Hospitals with an emergency department
Every hospital that runs an ED sees patients arrive with dental pain and nowhere to send them. The federal listing of Medicare-participating hospitals marks which ones offer emergency services: about 4,500 of 5,419 do. Inside that number are roughly 2,800 acute care hospitals and 1,300 critical access hospitals, which buy very differently, plus about 140 veterans and military hospitals that buy through federal procurement and are not a commercial target at all. A critical access hospital decides locally. A hospital inside a large system usually does not.
Who decides: the ED medical director owns the pathway, and the director of patient experience owns the score that a long wait with no resolution damages. Care management owns what happens at discharge, which is where a dental referral either exists or does not.
Who signs it off: the value analysis committee at a system hospital, with IT and legal review. At a critical access or independent hospital the administrator can often decide alone, which makes that sub-group the faster half of this row.