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Tag Archives: bundling
Will Emergency Physicians be Paid for Performing Ultrasounds ?
For many emergency physicians (EPs) the performance and interpretation of ultrasound examinations on patients in the ED has become an incredibly valuable and often life-saving tool, but until recently most health plans and government payers have balked at paying EPs for these services. Even though the F.A.S.T. ultrasound exam has become a widely used diagnostic modality in the evaluation of major trauma patients in the ED, and ultrasound training has now been incorporated into the … Continue reading
Compensating Emergency Physicians: If Not Fee-for-Service, What?
The push for payment reform in US health care is getting a great deal of support from every corner, and this will impact compensation for emergency physicians just as it will for nearly every specialty. Nearly everyone believes that our fee-for-service reimbursement system results in too much care for too little benefit. The perception that preventative and primary health care services are undercompensated, and procedural services to rescue failing health are overcompensated, seems to be … Continue reading
Coding Wars: UHC Escalates Down-coding Assault on ER Claims
Many health plans and third party payers have for years been using claims re-coding as a way of reducing plan benefits and payments to physician in order to add to plan profitability. Recently, United HealthCare (UHC) launched an escalation of this practice in an attempt to recoup millions of dollars paid to emergency physicians over several years, and it is about to boil over into a full-scale shooting war. The practice of down-coding or re-coding … Continue reading
Should Emergency Medicine be Carved Out of Payment Reform?
Should emergency physicians advocate that they be carved-out of payment reform? There may be no easy answer to this question, at least not yet; and in any case, advocating to be an exception to the transition from fee-for-service to pay-for-performance and risk-sharing may be a waste of time and effort. The tide is clearly turning, though not as quickly as payers and government regulators might wish; and it would appear that eventually, every physician and … Continue reading
What is Cost-effective Care?
Lately I have been pondering the question of how to identify cost-effective ways to manage patients in the ED. I have concluded that before I could identify evidence-based cost-effective approaches to care, I first had to define what cost-effective care means. It could mean an approach that is focused just on the cost of care in the ED; or it could mean the costs of care for an episode that extend beyond ED services to … Continue reading