Although the U.S. Supreme Court last summer gave states the right to decide their own participation in Medicaid expansion, the significant incentives written into the Affordable Care Act (ACA) will probably mean that most hospitals across the nation will be dealing with lots of new patients in the next decade.
The question is how those hospitals will be able to accommodate the extra admissions.
A Kaiser Family Foundation recent report suggests that even those states that do not expand Medicaid will experience a bump in Medicaid enrollment because of other mechanisms in the ACA that will encourage currently eligible patients to enroll. The report says even if no states expand eligibility, Medicaid enrollment across the country will climb 4.8 million by 2016 and 5.7 million by 2022.
If all states implement the expansion, the report says, an additional 21.3 million individuals could gain Medicaid coverage by 2022, a 41% increase compared to Medicaid without the ACA.
So far, twenty-one states (and the District of Columbia) have already indicated that they will expand Medicaid eligibility to people earning 133% of the federal poverty level, and thirteen states have decided not to participate.
The Kaiser analysis notes how the payment incentives can promote participation. Under the ACA Medicaid expansion, states would spend less on uncompensated care, and providers as a whole would receive more revenue than under ACA with no states expanding Medicaid.
“For example, we estimate that hospitals could receive $314 billion additional dollars between 2013 and 2022, or 18% more than they would receive under ACA with no states expanding Medicaid.”
But before those hospitals start counting their money, they must answer the question of how they will provide increased access for all those patients. Right now, many hospitals across the U.S. are running at what they perceive to be full capacity (90 percent census). However, studies have shown that the average is more like 60 to 70 percent.
Why the discrepancy? Because most hospitals still rely on outdated manual processes to keep track of patients and available beds. Hours pass before an empty bed is changed, let alone filled. Patient room doors are closed after discharge to hide the fact that a bed has become available on the floor. Nurses still have to make physical “rounds” to do bed counts, then report the number of available beds to patient placement. Departments still “own” their own beds and make their own placements, regardless of the needs of other departments.
With those types of processes still in place, hospitals will be leaving many of those new Medicaid reimbursement dollars on the table, because they will continue to have problems finding places for all those new patients.
However, there is a solution. It’s TeleTracking’s Real-Time Capacity Management™ platformwhere TeleTracking not only automates the entire patient flow and capacity management process, it tells you in real-time just how much more space you have available to increase your census. From the ED through PeriOP through discharge, it provides a “moving” picture of a hospital’s entire operation, so you know every moment where your patients, staff, medical devices and available beds are.
What plans has your hospital made to deal with the influx of newly insured Americans who will be knocking on your emergency room doors?