Upheavals brought by COVID-19 may accelerate certain trends.
Emergency departments are in the business of responding to whatever is thrown at them — and in that respect, 2020 certainly delivered. With the health care environment rapidly and profoundly changed by COVID-19, trends that were predicted before the pandemic deserve a second look.
Accelerated adoption of new technology — along with shifts in patient demographics, reimbursement systems, and health care policy — all have contributed to the new health care landscape. What’s more, the cracks found in our health care system should not be glossed over, as society reckons with the reality that the underserved are disproportionately affected physically and economically. As 2020 appears in the rearview, it’s a good time to regroup and formulate an updated vision for emergency medicine in 2021 and beyond, understanding that the ED is not only a place, but a medical specialty with unique practice challenges to overcome — and value to offer.
Value-based care will expand the ED’s role in care planning and outcomes.
Historically, emergency medicine has been a responsive treatment setting where patients were stabilized and moved home or to another level of care. Under a value-based system, EDs will be expected to take a more active role in care transitions and patient outcomes. Emergency providers will likely be held responsible for planning safe discharge dispositions and arranging follow-up care, especially for high-risk patients.
This expanded responsibility will support patient care in a new way, preventing recurring ED visits and unnecessary hospitalizations with better disease management at home or on an outpatient basis. Health care systems and patients are better served by reducing expensive ED visits and keeping people in the outpatient setting.
Identifying high-risk patients and creating new processes will rely on a data-driven approach combined with a case-management mindset. Preparing for this transition now by analyzing data and developing customized departmental action plans will position EDs to successfully participate in outcome-driven payment models.
Telemedicine will continue to contribute to increased access to care.
Telemedicine of all types surged last year, reflecting demand for socially distant care and boosted by relaxed government regulations. The trend is likely to continue as patients and providers get used to the new technology and realize its benefits. Insurance carriers are getting up to speed and offering more coverage for telehealth in 2021. And, it’s covered in CMS’s proposed changes to the Medicare physician fee schedule.
As patients take advantage of telemedicine for low-acuity, unscheduled care, they may be absent from the ED population for the foreseeable future. And while some patients are starting to return to an in-person clinical setting for elective procedures and more, many are not. For instance, the trend in pediatric ED visits was already declining pre-COVID, so we expect these numbers to continue to dwindle as well.
ED overutilization for low-acuity conditions may settle into a favorable pattern, reducing health care costs overall. While EDs were already treating a greater proportion of critically ill patients prior to 2020, the trend has been accelerated by the pandemic. Hospitals will rely on advanced health care analytics tools to carefully analyze their own data trends. ED groups, in particular, will need to leverage data to make smart moves such as adjusting resources, developing new services, and seeking value-based reimbursement opportunities. It’s this data-driven approach to practice management that will be the difference in physician groups having a seat at the table or being on the table in 2021.
The road to financial recovery of the health system may be a long one.
The financial recovery of the health system is unclear for many, and recent CMS reductions, effective January 1, 2021, may play a role in how long recovery efforts will take. Additionally, the recently passed No Surprises Act (a measure tucked away in the Consolidated Appropriations Act that was passed at the tail end of 2020) looks to spell more administrative burdens for hospitals. The language of the bill also places more pressure on providers to send patient bills faster, despite the challenges they often face in receiving adjudicated claims back from insurers.
As hospitals seek the best path forward in the new normal, data-driven management is the key to successfully navigating changes. At d2i, we feel strongly that having access to clean and reliable data can and will improve value, making the difference between health systems surviving or thriving in 2021.
Improved Prospects for 2021
As the world celebrates the release of novel coronavirus vaccines, the prospect of an end to the pandemic in 2021 is looking bright. As health care begins to recover from the disruption wrought by the pandemic, broader universal trends will emerge, some of them very promising.
These include the continued movement of unscheduled low-acuity care to appropriate virtual and outpatient settings, which is finally materializing after many years of effort in that direction. This has the potential to free EDs to focus their efforts on clinically and socially complex patients by extending care beyond their doors.
Integrated data solutions that tell each patient’s story help guide the way to a model where the primary focus is quality outcomes versus throughput quantity. Contact d2i to learn more about how our clients are using our cloud-based data analysis solutions or request a demo to get an under-the-hood look.