March 30, 2022

No one said life would be easy.  Look no farther than Sunday’s Academy Awards, when comedian Chris Rock was suddenly smacked upside the head on live TV by actor Will Smith (who went on to win the Oscar for best actor that same evening).  Fortunately for Rock, Smith’s assault did not involve a debilitating blow.  Nevertheless, the comedian (as well as the audience) was left a bit traumatized. 

You never know what life will throw at you.  Whether it’s a right hook at a social gathering or a traffic accident on the way home, trauma occasionally occurs; and that’s when you may find yourself heading to the emergency room (ER).  Emergency providers have seen it all: bullet wounds, stab wounds, fractured skulls, rodeo cowboys who’ve just been gored by the horns of a Brahma bull; the number of ways a body can be contused and abused is endless.  Then there are the severe ailments that don’t involve cracked bones or lacerated tissue but that nevertheless require the immediate attention of an ER doctor: severe vomiting due to ingesting a harmful chemical, a heart attack, intense pain due to appendicitis, to name a few.

Where would we be without the nearest ER unit when the situation is dire and people are desperate?  Emergency departments are an enormous asset to our communities, and we are very thankful for those who dedicate their lives to providing life-altering care when it’s needed the most.  But are these services being correctly staffed and adequately reimbursed?  What are some of the key issues in emergency medicine over the last year?  Today’s article will provide a few items for our readers to consider.

Pandemic Pressures

According to physician and lawyer Sai Balasubramanian (whom we’ll refer to as simply “Dr. Sai”), practitioners of emergency medicine are facing growing challenges.  In an article he wrote last year for Forbes Magazine, Dr. Sai asserted that the COVID pandemic actually led to the plummeting of emergency department volumes, despite the large numbers of COVID-positive patients.  This, in turn, led to a contraction in the demand for ER physicians.

The American College of Emergency Physicians (ACEP) conducted a survey nearly eight months after the onset of the pandemic.  A report on its findings included the following description:

Many emergency medicine group practices were forced to make workforce, coverage, and benefit changes: 21percent have had to lay off physicians; 31 percent have had furloughed physicians; 56 percent of groups have cut pay for the same work; 83 percent have experienced a decrease in productivity; 83 percent of groups have cut hours of ED coverage; 47 percent of groups have deferred or cut benefits.

The survey also described the frustrations that many physicians were personally facing, including loss in compensation, working more hours, and lack of support infrastructure.

Pre-existing Problems

According to Dr. Sai, this decline in ER physician prospects was not due to the pandemic alone.  Rather, he sees it as a trend that was simply exacerbated by the pandemic.  There were pre-existing concerns of job market saturation due, in part, to the increasing number of emergency medicine residency programs throughout the nation.  This resulted in an increasing supply of emergency medicine physicians, especially in large cities.

It is ironic that, while the country is experiencing a shortage of healthcare workers generally, there is a comparative glut in emergency medicine clinicians—at least in terms of Sai’s assessment of the situation in 2021.  As we head into the spring of 2022, there are new circumstances in play and new dynamics at work.  For example, ACEP released this month its projections of new applicants for ER residency positions.  It noted that there was a decline in the percentage of filled positions for 2022, which may be the beginning of a new trend.  The organization said that they are not yet able to identify a singular cause for this year’s numbers, with so many factors now at play.

Litigation Liability

It has been noted that the United States has one of the highest rates of litigation when compared to its global counterparts.  In its 2019 Advocacy Handbook, the Emergency Medicine Resident Association (EMRA) stated the following:

The impact of medical liability is massive; in fact, 99 percent of physicians in high-risk specialties by age 65 years old have already been subject to a claim, and approximately 7 percent of emergency physicians are sued each year […] Emergency medicine is a high-risk specialty for medical malpractice, with 1 out of every 14 emergency physicians getting sued each year.

According to Sai, the high-risk nature of emergency medicine is congruent with the nature of the work.  Emergency medicine physicians are forced to make quick decisions, based on limited information, in order to do what is best for the patient in the moment.  The conundrum of liability in emergency medicine is challenging, especially in terms of “defensive medicine.”  Interestingly, organizational leaders continue to emphasize that physicians should not be practicing defensive medicine, i.e., ordering a variety of extensive diagnostic tests or procedures to ensure that nothing is missed, in an effort to mitigate liability.  So, emergency physicians are “forced to straddle a thin line due to a perpetual fear that a missed diagnosis or failed treatment plan may result in a career-defining (and sometimes, career-ending) lawsuit,” according to Sai.

Coding Compliance

On top of the issues of staffing, salary rates and liability concerns, there is also the matter of proper coding of services.  There were several rule changes in 2022 as it concerns evaluation and management (E/M) coding, shared visits and critical care services within the hospital setting.  The ER physician may be affected by some or all of these changes.  We have published past articles on these changes, and we encourage our readers to go back a look at those alerts.  In addition, we want to emphasize that we, at MiraMed Global Services, provide a full range of facility and professional coding services.  We submit well over a million claims each year, and we have compliance experts on staff to help you with any issues that may arise.  If you would like to see a list of our hospital-specific business solutions, please reach out to us at info@miramedgs.com.