HB 1678 – Regulation of hospitals. Provides that a hospital must contain an emergency medical service facility. Provides an exemption from the emergency medical service requirement hospitals that provide only long term care services. Rep. Brown. Passed the House by a vote of 60 to 37.
I don’t have any direct knowledge of the problem here, but I’m going to guess that emergency rooms tend to be money losers for hospitals. A lot of the people who go to emergency rooms are poor and need expensive treatment. So, perhaps hospitals think that maybe they’ll make more money if they can just treat the non-emergency cases. On the other hand, if I am even correct that this is the problem the legislature is seeking to address, it’s only a band-aid. Emergency room treatment is a really expensive and inefficient way to provide medical care to the poor.
The vote was mostly, but not entirely, along party lines with Republicans mostly voting “no.” So, it will be interesting to see if the bill will be dead on arrival in the Senate. Senators Miller and Simpson are the sponsors, so it should at least get a hearing.
[tags]HB1678-2007, health care[/tags]
Generally, if Sen. Miller is involved, it in some way benefits the medical status quo.
In this case, I suspect the true purpose of the bill is to protect existing hospitals by ensuring that all hospitals have money-losing emergency rooms.
My guess is also it might have something to do with regulating the proliferation of specialty hospitals such as all the new cardiac-specific hospitals going in these days. IIRC there’s been a desire to regulate these new care specific hospitals and this might be one way they’ve tried to do it. An orthopedic hospital, say, specializing in high end hip and knee procedures wouldnt’ necessarily have or need an emergency facility open to the general public.
Many Bush -type conservatives maintain that since everyone has ER access, everyone has ‘Health Care’. Doesn’t it seem short-sighted for Republicans to vote against a requirement that all hospitals provide ER service? Many use ER as they would a clinic.We should expand ER service to offer walk-in diagnostic blood tests and colon tests.If ER is Health Care in a general way ,let’s improve it.
Interesting theory, Doug, but hospitals are often reimbursed by Medicaid, so I don’t think that Emergency Departments are money losers, at least, for the most part. Emergency Departments may not be the most efficient means to provide non-emergency care, but until there are 24/7 alternatives that will handle such care, ED’s are what we have. Some free clinics aren’t really free, and they are usually open from 8 to 5 Monday through Friday. Anything that that clinics can’t–or often won’t–handle they send to the local Emergency Department. Also, there are people from all income levels who do use the emergency rooms for true emergencies and on weekends and evenings when their regular doctors are not around. My “inside source” ;-) tells me that non-emergency care actually is a money maker for ED’s–at least those in rural referral center hospitals.
My guess is that a situation came up when someone went to one of those specialty hospitals and was unable to get emergency care for a heart attack or something. The Indianapolis area is really saturated with specialty care centers, so maybe the proposed legislation is a ham-handed way of dealing with that.
Any relationship between this bill and previous cases in the New Albany area using CON’s to try to prevent private hospitals from being built?
Anything is possible, I suppose. But, I kind of had those cases in mind when I was checking out this bill, and I can’t think of any connection.
I believe that braingirl and Pila are both correct.
First look at ERs within the hospitals. Why do hospitals want ER ?
The main reason is because by physicians performing procedures or services at the hospital, the hospitals can charge for that time (OR time, nursing time, implants, etc..). The ER is the access point inwhich you intake people needing a larger portion of these services. The more services that you offer at your hospital, the larger the volume of patients through the ER. Understand that most ER groups are private group of MDs that are profitable and the ancillary staff are hospital based. With a larger volume of patients, there are inherent problems of handling them. Coupled this with the fact of the EMTLA law. So now you have urgent/ emergent problems that HAVE to be seen (EMTLA) and evaluated. The urgent cases can be profitable such as PILA suggested because of lower complexity and you can move through these cases quicker (this will depend on your community payor mix). These cases are typically seen and evaluated by physician assistants allowing the physicians to concentrate there training upon higher acuity patients.
Now add to Doug’s previous forum on high price of drugs, etc.. in the hospital. Hospitals are faced with cost pressures and are tying to make up the difference. Diagnosis related group (DRG) hospital payment system means you are paid a lump sum patient’s major diagnosis. There is an emphasis on “lump sum”. This system began in New Jersey during the Regan Administration. It changed from hospitals charge whatever they want to a predetermined cost structure. Why are people being discharged earlier from hospitals to convalesce at home ? The billable time for them to be in the hospital is up. I do think medicine has advance but to some degree the billable DRG has some part in discharge time.
Hospitals are interesting entities when you think of them in a traditional buisness model and how to generate positive cash flow. However, you should probably try to differentiate between non-profit organizations and for-profit organizations. This bill is an example of non-proftis entities trying to put pressure on for-profits. Maybe because they (non-profits) are having a difficult time providing services when compared to the for-profits. Mostly because non-profits system are SOO massive there is inherent dissatisfaction/inefficiencies from providers who use them AND these same providers are tired of how money is being made on their backs. Thus a direct response to this was….non-profits hospitals system. My understanding is there is an halt for any NEW for-profit hospitals being built.
Correction in the second to the last sentence..should be for-profit hosptial system.
Matt, if my thick mind can condense that down, does that mean the bill tries to protect the status quo?
Joe
I not sure of how to interpret the meaning of “status quo”.
I would interpret this bill as the St Vincent’s Hospital systems (non-profits) are trying to compete with Ortho Indy (for-profit).
If you call yourself a “hospital” and replace a knee then you probably can charge more.
I have worked at both places and the for-profits is a better experience for patients and providers.
Wow, Matt! Very impressive. Inpatient stays are much short now when compared to 25 or 30 years ago. DRG’s and insurance requirements pretty much dictate how long someone stays in the hospital for care. Outpatient services and ED are often where the revenue is generated at non-specialty hospitals, so I do find it hard to believe that anyone is thinking of shutting down an ED due to an overwhelming number of uninsured, non-urgent cases coming through. (Please note, I could be wrong! :))
I’m sure there are times when ED staff are overwhelmed and wish that community clinics were open 24/7 to handle the workload of non-urgent cases. It really doesn’t make much sense to have to go to an ED to get treatment for strep throat or a minor injury. Even in a small town, a person has to go through triage, have their vitals taken, go through admissions, then see a doctor or maybe a physician assistant or nurse practitioner. With minor ailments, there is usually a long waiting time in between all of those things. ED’s are costly and time-consuming way to administer non-urgent care, but there aren’t many alternatives.
By status quo, I mean the situation where places like St. Vincent’s are competing with Ortho Indy.
It seems to me the purpose of the bill is to erect barriers to competition. Kind of like Sen. Miller’s midwife bill in past years.
Joe
What perfect opening to something that is near and dear to my heart HB 1241. This bill has a great deal of difficulty getting through the Senate Health and Provider Service committee. I believe the market is ready (from consumer to physician) for such a bill.
Indiana is the last state in the United States to for PA to presribe any medication.