Is the ED Too Convenient?
June 18, 2014 | Jane Stuckey
Some people assume that one of the factors driving inappropriate use of emergency departments is the fact that they’re always open — and thus more convenient for patients.
However, two recent studies, in Colorado and Oregon, have determined that time of day is typically not a factor in patients’ choosing the Emergency Department, even for the 60 to 65% of visits that are avoidable. The biggest factor for the Medicaid patient in a pilot study was the lack of physicians who accept Medicaid, or for others, some particular insurance. Medicaid in these states usually reimburses for an ED visit, so the patient has “no skin in the game.”
The cost to treat a patient in the ED is often two to three times what it costs to treat a patient in a physician’s office, and there is pressure on all to reduce the number of avoidable ED visits. A variety of players are making efforts to address this issue:
- Co-pays for various insurance companies continue to rise in an effort to deter unnecessary ED visits
- Increasing numbers of alternative retail healthcare providers are advertising low-cost services and extended hours
- 33% percent of physician offices, according to a recent study by the Advisory Board, are now offering extended hours at least a few days per week — not only for appointments, but for walk-ins as well
- 21% of primary care offices see patients on weekends
Despite these and similar initiatives around the country, ED use rates continue to rise, so more needs to be done. Education of patients as they join insurance plans is necessary, but a one-time explanation is certainly not enough. Physicians in the ED must also join the battle, and share advice with their patients whose emergencies are not life- or limb-threatening. Since patients visit an ED to see the physician, this probably would have an impact.
Another change that could be very helpful: when primary care physicians are notified that one of their patients has had an avoidable ED visit, they should have a staff member immediately call the patient and discuss alternatives. An on-call physician who could respond to patients during unusual times, and on-call nurses who work under protocols could also be excellent solutions. Last but not least, case management of those patients with frequent ED visits is becoming very important, not only in controlling costs, but also in ensuring improved continuity of care for the patient.
Colorado and Oregon have taken the first step in trying to understand what causes a patient to go to the emergency department. They hopefully can now take steps to have patients access the appropriate care. Of course, there is also a pressing need that has yet to be resolved: to provide enough physicians, ARNPs and PAs. But until we can somehow make more appropriate options for care more convenient and accessible, there may be little incentive for many patients to change their ways.
As a nurse who works in a free medical clinic in Georgia, I have also noticed the secondary social gains that patients receive when they are seen in the Emergency Department. For the indigent patient who struggles with a multitude of social issues, the immediate gratification of having someone care cannot be overestimated. This has never been studied — but should be. Still, we need to find better and more appropriate ways to solve this need. Look for more on this topic in a future blog.
ABOUT THE AUTHOR Jane Stuckey RN, BSN, MS, FACHE
Drawing upon experience as a COO in both non-profit and for-profit healthcare systems and Director of Clinical Affairs for a major insurance company, Jane recommends strategies that result in improved patient, staff, and physician satisfaction, operational efficiency, and financial strength. Read more from Jane.
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