The following information is the result of a survey conducted by an independent financial services company of three different hospitals using ENDS documentation system.

Figure 1 illustrates the average, or typical distribution of a hospital emergency room’s patient visits based on acuity level. These estimates are based on actual data provided by three ENDS client hospitals. On average, hospitals experienced a significant shift in acuity level due to the incorporation of the ENDS program into their emergency department operation. As seen in this graph, patient visits decreased by approximately 40% for Levels 1&2 while there was a corresponding increase in patient visits for Levels 3, 4, and 5 of approximately 60%. It must be noted that other factors will drive changes in the distribution of acuity level. For example, hospitals will experience changes in this distribution based on geographical location (urban v. rural), demographics and the existence or non–existence of urgent care, or after–hours care programs that alleviate some of the load of non–emergent walk–in cases into the emergency department.


Figure 2 shows the estimated impact of the ENDS program on a hospital emergency department’s revenue stream. The graph in Figure 2 is consistent with the graph trend–line in Figure 1 – that is, after implementation of the ENDS program hospitals experienced a significant decline in paid revenue associated with lower level visits, and a sizable increase in paid revenue due to Level 3, 4 and 5 visits. Of the hospitals surveyed, there was a wide variance of the percentage changes between levels; however, on average, these hospitals experienced an overall increase in paid revenue of approximately 45%. This estimate, of course, is conservative, and does not take into consideration any billings related to ancillary procedures.


Again, as seen in Figure 3, hospitals experienced a considerable increase in the average payment per patient–visit due to the ENDS program. Hospital A more than doubled its average payment from $102 to $219. Hospital B experienced a 55% increase from $101 to $157; and Hospital C experienced a 58% increase from $90 to $142. The impact of the ENDS program varies among hospitals and is driven by a host of other factors such as patient mix, patient volume and the hospital’s specific Medicare wage index. Medicare APC payment rates for the various levels are skewed, therefore, a shift from a Level 2 to a Level 3 visit equates to a 76% payment increase; a shift from a Level 3 to a Level 4 visit equates to a 72% payment increase; and a shift from a Level 4 to a Level 5 visit equates to a 220% payment increase.