Could Obamacare Reverse Trend of Uncompensated Care in EDs?

Emergency departments, which have suffered shortfalls in reimbursement for decades due to the high rate of uninsured in the United States, may begin receiving "considerably more" reimbursement once the Affordable Care Act is fully  implemented.  A study forecasting how emergency department reimbursements could improve was published online in October in Annals of Emergency Medicine .

"Assuming typical reimbursement patterns continue, emergency department reimbursement for outpatient visits to the ER may increase by 17 percent for uninsured people who go on Medicaid and by 39 percent for uninsured people who move to the private insurance market," said lead study author Jessica Galarraga, M.D., of the Department of Emergency Medicine at George Washington University in Washington D.C. "Historically, emergency departments have carried the bulk of the economic burden for uncompensated care in the health care system, which has led to hundreds of them closing. Over the next few years, that picture could change substantially."

Galarraga and Jesse Pines, M.D., also of George Washington University, analyzed data from the Medical Expenditure Panel Survey for 2005 to 2010. They estimated the amount of money that EDs might have collected for uninsured patients had they been covered by either Medicaid or private insurance.  Approximately 7 million people are expected to enroll in Medicaid as a result of the Affordable Care Act and 23 million are expected to obtain private insurance through health insurance exchanges. 

"One question is what happens in the 13 states whose governors have announced they will not participate in Medicaid expansion, especially those with high rates of uninsurance?" said Pines.  "Another is whether the reduction in disproportionate share hospital payments will outweigh the new sources of reimbursement. This is a time of great uncertainty, but one thing is sure: emergency departments cannot continue to provide top-notch medical care without an improvement in reimbursement." For more information, visit

KPMG: Bundled Payments Increasingly Attractive to Hospitals, Medical Groups

More than 60 percent of health care providers believe bundled payment models, which package out-  and in-patient costs, professional fees and post-discharge costs related to specific conditions into one payment, may improve the quality of health care delivered to patients and create cost-savings, according to a poll conducted by KPMG LLP, the audit, tax and advisory firm.

In the KPMG poll of 190 health care providers, largely represented by hospitals and health systems and large-scale physician groups, 38 percent said they are "already working with bundled payments," while 24 percent responded "Not yet, but we plan to." Thirty-six percent remain undecided on developing such plans and only 2 percent stated that they had no intention to offer them.

"Hospitals and large physician groups are warming up to bundled payment options as a means to enhance control over the total path of care [quality and cost] and to create a much more patient-centered experience," said Marc Berg, KPMG's head of strategy and transformation for Healthcare and Life Sciences. "Based on our study, providers are generating anywhere between 15 to 60 percent or more of their revenues from risk-based methods, such as bundling. This is much more than even one year ago. We expect those numbers to grow further as providers see how bundling can strengthen relations with physician groups and take steps toward becoming preferred partners with the payer community."

Berg added that the current Centers for Medicaid and Medicare Service Bundled Payment program provides a unique opportunity for providers, who must act quickly to participate in the program. CMS's bundled payment deadline is Nov. 1.

Forty-four percent of providers identified aligning physicians and hospitals as the greatest challenge in establishing a bundled payment plan. Nearly a third of respondents (31 percent) felt control of expenditures throughout the bundle posed the biggest challenge; while 18 percent believed the ability to harness performance information across the organization as the most significant barrier.

Providers were almost equally split when asked about the key components of bundled payment strategies. Twenty-eight percent indicated that the ability to harness and manage big data would lead to success. Twenty-six percent felt providing resources for program design, administration, and provider contracting were necessary. Another 26 percent cited commitment from top leaders as critical. Twenty percent believed an open mind to new ideas was essential.

Unrealistic pessimists less likely to take preventive action after receiving good news

Patients who are unrealistically optimistic about their personal health risks aremore likely to take preventive action when confronted with news that is worse than expected, while unrealistic pessimists are less likely to change their behavior after receiving feedback that is better than expected, according to researchers at the University of California, Riverside and Grand Valley State University in Allendale, Mich.

This poses a serious dilemma for health care professionals, said study authors Kate Sweeny, assistant professor of psychology at UC Riverside, and co-author Amanda Dillard, assistant professor of psychology at Grand Valley State University: Should they withhold accurate risk information from unrealistic pessimists to avoid undermining their perceptions of the severity of their potential consequences and ultimately their motivation for preventive behavior?

"The question reveals a tension between the goals of health-behavior promotion and informed patient decision-making that has plagued researchers in several health domains, most notably with regard to women's often overly pessimistic perceptions of their breast cancer risk," Sweeny and Dillard wrote in "The Effects of Expectation Disconfirmation on Appraisal, Affect, and Behavioral Intentions," published this month in the online edition of Risk Analysis: An International Journal. The journal is an official publication of the Society for Risk Analysis.

The psychologists conducted a series of experiments in which participants were told they would be tested for exposure to toxins found in everyday products. The researchers found that people who received risk feedback that was worse than expected expressed stronger intentions to prevent the threat in the future than did people who received risk feedback that was better than expected. All study participants received the same health feedback; only the expectations of the participants differed.