emergency department is the Wild West of health-care.† The MDxL Hospitalist
Company was formed to try and bring some order to this pivotal area
after the ED physician chooses to admit a patient, as well as provide
effective traditionalist hospitalist care.
Some things to consider:
- Nearly all critically ill, high-cost patients experience at least
one, but usually more than one emergency department visit.
- Admissions through the emergency department are much greater than
they need to be and, left unchecked, the trend/bias toward admissions
is on a high rate of rise, for the foreseeable future.
- Emergency department physicians are mostly interested in rapid triage
out of the Emergency Room.† The easiest route out is to admit.
- Hospital contracts with the ED physicians groups usually favor admission.
- ED physicians have little experience in outpatient care and no ability
to follow outpatients. Therefore they have little understanding of
what can be done outside the hospital.
- Diagnostic related groups (DRGs) usage, which is the Medicare payment
mechanism, has taught hospitals "easy admissions are the most
Some current physician quality issues
- Emergency department physicians who agree to cover the ED are frequently
those who need patients, are new to practice, or are involved in full
time coverage of the emergency department. These physicians may
benefit from "churn" whereby admissions get many consults
and a return of that favor helps build their practices.
- Hospitals are finding it increasingly difficult to find good physicians
to cover the ED because of late night admissions with no increased
pay, and required coverage of uninsured cases.
- Most patients are admitted over the telephone without being seen
and are frequently not seen for many hours or until the next day,
therefore, initial planning is delayed and LOS is longer.
- On-call assignment of attendings in the emergency room is frequently
a primary care physician or a specialist who is not necessarily the
best fit for the patientís problem.
- ED selected attendings frequently call in immediate specialty consults
Poor reach of Health Plans UM into the Emergency department.
- Most emergency department physicians call health plans for approval
but do not proactively discuss care management with health plans.
- Emergency departments use call lists, not necessarily health plan
preferred providers as preferred attendings.† Therefore, cost to the
to the health plans and to the patients are higher because non-participating
providers are frequently used for emergency department admissions.
- Non-participating providers generally have little incentive to work
with health plansí utilization management coordinators, and little
incentive to discharge the patient as timely as possible.
- There is no one pivotal place where a health plan can centralize
activities for working proactively with hospitalizing physicians.
How does MDxL Work?
- The MDxL network is a contracted or salaried set of selected community
physicians who act as custom-fitted hospitalists for patients admitted
by contracted health plans through MDxL.
- MDxL selects the network by using the experience of emergency department
physicians, available health plan data, hospital data, and physician-to-physician
- MDxL frequently uses large groups of specialists and generalists
since these groups have very significant 24-hour a day hospital presence
as well as specific efficiency, knowledge and contacts within the
- MDxL's flexible design allows it to range from a traditionalist
hospital model to a more customized specialist model. MDxL feels no
single approach fits all.
- When a contracted health plan patient comes to the emergency department
an MDxL sticker is placed on the chart.† If the ED physician wants
to admit the patient, then the MDxL nurse triage is called. The MDxL
physician evaluates a patient in the emergency room in a timely manner
prior to admission.
- In the ED the MDxL attending arranges care and places a finalizing
call to the MDxL triage nurse.
- If admitted, the MDxL triage assigns a length of stay and monitors
- MDxL may utilize on-site physician hospital captains to review cases.
- From the moment MDxL assigns an attending physician, demographic,
and some diagnostic data, is available on the Web for review and reporting
to MDxL and selected health plan staff. Data is available on a real
time basis to health plans.
- MDxL hones its physician network by continuously reviewing and evaluating
reports and physician cooperation.
MDxL Utilization outcomes - better, timelier patient care
- MDxL has consistently reduced hospitalization through the emergency
department by 20% or more.
- MDxL has reduced LOS of admitted patients by 20% or more.
- Patient satisfaction is high because patients get seen in the emergency
room by an appropriate specialist and out-of-pocket costs are less.
- Health plans have an access point to monitor, discuss, and manage
hospital and emergency department care more effectively.
- Emergency department physicians quickly learn that downloading risk
and responsibility of patients they wish to consider for admission
takes just one call to MDxL.
- Frequently, hospitals are initially concerned about control issues,
but eventually they learn the benefits of more efficient care and
willingly work with MDxL to utilize best practice methods.