MedPAC Urges 30% Cut To Stand Alone Emergency Room Payments

[Bill Call]

MedPAC (the Medicare Payment Advisory Commission) has proposed cutting payment rates by 30% for stand alone emergency rooms that are within 6 miles of an on campus hospital emergency room. Even though free standing emergency rooms have lower costs than hospital based facilities they generally receive the same reimbursement rates.
By costs I mean the cost to the provider. The patient pays the same rates at a stand alone emergency as they would at a hospital emergency room.

Insurance companies generally use MedPAC guidelines to determine their reimbursement rates.

What does this mean for the Lakewood stand alone emergency room?

Other stand alone emergency rooms in the region also include a minute clinic. Lakewood's stand alone ER does not.

[Bridget Conant]

What does this mean for the Lakewood stand alone emergency room?

Why do you think the Clinic has a clause in the contract that lets them “reassess” the need for an ER in Lakewood and further allows them to decide to not provide service any longer.

Nice negotiating job there, Summers and Butler!

Once the payment levels drop, bye-bye ER!

[Dan Alaimo]

How do they define "stand-alone emergency room"?

[Bridget Conant]

How do they define "stand-alone emergency room"?

Any ER without an attached full service hospital.

[pj bennett]

Why do you think the Clinic has a clause in the contract that lets them “reassess” the need for an ER in Lakewood and further allows them to decide to not provide service any longer.

Isn't that what happened in Sagamore Hills? Cleveland Clinic decided that the facility was underutilized. I know the plans were to turn it into an express care facility staffed by nurse practitioners and physician assistants.
I don't get out that way, so I don't know the final result.

And, I still remember Dr. Brian Donley's chilling words, when he said that the Family Health Care Center HAS to make a profit. Breaking even would not cut it.

[Dan Alaimo]

How do they define "stand-alone emergency room"?

Any ER without an attached full service hospital.

Some insurance plans have different co-pays for "urgent care" and "emergency room." Just yesterday I had to use one for a quasi-urgent matter because I couldn't get an appointment within a week with my primary doc. That's the reason why the difference between "emergency room" and "urgent care" is fresh in my memory, and why I'm wondering how they define "emergency room."

[Bridget Conant]

Here’s articles discussing it. The reimbursement will be about $150 less per claim.

https://www.npr.org/sections/health-sho ... anding-ers

http://www.modernhealthcare.com/article ... /180409947

The NPR article states:

But hospital representatives say the proposal could cause some free-standing ERs to close their doors.

[Dan Alaimo]

I followed these links, and some of the ones they linked to, and the answer to my question is not at all clear. One of them referred to the distinction between Emergency and Urgent care, but that is glossed over in the current news reports about this proposal.

One thing is clear, the Cleveland Clinic Lakewood Emergency Room would definitely be affected.