Hospitals confirm changes in procedure ordering

The Massachusetts Hospital Association announced today that the Emergency Department in all hospitals in the Commonwealth has requested limited elective procedures, or ones that are elective or anticipated within the next few months. This limited authorization is for elective procedures that are performed at an average cost of $7,000 each. The requested authorization involves certain tests, outpatient procedures and surgeries that are targeted to “overutilization,” or unnecessary.

Patients and health plans are involved in the decision and allowed to choose their own paths, depending on the plan and/or the patient’s individual preferences. Both hospitals and health care consumers are encouraged to communicate regularly with one another to ensure that all patients, including those who do not have health plans, are treated equitably and with access to appropriate care.

On Wednesday, April 18, preliminary estimates by the Commonwealth College and Medeiros Consulting Group forecasted the continued shift in hospital visits to outpatient care, rising from 17.4% of total patient visits in 2006 to 22.2% in 2015. They also project a drop from the 21.7% of outpatient care visits in 2007 to 21.1% in 2015.

Those figures include all inpatient and outpatient medical conditions but not chronic illnesses like diabetes, cancer, mental illness or conditions involving anesthesia.

The Emergency Department is playing a critical role in the Commonwealth’s health care system, but the use of elective procedures in the Emergency Department is at the core of what is likely to be a transition from inpatient to outpatient care. To this end, hospitals are requesting limited authorization to curtail unnecessary procedures, such as MRI scans, X-rays, or CT scans, if they are not anticipated within the next few months. This approach is part of the State’s transition to a reimbursement model that allows for more “value-based” care by paying for outcomes rather than just treatment and volume.

Hospitals acknowledge that patients and health plans are responsible for having an awareness of their own medical conditions and understand their own individual priorities for treatment of their medical conditions. Hospitals urge them to carefully consider whether an elective procedure they may be considering is supported by their own individual care and needs, as well as their family’s personal preferences and financial costs. Ultimately, hospitals want patients to feel empowered to make their own care choices to improve their overall health.

Hospitals are reaching out to their key stakeholders including hospitals, health plans, the public and health care consumers to enhance their understanding and communication, for example, through annual surveys that clearly inform consumers about conditions and medical options for care and how the system is changing.

How are hospitals contacting consumers about these changes?

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