The American College of Emergency Physicians had their annual meeting in Denver, Colorado this week, and presentations involved several new studies pertaining to people who are the most frequent users of emergency room care. I found that article to be fascinating, in part because it dispels so many myths about emergency room “frequent flyers.” We’ve written before about the fact that most emergency room patients do have health insurance and that emergency room overcrowding cannot be blamed on uninsured patients (as is often cited in casual conversation). Although most emergency room visitors do have health insurance, many of them have public health insurance via Medicare or Medicaid. And since the Medicaid rolls are expected to grow significantly over the next several years, it’s likely that ER overcrowding will grow to become more of a problem as some of those Medicaid patients are unable to access primary care outside the emergency room.
The studies regarding frequent visitors to the ER are particularly pertinent right now, as regulations regarding hospital readmission went into effect on October 1. Hospitals are now penalized if patients are readmitted to the hospital within 30 days of being discharged. If a patient arrives at the ER and is treated but not admitted, the penalty does not apply. But many of the frequent emergency room users do end up being admitted – sometimes because of a genuine medical need and sometimes because of logistical and scheduling problems when ER doctors are unable to coordinate care with home health providers or other doctors. In addition, urgent care clinics are more widespread now than they used to be, and during business hours those clinics are handling more of the minor emergencies (stitches, broken bones, minor infections, etc). That means that a greater percentage of the people who end up in the ER are actually seriously injured or ill – again, leading to a higher ratio of admissions to visits.
But the good news is costs: Emergency room care amounts to only two percent of US healthcare spending. We know that emergency room care is expensive relative to care provided in an urgent care clinic or PCP office, and I would guess that most people would pick a much higher number if asked to estimate the percentage of healthcare spending on emergency care.
Doctors in some of the studies cited a lack of access to digital medical records as a stumbling block when treating any patient in the ER, but especially those who are frequent visitors and/or have serious chronic medical conditions. In Colorado, a medical information sharing system is making great strides in connecting hospitals and doctors in a health information exchange, and all six of the hospitals in Northern Colorado are now part of that health information exchange. I would assume that makes it easier for doctors in the emergency departments of those hospitals to access records for patients who have been treated at any of the region’s other hospitals recently.
Elsewhere in Colorado, progress is being made in reducing the number of alcohol abuse cases that end up in the ER. Paramedics in Colorado Springs use a checklist to determine whether an intoxicated patient truly needs to be in the ER or whether the person can be taken directly to a lower-cost detox center. Roughly 150 patients per month are now being taken to the detox centers and bypassing the ER. Not only does this save money, but it also frees up space and nurses/doctors in the ER to take care of people who are seriously ill or injured. This is good news for Colorado health insurance carriers, ER staff, and patients.
The studies and the doctors at the meeting in Denver all seemed to be focused on how they could better serve the high-usage ER patients. I imagine that improvements in healthcare IT will help, as will the “pre-triage” sorting that is helping to divert patients away from the ER (to facilities like urgent care clinics, mental health providers or detox centers, for example) and freeing up ER resources to treat the sickest patients. Part of the problem will also have to be addressed by improving access to primary care, and that is another problem in itself – especially as millions more Americans get health insurance in 2014.
