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Abidova A, Alcântara da Silva P, Moreira S. Payment perception in the emergency department: The mediating role of perceived quality of healthcare and patient satisfaction. Medicine (Baltimore) 2024; 103:e38527. [PMID: 38847693 PMCID: PMC11155609 DOI: 10.1097/md.0000000000038527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024] Open
Abstract
The aim of this research is to identify the main factors associated with patients' payment perception and the effects of these factors on payment perception. Patients admitted between January and December 2016 at an emergency department of a public hospital in Lisbon, Portugal, were included in this study, with a representative sample size of 382 patients. A 5% margin of error and a 95% confidence interval were used, and all the data were collected between May and November 2017. To test the mediation models, stepwise multiple linear regression analysis was used. The effect of doctors on payment perception through satisfaction and through perceived quality of healthcare (PQHC) is explained by 3% and 4% of the variation, respectively, with statistically significant results (P < .01). Moreover, the effect of privacy and meeting expectations on payment perception through PQHC is explained by 4% and 4% of the variation, with statistically significant results (P < .01). Doctors play a crucial role in understanding the patients' payment perception (with direct and indirect effects). Mediators, in turn, strengthen this effect, in which the contribution of PQHC is more significant than that of satisfaction.
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Affiliation(s)
- Alina Abidova
- NOVA University of Lisbon, National School of Public Health, Lisbon, Portugal
| | | | - Sérgio Moreira
- University of Lisbon, Faculty of Psychology, Lisbon, Portugal
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Venkatesh AK, Janke AT, Koski-Vacirca R, Rothenberg C, Parwani V, Granovsky MA, Burke LG, Li SX, Pines JM. Estimated reimbursement impact of COVID-19 on emergency physicians. Acad Emerg Med 2023. [PMID: 36820470 DOI: 10.1111/acem.14700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The delivery and financing of health care services were altered in unprecedented ways by COVID-19 and subsequent policy responses. We estimated reimbursement losses to emergency physicians in 2020 compared to 2019 related to shifting acute care utilization during COVID-19. METHODS This was an observational analysis of the Clinical Emergency Department Registry (CEDR) and the Nationwide Emergency Department Sample (NEDS). Study sample included all ED visits from a sample of 214 emergency department (ED) sites in the CEDR in 2019 and 2020 as well as all ED visits in the NEDS in 2019. We identified level of service billing code for evaluation and management (E&M) services, insurance payer, and geographic location of ED visits across sites in the CEDR and linked these to fee schedules to estimate total professional reimbursement across sites. Our primary analysis was to estimate reimbursement in 2020 compared to 2019 across the CEDR sites. In our secondary analysis, we linked sites in the CEDR to those in NEDS to estimate nationwide reimbursement. RESULTS Total E&M reimbursement for emergency physicians in the CEDR was $1.6 billion in 2019 and $1.3 billion in 2020, reflecting a 19.7% decline year over year ($308 million loss). In our secondary analysis, we estimate nationwide losses of $6.6 billion, a -19.4% decline year over year. If emergency physicians had received maximum allowable federal relief funds via CARES Act Phases 1 to 3 (2% of 2019 revenue) this would sum to $680 million (2% of the $34 billion) or 10.3% of the estimated $6.6 billion pandemic-related losses. CONCLUSIONS Our analyses provide an estimate of the scale of economic impacts of the COVID-19 pandemic. These findings warrant consideration for policymaker relief and future redesign of emergency care financing. Ultimately, the COVID-19 pandemic likely expanded known cracks in the financing of health care into steep fault lines.
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Affiliation(s)
- Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Centers for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexander T Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy/Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan Koski-Vacirca
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Laura G Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Shu-Xia Li
- Centers for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
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Pines JM, Venkat A. How to fix the Merit-based Incentive Payment System (MIPS) in emergency medicine. Acad Emerg Med 2022; 29:128-130. [PMID: 34375465 DOI: 10.1111/acem.14371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
In this issue of Academic Emergency Medicine, Gettel et al. report participation and performance of emergency clinicians in 2018's Merit-based Incentive Payment System (MIPS). MIPS is an enormous government program that assesses U.S. clinicians on several factors and makes payment adjustments for Medicare fee for service patients based on those results. MIPS performance is assessed in variable ways based on clinical specialty.
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Affiliation(s)
- Jesse M. Pines
- US Acute Care Solutions Canton Ohio USA
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
| | - Arvind Venkat
- US Acute Care Solutions Canton Ohio USA
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
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Pines JM, Zocchi MS, Black BS, Kornas R, Celedon P, Moghtaderi A, Venkat A. The Effect of the COVID-19 Pandemic on the Economics of United States Emergency Care. Ann Emerg Med 2021; 78:487-499. [PMID: 34120751 PMCID: PMC8075818 DOI: 10.1016/j.annemergmed.2021.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/06/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
Study objective We describe how the coronavirus disease 2019 (COVID-19) pandemic affected the economics of emergency department care (ED). Methods We conducted an observational study of 136 EDs from January 2019 to September 2020, using 2020-to-2019 3-week moving ratios for ED visits, complexity, revenue, and staffing expenses. We tabulated 2020-to-2019 staffing ratios and calculated hour and full-time-equivalent changes. Results Following the COVID-19 pandemic’s onset, geriatric (age ≥65), adult (age 18 to 64), and pediatric (age <18) ED visits declined by 43%, 40%, and 73%, respectively, compared to 2019 visits and rose thereafter but remained below 2019 levels through September. Relative value units per visit rose by 8%, 9%, and 18%, respectively, compared to 2019, while ED admission rates rose by 32%. Both fell subsequently but remained above 2019 levels through September. Revenues dropped sharply early in the pandemic and rose gradually but remained below 2019 levels. In medium and large EDs, staffing and expenses were lowered with a lag, largely compensating for lower revenue at these sites, and barely at freestanding EDs. Staffing and expense reductions could not match revenue losses in smaller EDs. During the pandemic, emergency physician and advanced practice provider clinical hours and compensation fell 15% and 27%, respectively, corresponding to 174 lost physician and 193 lost advanced practice provider full-time-equivalent positions. Conclusion The COVID-19 pandemic adversely impacted the economics of ED care, with large drops in overall and, in particular, low-acuity ED visits, necessitating reductions in clinical hours. Staffing cutbacks could not match reduced revenue at small EDs with minimum emergency physician coverage requirements.
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Affiliation(s)
- Jesse M Pines
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
| | - Mark S Zocchi
- Department of Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Bernard S Black
- Pritzker School of Law and Kellogg School of Management, Northwestern University, Evanston, IL
| | - Rebecca Kornas
- Department of Emergency Medicine, Avista Hospital, Louisville, CO
| | | | - Ali Moghtaderi
- Department of Health Policy and Management, George Washington University, Washington, DC
| | - Arvind Venkat
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
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Pines JM, Zocchi MS, De Maio VJ, Carlson JN, Bedolla J, Venkat A. The Effect of Operational Stressors on Emergency Department Clinician Scheduling and Patient Throughput. Ann Emerg Med 2020; 76:646-658. [PMID: 32331842 DOI: 10.1016/j.annemergmed.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/15/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE We assess the effect of emergency department (ED) operational stressors on clinician scheduling and throughput. METHODS We evaluated 2014 to 2018 data from a national ED group. Operational stressors included measures of workload, patient acuity, and complexity. We used multilevel linear regression to estimate the effect of operational stressors, temporal factors, and facility characteristics on ED clinician scheduling; patient throughput, measured as shift-level patient departures per corrected clinician hour; and length of stay. RESULTS In greater than 14 million ED visits across 359 facility-years, the mean of patient departures per corrected clinician hour was 2.23 (95% confidence interval [CI] 2.15 to 2.31). Temporal and facility effects had the greatest influence on patient departures per hour (eg, -0.55 [95% CI -0.75 to -0.36] in 7 am to 3 pm shifts versus midnight to 7 am on Mondays, 0.25 [95% CI 0.03 to 0.47]) in teaching versus nonteaching hospitals, and 0.43 (95% CI 0.24 to 0.61) in larger EDs (30,000 to 59,999 ED visits/year) versus smaller EDs. Operational stressors had significant but small effects on patient departures per hour (eg, length of stay [per-minute increase] 0.002 [95% CI 0.0019 to 0.0023] and percentage admitted [per 1% increase] -0.003 [95% CI -0.004 to -0.001]). Weekday nights, particularly Mondays, had the highest proportion of shifts with increasing length of stay compared with previous years in the same ED. CONCLUSION ED operational stressors had minimal influence on patient throughput when included in adjusted ED clinician scheduling models, whereas temporal and facility factors were more influential. Therefore, incorporating operational stressors into ED clinician scheduling is less likely to balance workloads than accounting for temporal and facility-level factors alone. Length of stay on some shifts, particularly Monday nights, became increasingly long, suggesting they require additional resources.
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Affiliation(s)
- Jesse M Pines
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Mark S Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Valerie J De Maio
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Jestin N Carlson
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | - John Bedolla
- US Acute Care Solutions, Canton, OH; Dell Medical School, University of Texas, Austin, TX
| | - Arvind Venkat
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
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Pines JM. Maybe It's Time to Rethink Freestanding Emergency Departments. Acad Emerg Med 2019; 26:1297-1299. [PMID: 31631479 DOI: 10.1111/acem.13862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Baier N, Geissler A, Bech M, Bernstein D, Cowling TE, Jackson T, van Manen J, Rudkjøbing A, Quentin W. Emergency and urgent care systems in Australia, Denmark, England, France, Germany and the Netherlands - Analyzing organization, payment and reforms. Health Policy 2018; 123:1-10. [PMID: 30503764 DOI: 10.1016/j.healthpol.2018.11.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 09/11/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Increasing numbers of hospital emergency department (ED) visits pose a challenge to health systems in many countries. This paper aims to examine emergency and urgent care systems, in six countries and to identify reform trends in response to current challenges. METHODS Based on a literature review, six countries - Australia, Denmark, England, France, Germany and the Netherlands - were selected for analysis. Information was collected using a standardized questionnaire that was completed by national experts. These experts reviewed relevant policy documents and provided information on (1) the organization and planning of emergency and urgent care, (2) payment systems for EDs and urgent primary care providers, and (3) reform initiatives. RESULTS In the six countries four main reform approaches could be identified: (a) extending the availability of urgent primary care, (b) concentrating and centralizing the provision of urgent primary care, (c) improving coordination between urgent primary care and emergency care, and (d) concentrating emergency care provision at fewer institutions. The design of payment systems for urgent primary care and for emergency care is often aligned to support these reforms. CONCLUSION Better guidance of patients and a reconfiguration of emergency and urgent care are the most important measures taken to address the current challenges. Nationwide planning of all emergency care providers, closely coordinated reforms and informing patients can support future reforms.
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Affiliation(s)
- Natalie Baier
- Department of Health Care Management, Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17.Juni 135, 10623, Berlin, Germany.
| | - Alexander Geissler
- Department of Health Care Management, Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17.Juni 135, 10623, Berlin, Germany
| | - Mickael Bech
- University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark; Department of Political Science, Aarhus University, Bartholins Allé 7, 8000, Aarhus, Denmark
| | | | - Thomas E Cowling
- Department of Primary Care and Public Health, Imperial College London, Kensington, London, SW72AZ, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Terri Jackson
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Parkville, 3010, Melbourne, Victoria, Australia
| | - Johan van Manen
- Dutch Health Authority, Postbus 3017, 3502 GA, Utrecht, Netherlands
| | - Andreas Rudkjøbing
- Department of Public Health, University of Copenhagen, Nørregade 10, 1165 Copenhagen, Denmark
| | - Wilm Quentin
- Department of Health Care Management, Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17.Juni 135, 10623, Berlin, Germany
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