I am sure every ED has some boarders at some point during the year. Still,
the issue of how to best deal with this should be focused on two areas: 1)
what is best for the patients; and 2) how to get paid for your service.
*In my opinion*, it is best for both patient care and billing to admit to
an inpatient service as soon as possible. We maximize both our decision
making and billing early in the ED course on most non-critical patients,
which should be reflected in billing at the appropriate high level on
Since most insurance providers do not reimburse under "prolonged ED stay"
codes, we then admit the patients. We don't utilize an observation unit run
by ED physicians since it can difficult to staff as a "separate physician
group" in order to be reimbursed under current guidelines; in other words,
if, as an ED physician, we admit to ourselves, we can only bill for the
admission H&P OR the ED Stay, but not both.
In addition, continuing to manage admitted patients in the department while
more and more patients are coming in is bad for patient care! We should be
focusing on the new patients and allow the inpatient physicians to focus on
the admitted patients. This way, everyone is seen and cared for in the most
efficient process, and billing/collection is maximized.
This is why all patients boarded in our ED are managed by the inpatient
specialties and sub-specialties within 2 hours of the admission decision.
The ED physicians, as always, are available for codes and/or other emergent
conditions that come up.
PEM Division Director
Cardinal Glennon Children's Hospital
Saint Louis, MO
On Fri, Aug 21, 2015 at 3:48 PM, Bill Schroeder <[log in to unmask]>
> I'm looking for help from the listserv.
> How many of you have boarding from your admitted patients?
> If so, who is responsible for the boarders? The ER? The admitting
> physician/hospitalist? A joint effort? If joint, how do you divide the
> I assume the no matter what, the ER physician is willing to get involved
> if there is a code or other emergent condition.
> Thanks in advance and sorry if this has been recently discussed.
> Bill Schroeder
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