America’s emergency departments now produce about half of all hospital admissions, according to a recent RAND report. They also account for nearly the entire increase in admissions from 2000 to 2009.
The study also found that most people seek care in an ED because they believe they have no viable alternative, not because it is convenient.
It’s logical to think that will change as the federal government moves to provide health insurance to 25-30 million Americans who are currently uninsured. But a Harvard University study of newly insured Oregonians suggests the opposite. The study, published in the Journal of Science, found that ED use was about 40 percent higher for the newly insured.
One possible explanation for this surprising turn is that previously uninsured patients had very heavy out-of-pocket costs to deal with after visiting an ED. Having insurance greatly reduces those costs.
Data for the study was pulled from the Oregon Health Insurance Experiment, which used a drawing to assign Medicaid to 30,000 low-income adults from a pool of 90,000.
Proponents of the Affordable Care Act (ACA) have claimed expanded coverage will increase access to primary care for non-emergent conditions. They claim this would decrease health care costs overall by diverting those patients from EDs, which are deemed to be the most expensive source of healthcare. But some primary care doctors refuse to treat Medicaid patients. They then go to the ED, which is the only place in the U.S. healthcare system where the poor cannot be turned away.
These findings suggest that EDs will experience even greater volumes as the ACA moves forward, complicating an already serious nationwide overcrowding problem. From a cost standpoint, the impact may be negligible since economists say emergency room use makes up only a small part of healthcare costs in the U.S.
But study after study has shown that ED overcrowding negatively impacts both mortality and morbidity because patients don’t get access to care in a timely manner. And this holds true not only in the ER, but throughout the hospital.
In the past, most hospitals addressed ED overcrowding as an ED problem and relied heavily on direct approaches, such as triage upon entry, dedicated care teams and other process revisions.
Some of the nation’s leading hospitals, however, recognized that overcrowding is a downstream problem that is caused by delays in patient flow throughout the hospital. These hospitals addressed overcrowding on an enterprise-wide basis, overhauling not only processes, but the way processes are put into action. They became the early adopters of patient flow automation, which helps trim wasted time out of the entire patient care, and they have enjoyed stunning success.
Today, the overcrowding problem is widely recognized as enterprise-wide and patient flow automation has evolved into automated operations management, which provides a real time view into virtually all of a hospital’s daily functions. That means hospital leaders now have the means to attack overcrowding itself in real time.
Based on the Harvard study, that’s a capability they will find very useful.
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