Annals Study Details Cost of Boarding

A study in the October issue of Annals of Emergency Medicine is the first of its kind to detail the daily costs of boarding for a hospital.

“Our analysis found that caring for patients who are boarding in the emergency department nearly doubled the daily cost of care for the hospital,” said lead study author Maureen M. Canellas, MD, MBA, FACEP, assistant professor of emergency medicine at the University of Massachusetts T.H. Chan School of Medicine, and associate chief medical officer at the University of Massachusetts Medical Center. “Boarding is a systemic problem that requires collaborative solutions. This cost data should give hospital leaders a new perspective when addressing the boarding crisis.”

The total daily cost per patient was $1,856 for those boarding, which is nearly double the $993 for those receiving inpatient care. The daily cost of boarding intensive care patients in the emergency department was $2,267 compared with $2,165 for those being treated in the intensive care unit. The authors examined the cost of care for 25 patients who had a stroke and then boarded in the emergency department for a combined 563 hours at a large, urban, academic comprehensive stroke center hospital. The study used time-driven activity-based costing to quantify the care cycle by calculating daily resource use, salary data, and operating costs. This research was supported by the Emergency Medicine Foundation and Emergency Medicine Policy Institute’s Health Policy Research Scholar Award.

Boarding is more costly than inpatient care and the overall costs of boarding are likely higher than reported, the authors noted. The study did not factor in other costs associated with prolonged hospital stays, including occupied beds unavailable for evaluation and treatment of new patients, staff inefficiencies, or the potential for malpractice lawsuits.

Although this analysis focused on hospital costs, the dangers for patients are well established. Nearly 70 studies have shown that boarding was associated with elevated health and safety risks, prolonged delays in treatment, and increased likelihood of death. These dangerous bottlenecks are also associated with ambulance diversion, preventable medical errors, violent episodes, and care team burnout.

ACEP Continues to Lead the Call for Accountability, Solutions to the Boarding Crisis

ACEP met with the Biden Administration in late October to discuss its proposal to require hospitals to have plans in place for when they reach capacity. ACEP President Alison J. Haddock, MD, FACEP, urged the White House Office of Management and Budget to adopt an ACEP-developed standard that would require hospitals to create and implement protocol to move admitted patients out of the emergency department when the hospital reaches a specific capacity threshold. ACEP’s comprehensive multiyear efforts to address the root causes of boarding include alerting the White House, sounding the alarm through hundreds of troubling stories directly from the frontlines, and tying boarding-related attestations to hospital performance measures, among other initiatives.

ACEP efforts culminated in an October stakeholder summit convened by the Agency for Healthcare Research and Quality. ACEP is making sure that emergency physicians have a prominent seat at the table for critical conversations that impact you and your patients.

ACEP-Supported Bill Introduced to Stop Medicare Payment Cuts, Provide Inflationary Update

On October 29, the ACEP-supported bipartisan Medicare Patient Access and Practice Stabilization Act of 2024 (H.R.10073) was introduced in the House of Representatives by congressional physician champions and physician allies. Now, it needs emergency physician support to help enact it into law. This bill addresses the impending 2.8 percent Medicare Physician Fee Schedule (PFS) cuts scheduled to go into effect on Jan. 1, 2025, and provides a temporary update to the PFS via a one-year inflationary update of half the 2025 Medicare Economic Index (MEI), a proposal similar to recommendations that the Medicare Payment Advisory Commission (MedPAC) recently shared with Congress.

This bill is a vital stopgap to fully prevent the imminent cuts facing emergency physicians at year-end, establish an important precedent of reflecting inflationary pressures in the Medicare physician payment system, and provide the physician community and Congress additional time to collaborate on long-term physician payment reform. ACEP and 130 organizations representing physicians, health care providers, hospitals, and other organizations support passing this bill into law.

ACEP Vermont Chapter Voices Strong Opposition to Hospital Conversion Plan

A recommendation by Vermont’s Green Mountain Care Board (GMCB) to convert four hospitals into standalone emergency departments staffed by nonphysicians is being met with strong opposition from ACEP’s Vermont Chapter.

“Emergency medicine is a complex and demanding specialty that requires comprehensive training and expertise,” said Vermont ACEP President Niki Thran, MD, FACEP. “Every Vermonter deserves access to a fully qualified emergency physician when they arrive at an emergency department.”

The chapter’s letter to the GMCB outlined concerns about care quality and patient safety, emphasizing that nurse practitioners (NPs) and physician assistants are indispensable members of the care team; however, they simply do not have the training or education of an emergency physician. The letter explained that unsupervised nonphysician care can lead to:

Increased costs: NPs delivering care without supervision increased lengths of stay by 11 percent and raised 30-day preventable hospitalizations by 20 percent compared with emergency physicians.
Increased resource utilization: Multiple studies have demonstrated higher diagnostic test utilization, longer length of stay, and reduced clinical efficiency in non-emergency physician-led staffing models.
Lower patient satisfaction: Ninety-five percent of voters said it is important to them for a physician to be involved in their diagnosis and treatment, and 62 percent said patients are most likely to be harmed from scope of practice changes.
Increased medico-legal risk: More than 85 percent of malpractice claims against NPs are because of errors in diagnosis, treatment, and medication.
Increased inappropriate prescribing: Compared with physicians, nonphysicians are more likely to prescribe antibiotics when they are not needed and overprescribe opioids.

ACEP strongly supports state and national efforts to prioritize physician leadership. There is no substitute for a licensed, trained, and board-certified emergency physician.

In Case You Missed It

ACEP Announces New Migraine Point-of-Care Tool: ACEP’s new Migraine in the ED point-of-care tool is now available. This tool aims to help emergency physicians better diagnose and treat patients who present with this common complaint. Visit poctools.acep.org.
ACEP Releases Clinical Policy on Thrombolytics for Acute Ischemic Stroke: The recently approved Clinical Policy on Thrombolytics for Acute Ischemic Stroke will be published in the December issue of Annals of Emergency Medicine. The latest policy is an update of the 2015 Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department, and seeks to evaluate the outcomes for patients who present with an acute stroke from a large vessel occlusion who have received endovascular therapy with or without intravenous thrombolysis.
Don’t Miss ACEP Accelerate in Orlando Jan. 18-23: There will be multiple meetings in one fantastic location.
- AAWEP Power Up: Women in Leadership – Jan. 18
- Observation Medicine Science and Solutions – Jan. 18-19
- ACEP/CORD Teaching Fellowship Phase 1 – Jan. 18-22
- ED Directors Academy: Leadership Essentials – Jan. 19-23
- ED Directors Academy Small Group Masterclass – Jan. 19-22
- ED Directors Academy Team Strategies and Applied Management – Jan. 20-23
- Pediatric Emergency Medicine Assembly – Jan. 20-22
- Reimbursement & Coding – Jan. 20-22