPs). Patients themselves are increasingly responsible for a larger portion of the bill.

The burden is on emergency medicine practice administrators and their billing companies to complete the financial clearance process as early as possible—ideally immediately following medical triage and during the urgent care encounter.  The biggest hurdle is obtaining correct and accurate information to financially clear patients within the emergency setting.

Common Hurdles to Overcome
First, IT systems used during emergency transport and within the ED are commonly fragmented—even within a singular hospital system. Second, emergency encounters must focus first on medical triage and urgent care. Financial clearance is an afterthought. Patient access staff members in the ED often do not have ample time to complete financial clearance before patients are treated—and even released. Third, many organizations experience high turnover in the ED registration area, making it difficult to ensure compliance and consistency.

This article summarizes how one emergency medicine billing company works with its clients to provide financial clearance for emergency encounters—even for patients that present as self-pay.

How it works at ATD Resources, Inc.
As a full-service billing company that serves five emergency departments with a combined 140,000 visits per year, ATD Resources, Inc. knows the financial pressures of increasing patient payment responsibility and non-payment risk all too well. Amy Propp, CPC, CEDC, director of operations at ATD Resources, LLC, sent approximately $1 million to a collections agency each month before revamping her financial clearance process. Furthermore, nearly 50% of ATD’s 180,000 patient statements were returned due to invalid addresses.

To improve revenue capture, ATD focused on obtaining the right information the first time around as close to near-time as possible. This required partnering with a front-end financial clearance solution that integrated with each hospital’s information systems so emergency medicine patient access staff had access to real-time demographics and payment information. A three-step workflow was designed.

Step One:
Verify patients’ social security numbers, addresses, and other demographic information within the emergency department as quickly as possible: upon registration and immediately following clinical triage.

Step Two:
Generate an immediate report of all patients labeled as self-pay/no insurance and use Payor Logic’s financial clearance application to check whether these patients have any billable insurance or other payment sources. For example, in 2014, ATD identified 16% of patients as self-pay for their clients. However, after verification, 35% of these individuals were actually eligible for Medicaid.

Step Three:
For patients with no verifiable or billable coverage, ATD staff members use Federal Poverty Level status information to qualify patients for a discount or charity care—immediately communicating findings back to the emergency medicine group.

Step Four:
Finally, ATD works with Payor Logic to predict likelihood of payment. By calculating a propensity-to-pay score, ATD (on behalf of their clients) focus on patients with the highest likelihood of paying the bill. ATD can identify patients with a history of non-payment, adjust the debt, and quickly forward these accounts to collections.

Thanks to its new financial clearance process, ATD has captured more than $800,000 in revenue over 12 months for its emergency medicine clients. In addition, its returned mail volume was cut by more than 10%.

The Road Ahead
Given the increase in patient financial responsibility, emergency providers and their billing companies must find creative ways to expedite the clearance and collection process.  This critical step is becoming increasingly essential as a new era of self-pay patients are emerging amidst declining pre-acute care reimbursements within emergency services and emergency medicine.

About Jordan Levitt:
Jordan Levitt serves as a Managing Partner and Founder for PayorLogic, a healthcare technology company for self-pay accounts management, insurance verification and financial clearance within emergency services, emergency medicine, laboratory, medical imaging, durable medical, and hospitals. Jordan can be reached at: jordanl@payorlogic.com.

Washington Hospitals Sue Over Cruel and Unusual Medicaid ED Visit Limits

Posted on October 17, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I’ve heard of some draconian budget-cutting measures, but the following, proposed by officials in Washington state, just about takes the cake. Good to see that the state’s hospitals, along with its doctors, are rightfully attempting to slam the door shut onMedicaid planners’ obscene antics.

A new state plan in Washington proposes to limit payment for Medicaid patients’ emergency department visits, on the extremely dubious assumption that such patients can self-diagnose whether they ought to be there in the first place. Not only is this program unlikely to save any real money (unless you count the money saved by not having to care for dead beneficiaries), it assumes that emergency department staffers are adding useless layers of expertise so often that their services should be choked back dramatically. The truth is, there’s boatloads of evidence that the poor aren’t the biggest users of ED services for non-emergent conditions, but I suppose these state penny-pinches wouldn’t be bothered by the facts.

Get this. The state’s Medicaid folks want to cover only three “non-emergency” visits per year — enough of a disincentive to prevent people from going in the first place — but it doesn’t end there. The plan would classify more than  700 diagnoses as “non-emergent,” including (wait for it) chest pain, abdominal pain and breathing problems.  So, I take it that pregnant women, infants, children, the disabled and the mentally ill are supposed to decide with a home thermometer and a bit of prayer whether they’re actually in danger?

According to the folks suing the state, which include the state medical association, hospital association and chapter of the American College of Emergency Physicians, this program not only endangers patients, but also has thrown a cloud of smoke around payment issues. Specifically, the plaintiffs argue that the state is threatening patients that they’ll be billed directly, while EMTALA and state charity care laws prohibit patient billing.

Folks, if I were a hospital executive, I’d be suing to avoid legal and political messes that will arise here, sure. But I’d be sick to my gut about what such rules would mean to real people, too. I truly hope that’s what the suing hospitals have in mind.