Editor’s’ note: The remarks that follow are opinions based on the best information we can find from public sources and from private interviews, with and without attribution. We believe them to be factual.
Will IU Health hire physicians from Parkview and Lutheran systems or will they bring in outside doctors?
From what NICHE has seen, the answer is yes to both. IU Health is quite open to hiring local, qualified physicians who seek a change, from competing systems, depending also on their availability to contract should they be bound by a non-compete agreement with an existing employer. However, Dr. Geoff Randolph, Chief Medical Officer for IU Health in Fort Wayne, has said that they would also seek to recruit physicians from outside the area, including family practice residents who train here, with the purpose of increasing access for patients. To shuffle physicians from one system to another (given no other reason) does not increase the physician to patient ratio in this region. NICHE welcomes efforts by all three systems to make northeast Indiana attractive to physicians.
Why are so many emergency rooms/departments (ER/ED) being built and expanded? Parkview’s Randalia ED has grown and Lutheran Hospital Network is expanding its Lutheran Hospital ED.
If you’ve read our articles on EDs and trends in healthcare, you’ll recall that several factors are strongly trending to reduce hospital admissions nationally:
Federal policy (CMS) has a finger on the scales that promotes patient treatment as outpatients and encourages hospital dismissals as quickly as possible.
Insurance copayments and deductibles are higher and thus patients are discouraged from seeing physicians and being admitted to hospitals.
More options are available for outpatient treatment
These factors have combined to depress hospital admission numbers nationally. But, the ED is the primary portal for hospital admission, especially for the elderly. In fact, 75% of patients over 85 are admitted through the ED and 57% of those over 65 (see (https://www.ncbi.nlm.nih.gov/pubmed/27037128). As we posted earlier in the week since Medicaid has been expanded and contrary to government expectations, ED visits increased by 40%. An expected increase in visits to primary care offices did not materialize. Thus, hospitals see ED expansion as a way to increase admissions.
A Type A ED must be open 24/7. Any adjoining spillover area designated for lesser treatment is a Type B ED and must not use Type A billing codes, meaning Type B EDs are paid less even for the same treatment. Urgent care centers do not qualify as Type B EDs. Lastly, hospital-owned freestanding EDs (FSED) are reimbursed by CMS at twice the amount of an urgent care facility. Thus a trend toward emergency department expansion both to accommodate more visits and to gain hospital admissions.
But trends in CMS regulation tend to discourage ED use, and patients need be aware that the average cost of an ED visit is over $1,200 compared to less than $100 at an urgent care facility (see “25 facts and statistics on emergency departments in the US,” https://www.beckershospitalreview.com/…/25-facts-and-statis…).