Emergency Department Increases in Volume Stress System

Posted on Tue, May 26, 2015
Emergency Department Increases in Volume Stress System

Increases in emergency department visits creates increased urgency for improving patient experience of care.

A recent poll conducted by the American College of Emergency Physicians (ACEP) found that emergency departments are realizing an increase in volume as contrasted with the same period last year, despite the increase of the insured under the Affordable Care Act.
 The Centers for Medicare & Medicaid Services (CMS) is in the process of finalizing the EDCAHPS, a/k/a the Emergency Department Patient Experience of Care (EDPEC), Survey for use with adult patients who have visited the emergency department.  These surveys represent a change in the way CMS pays for services.  Rather than paying for the number of services provided, CMS is moving in the direction of paying for high quality service, the quality measured clinically, administratively, and through the use of patient experience of care surveys, which will affect payments to Medicare providers.
CMS has recognized that patient care in the emergency department is a critical predictor of overall patient experience, and, therefore, will require an emergency department survey which focuses on hospital performance management.  This survey will ask patients about their experiences on arriving at the emergency department, during emergency department care, and post-emergency department care, either due to admission to the hospital or discharge.  Given CMS's desire to transform the patient experience, penalties for poor performance will undoubtedly mirror HCAHPS in order to ensure providers will modify existing behaviors to improve patient experience. 
However, given the data which demonstrates increased volume in emergency departments across the county, are we about to create the I Love Lucy "candy conveyor belt episode" within healthcare as CMS continues to monitor the patient experience, and, specifically, emergency department experience as a predictor of overall patient satisfaction?  The healthcare providers are now tasked with doing more in an expedited fashion, while at the same time remaining cognizant of the need to do so consistent with the national priorities to improve the quality of healthcare.  The six priorities include:  making care safer by reducing harm caused by the delivery of care; ensuring that each person and family are engaged as partners in their care; promoting effective communication and coordination of care; promoting the most effective prevention and treatment practices for the leading causes of mortality starting with cardiovascular disease; working with communities to promote wide use of best practices to enable health living; and making quality care more affordable for individuals, families, employers and governments by developing and spreading new healthcare delivery models. 
Therefore, the resources committed to the emergency departments will now be stressed to a point never experienced with the goal of providing timely, efficient and exceptional healthcare over a period which may span hours rather than days, as experienced by those surveyed under the traditional HCAHPS patient experience survey.  This may pose an explanation for the initial results obtained by CMS in its "test" EDPEC surveys, which resulted in very low and negative scores for the departments surveyed. 
When a system such as healthcare is placed under stress, its resources are challenged to provide more with less, ordinarily deficiencies in the process are exposed, and, therefore, the healthcare provider who simply hopes for the best and plans for the worst, will fall within the "penalty zone" anticipated in the EDPEC system to mirror the HCAHPS penalty, resulting in lower reimbursement.  Given the fact that the typical emergency department provides high volume, and thus high billings, the penalties could be catastrophic.
It is, therefore, critical that the emergency department providers are not only aware of the categories surveyed, but utilize and capture quality improvement rules necessary to afford management the ability to make decisions based upon reliable data, and, thus, avoid the natural pitfalls of the increased volume faced by the emergency department and the resulting stresses to the system.

Prash Pavagadhi
Qualitick CEO
Prash Pavagadhi is a leader in the field of management and marketing both nationally and internationally.  He is the President and CEO of Qualitick, an organization dedicated to bringing innovative data capture, analytics, and quality improvement solutions to the market.  He has worked in diverse markets in both North America and Europe, working with Fortune 500 organizations like Xerox, Corp (UK). and Eaton Corp.  His insightful business and marketing strategies help organizations across numerous industries improve quality initiatives and performance.  The author is also active in the community in Tampa (FL), including a Past President of the Indo-U.S. Chamber of Commerce and also served  on the Board of Directors at the Museum of Science & Industry.  Prash also authored, ‘The Knowledge-Power Paradigm,’ a book which explores the business strategic impact of information as a critical competitive advantage for organizations in this century.

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