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Emergency Room Tension

Your program runs the risk of developing a negative perception, not only from the ED, but also from the hospital leadership, if your hospitalists are not able to admit patients in a timely manner. I suggest you do your best to turn this problem into an opportunity. The hospital leadership is motivated to resolve this problem.

  • Ask to discuss additional support to increase staffing.
  • Consider realigning your staffing model to increase resources at the busiest times of the day. Most hospital EDs are busiest in the late afternoons and early evenings.
  • Create a hospitalist admissions team whose sole job is admitting patients. Work with outpatient providers to encourage direct admissions from clinic, thereby bypassing the ED altogether.
  • Consider utilizing non-physician providers to assist in patient care, which will allow your physicians to focus on admissions from the ED.
  • Track hospitalist response time for admissions. Share this information with your hospitalists and create incentives to improve performance.
  • Focus efforts to improve communication between hospitalists and the ED staff. Set up routine meetings to address transitions of care.

You can minimize the risk of tension between the hospitalists and the ED staff if both parties have a mutual understanding of each other’s problems and work together to address the differences.

Medicare Expands List of ‘No-Pay’ Conditions

You mentioned in a previous article that Medicare was considering expansion of its no-pay hospital-acquired conditions. Did they decide to add all of the items?

Robert W. Lukens, Braintree, Mass.

Dr. Hospitalist responds:

As you noted, in April 2008 Medicare proposed to expand the list of non-payment hospital-acquired conditions. Medicare initially announced in 2007 it would stop paying to treat certain hospital-acquired complications it believed preventable with good care. After a review of public comments, Medicare has decided to add the following conditions to the list:

1. Deep venous thrombosis (DVT)/ pulmonary embolism (PE);

2. Inpatient glycemic control, including the following:

  • Diabetic ketoacidosis;
  • Diabetic coma;
  • Hypoglycemic coma; and
  • Nonketotic hyperosmolar coma.

3. Surgical site infections after the following surgeries:

  • Total knee replacement;
  • Laparoscopic gastroenterostomy;
  • Laparoscopic gastric bypass; and
  • Ligation/stripping of varicose veins.

Of the three new proposals, the DVT/PE measure is the most controversial. Evidence suggests DVT/PE are not completely preventable. Hospitals will rely on hospitalists to develop systems to minimize this complication. TH

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