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In the News: Mar 21–28

Specialized Psychiatric EDs Improve Care and Increase ROI

A recent CNN Health article discusses the creation of psychiatric EDs to address efficiency in traditional EDs and improve quality of care for patients with behavioral health conditions. As behavioral health conditions increase in prevalence, so does the rate of patients seeking care for mental illness or substance use disorders in the ED. Currently, 1 in every 8 ED visits is related to mental health and/or substance use. Traditional EDs feel the strain and often do not have the appropriate resources to provide treatment for these patients.

Health systems are creating psychiatric EDs staffed with specialists with the intention of stabilizing and treating patients with behavioral health conditions and providing them with additional resources to ensure longer-term care. There are roughly 100 psychiatric EDs nationwide, and the number is growing.  Research studies have shown these specialized EDs have a high return on investment (ROI) because patients spend less time in emergency care and are provided with comprehensive treatment necessary for their condition.

As traditional EDs continue to feel the strain from the increasing number of behavioral health patients, Sg2 believes that it is imperative for health systems to develop a plan to increase throughput while providing effective treatment to this patient population. To learn more about how your organization can address challenges related to throughput and boarding of behavioral health patients in the ED, please read the Sg2 FAQ Interventions Targeting Behavioral Health Throughput in the ED.


MedPAC Recommends Increase to IP/OP Payment Rates

A recent Becker’s Hospital Review article highlights key takeaways from the Medicare Payment Advisory Commission’s (MedPAC) newest report to Congress earlier this month. MedPAC’s report on Medicare payment policy provides Congress with recommended changes to be considered for 2020.

This year’s MedPAC report calls for a recommended 5% reduction in home health payment rates and mentions potential further reductions through other means. Additionally, the report suggested increasing hospital IP and OP payment rates by 2% due to a variety of factors, including Medicare patient access, hospital access to capital and hospital quality. Although no payment rate changes were recommended for ambulatory surgery centers (ASCs), MedPAC did call for HHS to prioritize collecting ASC cost data.

While this MedPAC report outlines several Medicare policy recommendations, any changes to Medicare payment policy would be implemented through regulation by CMS or through legislation by Congress. To learn about potential health care policy changes and their impact, watch the Sg2 Experts Live Q&A: Payment and Policy Update (Spring 2019).


A New Series Explores Employers’ Role in Health Care

A recent 5-part series in Harvard Business Review explores the role of employers in health care (including a brief history of value-based purchasing by employers) from Walmart’s direct contracting in 1997 to the current work of accountable care organizations (ACOs). Part 2 of the series examines 2 strategies in employers’ new “health care playbook”: a centers of excellence strategy where employers develop episode-based bundled care contracts with the highest-performing providers and an ACO strategy where employers pay a set amount per employee for a defined episode. The article’s authors recommend that employers gather data, set goals, and look at their size and geography before selecting providers to work with.

Employers spent nearly $700 billion in 2018 on employee health care, and they continue to look for ways to control employees’ rising health care costs. Sg2 believes that employer contracting offers health systems an opportunity to cement relationships and capture commercial volumes by addressing employers’ pain points. To learn about the broad menu of employer contracting options available, read the Sg2 report Employer Contracting: Strategies for Netting Commercial Revenue and Volumes.

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