Pines Jesse M, Stierwalt Joshua B
Md Med. 2015;16(1):15, 17.
The 2014 Maryland Medicare Waiver alters the reimbursement model by transitioning from fee-for-service to global payments for hospitals. This increases the need for hospital-based emergency departments to become more cost-conscious, particularly regarding high-cost imaging and admission decisions. Evidence based medicine offers a potential solution to achieve these aims. Development and use of validated clinical decision rules and care pathways can reduce unnecessary testing and reduce hospital admissions where a patient could be treated as an outpatient. Paired with functional systems incorporating alternative care pathways and health information technology, clinical decision rules can reduce cost without sacrificing patient safety or experience.
2014年马里兰州医疗保险豁免政策改变了报销模式，从按服务收费转变为对医院的整体支付。这增加了医院急诊科提高成本意识的必要性，尤其是在高成本影像检查和住院决策方面。循证医学为实现这些目标提供了一个潜在的解决方案。开发和使用经过验证的临床决策规则及护理路径可以减少不必要的检查，并减少可作为门诊患者治疗的患者的住院情况。与包含替代护理路径和健康信息技术的功能系统相结合，临床决策规则可以在不牺牲患者安全或体验的前提下降低成本。
