Tufts University School of Medicine, Boston, MA; Baystate Medical Center, Springfield, MA.
OptiStatim, LLC, Longmeadow, MA.
Ann Emerg Med. 2014 Apr;63(4):404-11.e1. doi: 10.1016/j.annemergmed.2013.08.020. Epub 2013 Sep 17.
We determine the contribution margin per hour (ie, profit) by facility evaluation and management (E&M) billing level and insurance type for patients treated and discharged from an urban, academic emergency department (ED).
Billing and demographic data for patients treated and discharged from an ED with greater than 100,000 annual visits between 2003 and 2009 were collected from hospital databases. The primary outcome was contribution margin per patient per hour. Contribution margin by insurance type (excluding self-pay) was determined at the patient level by subtracting direct clinical costs from contractual revenue. Hospital overhead and physician expenses and revenue were not included.
In 523,882 outpatient ED encounters, contribution margin per hour increased with increasingly higher facility billing level for patients with commercial insurance ($70 for E&M level 1 to $177 at E&M level 5) but decreased for patients with Medicare ($44 for E&M level 1 to $29 at E&M level 5) and Medicaid ($73 for E&M level 1 to -$16 at E&M level 5). During the study years, cost, charge, revenue, and length of stay increased for each billing level.
In our hospital, contribution margin per hour in ED outpatient encounters varied significantly by insurance type and billing level; commercially insured patients were most profitable and Medicaid patients were least profitable. Contribution margin per hour for patients commercially insured increased with higher billing levels. In contrast, for Medicare and Medicaid patients, contribution margin per hour decreased with higher billing levels, indicating that publicly insured ED outpatients with higher acuity (billing level) are less profitable than similar, commercially insured patients.
通过对设施评估和管理(E&M)计费级别和保险类型进行评估,确定从城市学术急诊部门(ED)出院的患者每小时的边际贡献(即利润)。
从 2003 年至 2009 年间,从医院数据库中收集了超过 100,000 次年度就诊的 ED 接受治疗并出院的患者的计费和人口统计数据。主要结果是每位患者每小时的边际贡献。通过从合同收入中减去直接临床成本,在患者层面上确定了按保险类型(不包括自付费用)计算的边际贡献。不包括医院间接费用和医生费用及收入。
在 523,882 例门诊 ED 就诊中,商业保险患者的边际贡献每小时随着设施计费级别增加而增加(E&M 级别 1 为 70 美元,E&M 级别 5 为 177 美元),但医疗保险患者(E&M 级别 1 为 44 美元,E&M 级别 5 为 29 美元)和医疗补助患者(E&M 级别 1 为 73 美元,E&M 级别 5 为-16 美元)则相反。在研究期间,每个计费级别下的成本、收费、收入和住院时间均有所增加。
在我们医院,ED 门诊就诊患者每小时的边际贡献因保险类型和计费级别而异;商业保险患者最有利可图,医疗补助患者最无利可图。商业保险患者的每小时边际贡献随计费级别增加而增加。相比之下,对于医疗保险和医疗补助患者,每小时边际贡献随计费级别增加而减少,这表明具有更高急性(计费级别)的公共保险 ED 门诊患者的利润低于类似的商业保险患者。