State Wants Hospitals to Report Better ER Data, but Hospitals Resist Mandate

The hospital association argues for voluntary ER data reporting, seeking to avoid a new mandate or fees. But the state says the best way to ensure hospitals report this data -- and to help identify the misuse of emergency rooms for mental patients -- would be a statute.

The Oregon Health Authority wants Oregon hospitals to step up their data reporting to include information on emergency department visits, but the Oregon Association of Hospitals and Health Systems is fighting the legislation.

Jon Collins, a health analyst at the health authority, said that half the 350,000 inpatient hospital admissions in Oregon begin in the emergency room, but the state has less data about the state’s 1.4 million annual ER visits than what goes on once the patient is admitted for inpatient care.

“Discharge data would give information from every single patient, regardless of payer,” including the uninsured and those with federally regulated health plans, which are not required to submit data to the state’s all-payer, all-claims database, Collins said.

Todd Bybee of Tuality Hospital said that hospitals were not opposed to sharing this data, but they oppose paying additional fees to the Oregon Health Authority, they oppose a legislative mandate, and they oppose allowing the state agency to have rulemaking authority over the information that must be reported, since some data the state seeks may be above and beyond what they collect currently.

In his written testimony, Bybee noted that discharge data sent to the state are based on what is necessary for billing, and standards are set by the National Uniform Billing Committee, not Oregon hospitals or the Oregon Health Authority.

But Collins said the data the health authority is currently authorized to collect is gathered along with fees charged to hospitals to cover the cost of the contractor who aggregates and disseminates the data. The new fee must be approved by the Oregon Health Policy Board and reported to the Legislature.

“It’s pretty clear that not having ER data is a pretty big gap,” said Sen. Elizabeth Steiner Hayward, D-Beaverton. “We already have in-patient data and discharge data.”

Sen. Laurie Monnes Anderson, D-Gresham, said that ER data was particularly important to track when hospitals use emergency rooms to board patients during psychiatric episodes, and would shine light on whether patients are being routed to more appropriate in-patient and outpatient care.

The strongest supporters of Senate Bill 816 are advocates for people with mental illness, who have been working to reform the way hospitals treat psychiatric care, in an effort to move away from emergency room boarding.

“More robust reporting from hospitals will help identify trends and use of emergency rooms when someone is in a behavioral health crisis,” said Teresa Dean, a Medford nurse who testified by phone.

The state of Washington was sued for its emergency department boarding problem, and Collins argued that the Oregon Health Authority might be able to avoid a similar legal challenge if it could better monitor and analyze the situation in Oregon’s emergency departments. He opposed voluntary reporting because some hospitals have not always been forthcoming with other data releases, forcing the state agency to take action to force those hospitals to comply.

“Voluntary reporting allows OHA no enforcement mechanism and will not help the state guard against a lawsuit,” Collins said.

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