Responses by: Drew Swiss, Vice President of Finance, Montefiore Medical System (Bronx, N.Y.)
Have you seen more patients come through the emergency departments during the recession?
Yes. We have seen a 30 percent increase in our self-pay activity. I believe that other hospitals in the New York metropolitan area are seeing increases as well. We try our best to get these patients on Medicaid coverage, but it doesn’t always work. Seventy-five percent of our business is Medicare and Medicaid. We have increased our provision for bad debt and charity care based on our experience in 2008, where we also saw an increase in self-pay activity.
Could you explain how a system-wide management approach to the ED improves efficiency?
Montefiore is the third busiest ED in the country. We have about 290,000 visits per year at our three EDs. About 75 percent of all our admissions come through the ED. We have one central management team for the entire ED. We have an operations vice president, a clinical vice president and a chairman that work as a team for all the EDs in our system.
What are challenges related to documentation in the ED?
There’s more under-billing than over-billing in the ED. Inaccurate documentation used to be a problem for us. We now use a template software program to facilitate documentation for the physicians. It’s sort of like a miniature care plan for a patient. Doctors are not really trained to document and that affects accurate billing. We experienced a $3 million a year revenue improvement when we implemented this process.
Will Montefiore pursue any federal stimulus funds?
Yes, we have a task force formed to evaluate the areas of the stimulus that would be appropriate for Montefiore. In the area of technology, we’re in the process of rolling out our ambulatory EMR, but we have had an inpatient EMR for a long time.