If the hospitalist service is provided by an independent, contracted group, they may be paid for treating the unassigned, uninsured patients. Often the payment is in the form of a case rate, based on the “average” number of services provided in an admission and using a Medicare or other mutually agreed upon fee schedule.
If the hospitalists are employees of the hospital, it is expected that they will assume responsibility for unassigned, uninsured patients. Although the hospital medicine group will not receive direct reimbursement for seeing these patients (unlike a contracted hospitalist group), the value of this service to the hospital must be recognized. In these situations, hospital administrators should acknowledge the critical need to credit the hospitalists for real work that must be performed but that generates little or no revenue. An equivalent case rate can be credited as a paper transaction to the hospitalist group to address the value of these services.
Given the current economic environment, the issue of treating unassigned and uninsured patients will not soon diminish. Demand is likely to increase with the nationwide growth in the number of uninsured patients. Physician resistance to call coverage and the rise of malpractice premiums will continue to create more pressure for hospitals to find solutions to this crisis. “We recognize that hospitalists are only part of the solution,” says Ron Angus, MS, Past President of SHM. “Hospitals and government agencies must provide funding to cover the costs of inpatient care for acutely ill, uninsured – and usually unassigned – patients. Hospitals must also find ways to ensure that other specialists are available to hospitalists for acutely ill inpatients who require specialty expertise or procedures. With such cooperation and participation, hospitalists can be an important part of the solution to the problems now reaching crisis proportions in American emergency rooms” (7).
- Appleby J. Hospitals plagued by on-call shortage. USA Today June 16. 1999.
- Blaming the docs: patient dumping probes see physicians as culprits in turning away indigent from ERs. Modern Healthcare August 9, 1999.
- Winston K, The Advisory Board Company, Clinical Initiatives Center. Cause for concern: ensuring adequate and timely on-call physician coverage in the emergency department. ED Watch Issue #4, May 2, 2000.
- Foubister V. Is there a dearth of specialists in the ED? American Medical News July 12, 1999.
- Wanted: doctors willing to take ER call. ACP-ASIM Observer American College of Physicians-American Society of Internal Medicine, November 2001.
- Aronson M, Beth Israel Deaconess Medical Center. Personal interview. December 2004.
- Angus R, letter to the editor, ACP-ASIM Observer American College of Physicians-American Society of Internal Medicine, December 2001.