Emergency Department Medical Directors’ Knowledge of Medicare Payment Policies for Inpatient Admissions
Public Deposited- Last Modified
- February 27, 2019
- Creator
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Owens, Scott
- Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
- Abstract
- Introduction: The policies governing Medicare reimbursement for inpatient admissions affect admission status for older adults. These rules strongly influence the willingness of hospital providers to accept patients from the emergency department. We contend that emergency physicians have limited knowledge of these rules, and that knowledge is tied to how EM medical directors would manage patients in hypothetical cases designed to be inappropriate for admission under current Medicare guidelines. Methods: We administered an online survey to emergency department medical directors presenting two hypothetical cases designed to miss one or both of the Medicare severity of illness and intensity of service criteria. The cases also raised issues of 30-day readmissions penalties and condition at presentation vs. admission. We asked Respondents questions about the applicability of Medicare rules to the cases, how they would manage the patients, and what case management resources they use or could use in managing these patients. Results: Sixty-two medical directors of the 1,460 reached via the Medical Directors listserv completed the survey. Overall, knowledge of Medicare admissions guidelines was limited, with the average respondent answering 56.3% (S.D. 13.1) of questions correctly. We found no correlation between two kinds of Medicare knowledge, that of of the intensity of service/severity of illness rules, and knowledge of the rules governing 30-day readmissions. Physicians with greater knowledge were less likely to recommend inpatient admissions that Medicare guidelines would consider inappropriate. They were also more likely to recommend skilled nursing placement over inpatient admission in a hypothetical case that would qualify for skilled nursing, but not inpatient care(p=0.02). Conclusion: Knowledge of Medicare admission and readmission rules among emergency department medical directors is limited, and stronger knowledge is associated with more likely recommendations for appropriate care, and may be associated with a reduction in social admissions. This pilot study successfully identified targets for further inquiry including the role of case management in preventing social admissions for injured older adults and the identification of predictors of EM physician awareness of Medicare inpatient payment policies.
- Date of publication
- August 2012
- DOI
- Resource type
- Rights statement
- In Copyright
- Note
- Paper type: Policy
- Track: HC&P
- Advisor
- Tolleson-Rinehart, Sue
- Degree
- Master of Public Health
- Degree granting institution
- University of North Carolina at Chapel Hill
- Graduation year
- 2012
- Language
- Deposit record
- b6f6bdeb-f0b9-4907-a2ad-769b5d2e1080
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