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A New York hospital's charge capture initiative gives the ED a financial boost.

A recent study in the Annals of Emergency Medicine warns that the survival of emergency departments is at risk due to the rising cost of treating patients while reimbursement rates are falling. The result is more financial pressures on an already strained emergency care system.

But some hospitals are finding ways to fight the tide.

Mount Sinai Medical Center in New York is using technology to capture charges better and ensure higher reimbursement rates, says Kevin M. Baumlin, MD, an associate professor of emergency medicine and reimbursement specialist at the hospital. Baumlin led a charge capture initiative in response to hospital leaders who in 2003 warned Baumlin and his colleagues that "they were going to kick out our practice unless we increased our revenue," he says. "We’re an academic practice, but we still need to make money." Indeed, in a world where reimbursement pressures continue to build and where private companies have arisen to offer outsourcing of EDs, physician groups running the ED have to get better at collecting the charges they’re due—or many of them might be done.

Mount Sinai got better fast. In one year, the hospital generated a $7.5 million revenue increase due to more diligent charge capture. Baumlin, who practices in the ED as well as consults with other hospitals looking to improve ED charge capture, says the key to improvement starts with communication and a process for improving documentation. "I work with individual docs if they are deficient in their charting and look for ways we can bring money into the practice by coordinating critical care visits, for example. What CMS will pay for is a constantly changing environment. So it’s not just something you can just do, you have to keep up with it."

Baumlin says that rewarding charge capture with bonuses has helped secure physician buy-in for documentation improvements. "I try to make it easy for the docs using technology and prompting," he says. "And I’ve been able to give them bonuses where they weren’t getting bonuses before."

On the practice side alone, Mount Sinai hit $8.1 million in revenue for 2007 since starting the program in 2003 and 2004 with between $2.5 million and $3.5 million in annual revenue, Baumlin says. "Granted, our volumes have gone up, but that’s in part because we have been able to increase our level of service," he says. "All I’m trying to do is get them paid for the work they’re doing. That’s the real bottom line."

Philip Betbeze

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