Re-Program Your Emergency Room

I am often asked, “If we were to only do one thing to reduce hospital readmissions, what tactic would you recommend?” 

My answer is simple. “Re-program your emergency room.” 

It’s that simple. 

Since releasing my first book on the hospital readmission penalty, Readmission Prevention: Solutions Across the Provider Continuum, I have been invited to keynote on healthcare topics around the country and across the world. 

Whenever I exit a stage and network with other healthcare executives, one of the most common topics I’m asked to address is what can they do to avoid the readmission penalty.  

As a former hospital CEO myself, I’m acutely aware of how our healthcare system operates and I’ve watched how it has evolved over the decades. My experience has led me to think about the challenges and see where the opportunities are for improvement. 

So whereas simply saying “re-program your emergency room” sounds great as a bumper sticker slogan. It’s not very helpful unless you know what it actually means and how you can actually do it within the existing constraints. 

So what does “re-program your emergency room” actually mean? It means educating your emergency department doctors that the game has changed… it is no longer a heads in beds play, where the doctor’s job is to find “justification” to admit. The emergency doctor’s job has transitioned from “justifying admission” to “analyzing and determining if the patient meets criteria.”

Many doctors don’t want to hear this but in many ways, CMS has eliminated the doctor’s opinion from the process and made qualification of admission to hospitals criteria-based – grounded in quantifiable test results and outcomes. 

There is no way to sugarcoat it, re-programming your emergency physician group – a hired outside physician group – is going to be difficult. Why? Well traditionally in the fee-for-service era, most hospitals picked the emergency physician group that convinced them they could admit the most patients – which translates to the most revenue – heads in beds! 

Remember, the name of the game in a fee-for-service world is “justify and admit.” The new rules penalize that type of strategy. The new rules are “Analyze and determine if the patient meets the established criteria.” Doctors can still write admission orders for patients who do not qualify, but payment will be denied, and collecting any reimbursement for that patient is almost always going to be a long and tedious process that is seldom profitable in the end. 

Thus, re-programming the perceptions, practices, and deep-rooted, long-standing habits of emergency physicians can be a lengthy, but necessary, process. The training requires much repetition to get the emergency physician out of the “heads in beds” mindset because that’s how they were trained. 

But if you can achieve this shift and your hospital prioritizes value-based care, while eliminating avoidable hospitalizations you will reduce expenditures, administration costs and costly readmission penalties. 

If you have questions about any of this please don’t hesitate to book a free 30 minute consultation.