Texas Care Emergency Room Analysis

Emergency Room Care ($302 per visit and 4 visits per year (each quarter) for 20 years) = $24,160

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

The lack of health insurance reached began to become a serious issue in the mid-1990’s reaching a crisis level in the 2000’s. Individuals without insurance turned to emergency rooms across the country to obtain care routine care, turning emergency departments into primary care facilities. In many instances, people who presented at emergency rooms for treatment could not be turned away due to various health and safety regulations; therefore, patients were seen without the ability to pay often leaving the hospitals with millions of dollars in uncollectable debt, subsequently leading to the insolvency of hundreds of hospitals across the United States.

The report provides a good data compilation, but provides little insight into the meaning of the data. Although the report provides little analysis, tax-exempt hospitals have provided significant amounts of financial assistance and other community benefits. [What remains to be seen, however, is whether insurance expansions under the ACA thereby decreasing pool of uninsured patients will cause these numbers to decrease in the future. Tax-exempt hospitals could further struggle to justify tax-exempt status.]

The North Texas State Hospital (NTSH) is part of the Department of State Health Services (DSHS) administration. NTSH is a mental healthcare facility that has two campuses: one department is located in Wichita Falls, TX and the other in Vernon, TX. Including both campuses DSHS is the largest mental hospital in the state of Texas, which provides psychiatric services for the mentally ill. NTSH is the only facility in the entire state of Texas that provides forensic psychiatric care. Forensic psychiatric care is a specialized service for prisoners who have mental disorders. NTSH offers a 284-bed maximum security program for adults and a 78-bed adolescent Forensic Program (DSHS Center, 2017). NTSH aims to improve the health, safety, and wellbeing of individuals by providing the right stewardship, reducing health care problems, improving public health awareness, and preventing diseases. In order to improve health and safety, NTSH is accredited by the Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission is an independent, not for profit association that set standards to evaluate

Big Bend Medical Center is a full-service, not-for-profit, acute care hospital with 325 beds located in Big Bend, Texas. The bulk of the hospital’s facilities are devoted to inpatient care and emergency services. (Gapenski, pg. 27) The outpatient services section of the hospital is used by the Outpatient Clinic, as well as the Dialysis Center. The Outpatient Clinic, which makes up about 80 percent of the outpatient services section, has recently grown in volume and has created a need for 25 percent more space than it currently has. Moving the Dialysis Center to a new building was decide to allow expansion of the Outpatient Clinic. A change and focus on the allocation of costs has some department heads angry and claiming of

EMTALA is the Emergency Medical Treatment and Labor Act that was developed in 1985 as part of the Title IX of the Consolidated Omnibus Budget Reconciliation Act that went into effect in the year 1986 (Sara Rosenbaum, 2012). EMTALA was developed after an article was published in 1986 that documented how Cook County Hospital in Chicago was receiving patients that were “dumped” there that were unemployed, minorities, and lacked health insurance (Singer, 2014). This problem also occurred in 1983 in Dallas where over 200 patients were transferred between hospitals that were not stable (Singer, 2014). EMTALA is under the direction of the Department of Health and Human Services and was developed to address the needs of Americans

Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

According to the American Hospital Association the cost of equipment, services, and information services has risen drastically. A huge problem for hospitals now is that there has been an enormous increase in patients who have Medicare or Medicaid. The Hospital Association states that “60% of all admissions. Neither program fully reimburses the cost of hospital care.” Not only is the hospital not getting paid the full amount through the health insurance, but they have also seen a jump in people who do not have insurance and cannot pay for their hospital expenses this averages out to about six percent of hospital expenses. Hospitals must assume these costs as a part of their charity pay. These costs are then calculated and increase the costs of health care for people who pay for it, in order to cover these costs.

The Hospital Fairness and Transparency Act, state of Massachusetts, I feel it is important for communities’ to be aware, and to ensure their taxpayer dollars are instead dedicated to safe patient care and necessary services in the Commonwealth, and in other states as well. I find it admirable that Advocates actually provided legislators with a list of hospitals with funds stored in offshore accounts and will urge legislators to demand greater transparency by passing the HPTFA. Today communities are asking more questions related to healthcare facilities finances in their communities. Massachusetts health care costs

Since most specialty procedures are inpatient services, EMC’s inpatient occupancy rate suffers. The occupancy rate for Emanuel Medical Center – fifty percent – is far below that of its competitors and industry benchmarks. To accompany this, EMC (on average) receives a lower reimbursement for in-patient Medicare services per patient seen in comparison to its competitors. A result such as this is correlated with directly to the fewer amount of specialty services that EMC offers. In order for Emanuel Medical Center to be able to compete with other hospitals in its service area, it is imperative that EMC evaluates what services they currently offer and are capable to offer in the future to add value to the hospital, increase its revenue stream, and expand its patient mix. Currently, Emanuel Medical Center has not succumbed to its increasing financial pressurealthough EMC has had a negative operating income for five straight years. A negative operating income places EMC at a disadvantage because it limits the hospitals ability to renovate its aging building or hire new specialists to offer revenue enhancing procedures. EMC’s competitors, on the other hand, have large sources of revenue due to their mergers with large healthcare networks such as Catholic Healthcare West. Another competitor, Kaiser Permanente Modesto Medical Center, has extremely large financial resources due to the fact

Safety net hospitals have played an important role in the United States health care system. They provide a significant amount of care to low-income, uninsured, and vulnerable populations. While treating these types of populations, they are still able to provide high cost services such as trauma and burn care. They often take on additional roles and responsibilities such as the training of medical and nursing students (Coughlin et al., 2014). These hospital systems are well known for their open door policy (Wynn et al., 2002). They will examine and treat all individuals, whether or not they can pay for any of their services. The hospitals are not distinguished from other providers by ownership. Some are publicly owned and operated by local or state governments, while others are non-profit. However, they are distinguished by their commitment to provide access to care for all individuals with limited or no access to health care due to their finical circumstances, insurance status or health condition (What is a Safety Net Hospital, 2015).

It was the disillusioned and somber faces of embittered, exhausted nurses and doctors that began to come into focus. An understanding of why so somber sorely became crystal clear. The hollow eyes, lacking sincere expression, a hardened brow, it was their game face. Disassociated from pain, emotional insult and the failure of not being able to save a human life sometimes due to lack of time or ambition, they refused to allow anything to penetrate them, or hurt them personally. It is the self-preservation that only comes with experience which most times are uncontrollable. A prolonged feeling of flight or fight wearing a body and spirit down, grinding at the core of empathy or survival. Pure adrenaline rushes propel healers headlong into the role of herders where they have no time for fragile humanitarian interaction and insidiously a place of healing becomes something like a slaughterhouse.

Apart from the Affordable Care Act, there has been increased government and court involvement in the determination of how healthcare issues are run, like the recent denial of the nonprofit tax exemption status to some hospitals in Chicago (Bergen 2). These hospitals, which include the Northwestern Memorial Hospital and the Prentice Women’s Hospital, are known to provide important healthcare services to patients who cannot afford to pay the expensive costs in private hospitals (Bergen 2). These unfavorable healthcare policies among others are bound to be more frequent and the resultant problems may promote the emergence of other bigger ones unless immediate action is taken.

Non-Profit hospitals can often assist potential patients to care for the uninsured in their community (Kovner & Knickman, 2008).