Maintaining the quality of patient care while coping with economic challenges requires strategic financial planning, inspired collaboration, and savvy use of technology and advanced data analytics.
Technology is helping hospitals and EDs cope with costs and improve care
Despite the official end of the pandemic, emergency departments continue to face surges in patient volume and longer-than-usual wait times, a trend that intensified in 2023.
Adding to these challenges are widespread staffing crises, the all-too-common practice of patient boarding, and ongoing disenrollment from Medicaid. Lack of access to healthcare is particularly acute in the realms of mental health and pediatric care. Meanwhile, the Centers for Medicare & Medicaid Services has slashed reimbursements for physicians and facilities, increasing the risk of rural healthcare facilities closing.
A Shortage of EM Physicians
In 2021, scholars predicted in an article for Annals of Emergency Medicine that by 2030 there would likely be too many emergency medicine physicians.
This prediction is not panning out. In 2023, for the first time, the number of applicants for EM residencies was fewer than the number of available positions, leaving over 500 positions unfilled.
Widespread burnout among EM physicians, many of whom are choosing early retirement, is a sign of the declining appeal of emergency medicine. Facilities have responded by hiring more advanced practice providers (APPs); in recent years, APP staffing in EDs has surged by over 70%.
Changes in MIPS Reimbursement
Medicare’s Merit-based Incentive Payment System (MIPS) has had a rocky rollout, in part because of pandemic hardship waivers. But with the publication of the final MIPS rules for 2024 in November 2023, these waivers have been discontinued and all eligible physicians will now be scored.
Designed to be budget-neutral, MIPS pits providers against each other, with underperforming physician’s penalties subsidizing the incentives of those who excel. This sudden emphasis on quality metrics is likely to catch many providers off guard, especially those in independent practices or smaller groups. The MIPS provision for payment adjustments encourages providers to improve their performance metrics. Healthcare providers are now tasked with carefully choosing their quality metrics, reviewing protocols and documentation processes, and enhancing reporting methods. Alternatively, they may explore participation in the recently introduced MIPS Value Pathway for a more streamlined approach. Operating on a two-year cycle, MIPS rewards high-quality care with financial benefits that accrue in subsequent years. The system represents how CMS is incentivizing the transition from traditional fee-for-service models to quality-based payments.
Higher Costs of Providing Care
In 2024, emergency medical care costs more for many reasons: the higher pay needed to attract and retain healthcare professionals, the increasing costs of maintaining medical supplies and facilities, and the strains of staffing challenges and greater demand for emergency services. Maintaining the quality of patient care while coping with economic challenges requires strategic financial planning, inspired collaboration, and savvy use of technology and advanced data analytics.
More Innovation, More Efficiency, Lower Costs
Much of the innovation going on now involves big data and artificial intelligence. Applying artificial intelligence (AI) to medical record-keeping can streamline documentation and make patient discharges more efficient. As machine learning and AI mature, d2i and its partners are leveraging its treasure trove of 50M+ ED encounters to develop sophisticated algorithms to optimize demand capacity and improve medical decision-making to impact patient safety and outcomes.
One example of this type of innovation is d2i and The Sullivan Group’s RSQ® Dashboard, which helps users address the rising costs of medical malpractice and the urgent need to avoid medical errors. The dashboard enables providers to monitor high-risk areas and mitigate potential risks before they turn into adverse events. By enhancing the feedback to providers regarding medical decision-making on high-risk cases, the tool drives immediate patient follow-up and positive changes in clinical practice. The results: Fewer adverse outcomes, fewer lawsuits, and lower medical risk insurance premiums.
Navigating the MIPS landscape, addressing staffing concerns, and embracing life-saving and cost-saving advances being driven by big data and artificial intelligence are helping practitioners and healthcare facilities to both improve the bottom line and provide the best possible emergency care. As costs run higher and efficiency improvements continue to be necessary, will your practice be at the forefront of this transformative era? Contact d2i to discover how we can help you prove your value, improve performance, and navigate the evolving healthcare landscape.