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CMS Quietly Makes Some ED Wait Times Public

 |  By cclark@healthleadersmedia.com  
   March 07, 2013

How fast can an emergency department diagnose, triage, and assure proper care for all patients who come through its doors, however scared, intoxicated, delusional, in pain, infectious, bleeding, and maybe even close to death they may be?

With precious little fanfare, Uncle Sam last month rolled out a big, fat database with seven measures comparing a service that many people—healthcare providers and patients alike—consider the most critical any hospital can provide.

The government's data reveals how long a hospital's ED keeps patients waiting to…

…Be seen by a healthcare professional
…Receive pain medication if they have a broken bone
…Be taken to an inpatient bed if they need admission
…Receive appropriate treatment and be sent home, or
…Receive an appropriate brain scan if they might be suffering a stroke


See Also: CMS Posts ED Wait Times, Rankling Some Hospitals


I thought the Centers for Medicare & Medicaid Services would make a bigger fuss about such a major release. Certainly with so much concern about ED overcrowding, and the number of patients being boarded in hospital hallways and even closets, coughing on each other and getting sicker as they wait, a three-month picture of the state of an ED's throughput  speed should be a very big deal.

The wait times, reflecting care from January 1 to March 31, 2012, are listed on the Hospital Compare website under the tab, "Timely and Effective Care," paired with comparative numbers at the state and national level., This way anyone can see how any hospital stacks up against up to two others at the same time.

But after a few conversations with emergency care experts who know how to read between the lines of this 29,664-record database, I started to realize how raw and flawed this effort still is.

For example, I learned late Wednesday that because of a bizarre glitch by the Georgia Hospital Association, which extracts data reports from claims for its member hospitals, wait times showing for 170 Georgia EDs are hopelessly inflated. [Editor's note: The Georgia Hospital Association has informed HealthLeaders Media that an error by GHA affected the emergency department wait times of 11 Georgia hospitals, not 170.]

The Georgia wait times appear—incorrectly—to be among the worst in the country because every patient is coded as if he or she arrived at midnight, regardless of what time he or she really arrived.

Second, the data reveals that many of the thousands of hospitals reported no data on several measures, perhaps because they weren't interested in obtaining the 2% market basket update on its outpatient reimbursement that CMS rewards hospitals that go to all this trouble.

Or maybe because they didn't want to spend the time, or didn't want to face a long-standing problem prompting questions from not just patients, but donors and politicians as well.

Third, as I heard from Jesse Pines, MD, an emergency room doctor and researcher who directs the center for healthcare quality at George Washington University, an awful lot of hospitals, many of them with very heavy emergency room traffic, submitted "too few cases" to "reliably tell how well a hospital is performing."

"The thing that was surprising for me with some of this stuff is that a lot of these hospitals have tens of thousands of (ED) visits in a year, and it seems remarkable that some of them wouldn't have enough patients to report on," Pines says.

"It's one thing for a patient to have something like a heart attack, where people go directly to the cath lab. But for ED patients, there should be plenty to report on.  It seems that either they don't want accurate numbers to be up there or…actually I can't come up with another reason," he says.

Pines is also a spokesman for the American College of Emergency Physicians. And as such, he has drilled down extensively into the idea that emergency room care at each hospital will improve when it is measured and compared with other emergency rooms in its community, state, and across the country.  In general, ACEP is pleased that CMS has reached this point, he says.

For example, even in the data set now up on Hospital Compare, one can discern enormous variation in times for each measure, and make decisions accordingly.

I took a look at just a few larger hospitals, just to see the spread. For ED-1, the time patients spent in the ED before they were admitted to the hospital as an inpatient, the average wait times ranged from 979 minutes or nearly 16.5 hours at 745-bed Los Angeles County/University of Southern California Medical Center, to 2.5 hours at 460-bed Atlanta Medical Center in Atlanta, GA, to 2.8 hours at 198-bed Swedish Medical Center in Seattle.

One could say that big city hospitals that are more likely to have people in their EDs who are poor, and use the hospital as a primary care doctor's office, might be more crowded, and have more waits. That would be understandable.

But even in my own urban neck of the woods, San Diego, CA, the three hospitals within a few miles of my home: UCSD Medical Center, Scripps Mercy Hospital, and Sharp Memorial, which treat many of the same populations, all show varying times on most of the seven measures. 

For example, I would wait 22 minutes to be seen by a healthcare professional at Scripps Mercy, 27 minutes at Sharp (just under the state average of 33 minutes) but 78 minutes at UCSD.  But if I wanted pain medication for a broken bone, I would get it faster at Sharp, in 54 minutes, as opposed to 70 at Scripps Mercy and 85 minutes at UCSD, longer than the state average of 69 minutes.

In time, public reporting should prompt all hospitals to improve their EDs, hopefully in time for when more people receive coverage and seek care, and as baby boomers like me get closer to the day when the ED may mean the difference between life and death.

But hospitals need to get moving to find their vulnerabilities and smooth their flow, and this new public report of the data seems the perfect nudge to do that.

"The theory is that when hospitals report this information, it makes them focus on it, and improve throughout their ED," Pines says, "but it's very hard to do. Certain performance measures are easier to fix—like simple process measures like giving patients an aspirin—than improving ED throughput, which involves development of interdisciplinary teams."

"The good thing about having public reporting of all this is that it allows for a hospital's reputation to be tied to performance in its emergency department."  It pushes hospital administrators to focus on the ED as well, he says.

Let's hope it does.  And let's hope this big fat database improves so it can move this process along.

 

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