Redesigning the Emergency Department for 15 Million Newly Uninsured: Financial and Operational Strategies to Strengthen Flow

Speakers

Cody Walker Baptist Health AR
Cody Walker, FACHE,
President, Baptist Health Medical Center-North Little Rock
Headshot Bill Phillips
Bill Phillips
Chief Operating Officer, University Health
Cecelia Moore, Vanderbilt (1)
Cecelia Moore, MHA, CPA, CHFP,
Chief Financial Officer, Vanderbilt University Medical Center
jason
Jason Harber
Head of Inpatient Flow Business, LeanTaaS

Summary

Emergency Departments have long been the front door of the hospital — and the pressure valve for everything upstream and downstream. Yet today, EDs nationwide are facing unprecedented strain from growing patient volumes, staffing shortages, and downstream boarding challenges that ripple across the system. 

Now, new policy shocks threaten to intensify these pressures, with an estimated 15 million people projected to lose Medicaid coverage by 2034 and turn to emergency care as their primary access point.

The financial stakes are staggering: $12 billion lost annually from ED boarding across the US, $10,000-$20,000 lost per patient on average from declined transfers, and $2,000 lost per patient per day from extended lengths of stay.

In this discussion, financial and operational leaders will share how they are aligning financial strategy, technology investments, and operational redesign to strengthen ED performance. Together, they’ll discuss how thoughtful coordination between finance and operations can reduce leakage, improve throughput, and create the stability hospitals need to weather growing access challenges.

Learning objectives:

  • Understand the financial impact of ED boarding and access bottlenecks — and how system-level investments can mitigate revenue loss and strengthen margins.
  • Explore how aligning operational and financial strategies can reduce inefficiencies, improve throughput, and expand patient access.
  • Learn how predictive technologies and data-driven planning support more agile staffing and resource allocation.
  • Gain a cross-functional perspective on how finance and operations leaders are partnering to stabilize the “front door” of the hospital amid rising demand and shifting payer dynamics.

Related resources

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Chapter 1: The Looming Challenge

If you work in the healthcare industry, or even if you’re just an interested observer, you don’t need a book to tell you that the financial pressure is on as never before. A perfect storm of circumstances is swirling together, one that will make survivability, not to mention profitability, a greater challenge for healthcare companies than we’ve seen in the modern era.

As with banks, retailers, and airlines, which had to rapidly enhance their brick-and-mortar footprints with robust online business models—it is the early movers eager to gain new efficiencies that will thrive and gain market share. The slow-to-move and the inefficient will end up being consolidated into larger health systems seeking to expand their geographical footprints.

The pressures on healthcare

Let’s look at just a few of the looming challenges healthcare must meet head-on.

An aging population

By the year 2030, the number of adults sixty-five years of age or older will exceed the number of children eighteen years or younger in the United States. We are living longer than our parents did. Positive news for sure, but problematic for several reasons.

The older we get, the more medical help we need. Older people have more chronic diseases. By 2025, nearly 50 percent of the population will suffer from one or more chronic diseases that will require ongoing medical intervention. This combination of an aging population and an increase in chronic diseases will create a ballooning demand for healthcare services.