ER Docs Play Critical Role in Controlling Healthcare Costs

May 23, 2013
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emergency careOriginally published on MedCityNews.

Insightful new healthcare research from the RAND Corp. emphasizes the growing influence on healthcare spending based on decisions made by the 4 percent of U.S. physicians who work in emergency rooms.

emergency careOriginally published on MedCityNews.

Insightful new healthcare research from the RAND Corp. emphasizes the growing influence on healthcare spending based on decisions made by the 4 percent of U.S. physicians who work in emergency rooms.

Commissioned by the Emergency Medicine Action Fund, the new analysis proposes that emergency physicians serve as the major decisionmakers for nearly half of all hospital admissions in the U.S. And when the average cost of a hospital stay is 10 times that of an ED visit, that puts those departments in the hot seat for deciding which patients need to be admitted and which can be cared for in other settings.

Office-based physicians are relying more on EDs, too. Using public-access data from five nationally representative surveys, RAND researchers determined that the growth in inpatient hospital admissions between 2003 and 2009 was attributed to a 17 percent rise in unscheduled hospital admissions from EDs. On the other hand, admissions from referrals by an office-based physician dropped 10 percent, suggesting that physicians are directing more patients to the ED instead of directly to the hospital.

“Whereas policymakers and third party payers have largely focused on the cost of ED care relative to treatment in other outpatient settings, the role of EDs in either facilitating or preventing hospital admissions may be a bigger story,” the authors wrote.

So charging higher co-pays or turning away patients from the ED probably isn’t the best way to drive down costs. “Efforts to reduce non-urgent and non-emergency use of emergency departments oversimplify a complex problem, and should instead focus on increasing access to affordable options outside the emergency room,” said Dr. Andy Sama, president of the American College of Emergency Physicians, in a statement.

Other stakeholders seem to be catching on to that, too. St. Luke’s Hospital in Iowa used a $50,000 grant from Transamerica to launch a popular Emergency Department Consistent Care Program that helps connect frequent ER visitors with primary care providers and coordinate visits with other health professionals. After one year, people who visited the ER 12 or more times in a year reduced their ER visits more than 60 percent.

Many payers take similar strategies. Optum Health, for example, has a decision support solution that engages with patients after every emergency room visit, to reinforce the primary care provider relationship, educate ER users on alternatives and refer them to health management programs.

“Policymakers, third party payers, and the public should be aware of the various ways EDs meet the health care needs of the communities they serve and support the efforts of ED providers to more effectively integrate ED operations into both inpatient and outpatient care,” the authors concluded.