Soaring ER use adds more pain to health costs

About half of all patient admissions come through emergency rooms, creating yet another spending problem.

By Bruce Kennedy May 24, 2013 10:35AM

Injured man on crutches © image100, CorbisIn another sign that America's health care system needs healing, a new study suggests that overworked hospital emergency rooms have evolved into the main entrance point for most patients and that the ER is where most hospitals need to work on controlling costs.


The Washington Post notes that trips to U.S emergency rooms have soared in recent years, from 67 million in 1996 to 119 million in 2008. The Agency for Healthcare Research and Quality estimates emergency department costs account for up to 5.8% of total health care spending -- or up to $151 billion.


"The ER has become increasingly important as a place where people go for acute unscheduled care," Michael Lee, an assistant professor of emergency medicine at Brown University's Warren Alpert Medical School, told Business Insider. "However, there has been little rigorous analysis of its cost structure."


A new study by Rand finds emergency departments take about half of all hospital admissions nationwide. Inpatient admissions and treatment make up 31% of all national health care spending, which means emergency departments can have a major impact on determining overall costs.


"Use of hospital emergency departments is growing faster than the use of other parts of the American medical system," Dr. Art Kellerman, a senior researcher at Rand and the study's senior author, said in a press statement.


"While more can be done to reduce the number of unnecessary visits to emergency rooms, our research suggests emergency rooms can play a key role in limiting growth of preventable hospital admissions."


One of the biggest factors behind the rise of ERs' importance is the economic downturn. Between 2001 and 2008, according to the study, ER use grew at about twice the rate of population growth. At the same time, the number of hospitals nationwide contracted -- with the loss of nearly 200,000 beds -- leaving ERs "crowded with admitted patients who could not be transitioned into inpatient care."


ER doctors, meanwhile, have become more aggressive in their use of costly technologies to diagnose an increasingly older and sicker population. The Rand study quotes a team of Harvard analysts who determined Medicare charges related to emergency medicine were second only to radiation oncology when it came to rising costs.


According to the study, emergency departments "often feel obligated to repeat tests because they cannot get access to the patient's medical record."


Another important factor: Emergency rooms "are the only place in the U.S. health care system where the poor cannot be turned away," the study notes. "As a result, they are disproportionately used by low-income and uninsured patients who cannot reliably get care in other settings."


The researchers say their findings suggest efforts to reduce nonemergency ER visits should focus on finding ways to provide patients with better and more timely access for such care, which in turn would reduce costs by minimizing duplicate tests and cutting down on unnecessary hospital admissions.


"We believe there needs to be more effort to integrate the operations of emergency departments into both inpatient and outpatient care systems," noted lead author Kristy Gonzalez Morganti.


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129Comments
May 24, 2013 1:39PM
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I work in an ER.  We get patients on Medicaid who have NO COPAY come in for a hangnail, runny nose, sore throat, cough for 1 day, etc.  The is no reason these people should come to the ER.  But since the bleeding heart liberals have made it so Medicaid patients don't have to pay into the system, pay a copay, pay a monthly premium, these people come to the ER for these stupid reasons.  This drives up costs for everyone and creates long wait times.  ERs cannot turn people away, even for the most stupid issue and this is part of the problem.
The other part is we have a huge population of people who think they are entitled to all kinds of free things without having to have any responsibility for anything. When people with private insurance go to the ER, there is most likely a copay to discourage ER abuse; for Medicaid patients there is no such disincentive...fixing that would go a long way in fixing some of these ER costs...
May 24, 2013 11:10AM
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Obama-Care will never work.  Socialized medical care will fail.  These people are going to the emergency room rather than to a clinic because they are not going to pay any of their money for the care provided.  The only way for the public to become involved in making sound financial decisions about their healthcare and the cost of healthcare is for all to have some of their skin in the game.  These people don't give a damn because someone else is paying for it for them.
May 24, 2013 1:09PM
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When the Government starts paying for everyone who claims they cannot afford to buy Obamacare next year then: "You ain't seen nothing yet"
May 24, 2013 11:46AM
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My wife and I had occasion to visit our local ER a few weeks ago when we took an elderly neighbor their after she suffered a fall injury outside her home.  She was pretty well banged up and bleeding as a result of her fall.  When we arrived at the ER it was overflowing with people waiting to be seen by ER staff, and with no available seat for our injured neighbor.  After STANDING in the ER waiting area for over 4 hours, and with no physician yet in sight, our neighbor asked that we take her home.  Then, on our way out of the ER, we encountered another elderly neighbor who had just walked into the waiting area with her husband.  We asked our neighbor, " what happened to your husband?".  To which she replied, " Oh nothing.  I just brought him here for his quarterly check-up".

 

Go figure.

 

 

May 24, 2013 1:53PM
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Spendthrift2010,

 

Bull! Those people who come to the ER for minor reasons take up valuable time and space (the sitting kind) for those who actually NEED those resources. If you came into the ER on a Saturday with your elderly mother because she had fallen, hit her head, and had a deep gash (and possibly a concussion), would you want her to be able to sit down (and wait) while someone else is there just to get a "check-up" or has a headache? Get real. The ER is overused, many times because we have become a "got-to-have-it-now" mentality and can't wait for the doctor's office to open on Monday (or the next morning). And why don't they go to Urgent Care anyway?

May 24, 2013 11:14AM
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I thought that if I liked the healthcare plan that I had, that I would be able to keep it (lie), and I thought that the PPACA (Obama-Care) was going to reduce cost by making care providers and drug companies take less for the services that they were providing (lie).
May 24, 2013 3:01PM
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Why don't we let in some more people that we can put on Medicaid, pay for their education, housing and food and then they can bomb us. Get rid of all the illegals and put the welfare lifers to work. 100 buck co pay to go to the emergency room. Then and only then will you correct this problem. Idiots that voted this welfare president in. Now we are all paying the price in our everyday life.
May 24, 2013 4:02PM
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Last time we used the emergency clinic at Pomona valley hospital, my wife had a very serious blood problem due to a botched transfusion.  The emergency room was full  of people, most of whom were post and pre-natal women, and children with cough and runny noses etc. It took 40 min. to get my wife looked at and that was only because I made a scene and had her doctor call.  People will invariable take this post the wrong way and think it's racist or anti poor but almost all of the people in the waiting room could not speak English.  Sorry if that makes people uncomfortable but that is just the way it is for most of the hospital emergency clinics
May 24, 2013 3:34PM
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blame the stupid, lazy trash in this country for most of the problems. they are useless people who drain the society as a whole. maybe they should learn to go without a little
May 24, 2013 3:33PM
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I have an insurance policy where I pay all the expenses out of pocket until my deductable is met.  I have plenty of 'skin' in the game.  My daughter had a non-displaced arm fracture.   She had 1 emergency room visit and 3 trips to an ortho doctor.   The total was $2800!   Her treatment consisted of an X-ray and a splint.  

 

Nobody can tell you in advance how much anything will cost.  The doctor says ask the insurance company.  The insurance company says ask the doctor.

 

It doesn't matter who's policy is enacted costs are out of control.   I have NO problem turning people away who don't have the ability to pay.   So long as a bandaid doens't cost $100!

 

Why don't we create a system of clinics using the Army's care system?  Hire all the medics and let them treat people.   

 

 

May 24, 2013 2:20PM
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puzze face, people like you are why other people can get away with saying that opposition to Obama's POLICIES is racially based when my opposition has absolutely NOTHING to do with that.  I would venture to say that most people's opposition to POLICY is based on policy.  This is really not helpful, stick to the issues.

May 24, 2013 4:33PM
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Sounds good in theory but, as a former ER nurse, I can tell you that much of the expense of emergency care involves "treating the lawyer," not just the patient.
May 24, 2013 2:57PM
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Just how much of that cost  came from illegals?  They always for get the most important part don't they.
May 24, 2013 4:03PM
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a lot of doctors have days or even weeks back log to see patients. and urgent care can be real expensive. I do think the ER is abused but that is part of the reason if they could get an appointment the next day it would be different. I work 60 to 80 hours a week at 9 dollars an hour I guess I am one of those low lives good for nothing lazy scum because I can not afford medical care and insurance After I pay rent car insurance car payment  gas and food theirs not much left I am 55 and while I would try to get more hours I am just not up to it at my age Maybe if employers were not so cheap and pay am honest wage or provide insurance we might not need help. Or maybe we should curl up die because were poor and an imposition on others

May 24, 2013 6:35PM
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I work in an ER in Florida. I have been a RN for almost 20 years. The census has exploded this last year. I see, as others have mentioned, the usual abuse of the ER as a "clinic" or primary care physician alternative for the afore mentioned reasons. I also see the DR's practicing "Law" as opposed to medicine, fearful of litigation in all appearances to me. The thing that shocks me and disgusts me is the massive un-needed diagnostic tests these physicians are ordering. I am not sure what has triggered this trend. I am sure the "pt satisfaction numbers" is driving some of this as it is tied directly to insurance reimbursement, specifically medicare reimbursement. These unnecessary tests not only slow and bog down already overcrowded ER's and thus increase wait times but add to an already overwhelmed ED staff increasing work load and backlog and delay. The Dr's must be under pressure to reduce their Time numbers" and I have seen a whole set of orders being put in for a pt BEFORE the DR even see's the pt. One example is that a 70 'sh year old pt comes into the ED with a complaint of head pain for 2 weeks , he was ambulatory and in no apparent distress, steady gait alert oriented , warm pink and dry, the DR ordered a CT scan of the brain and a full series of blood work including Blood Cultures and ekg and chest x-rays , all BEFORE the practitioner laid eyes on the pt, but based on the chief complaint, this starts the clock so to speak and the DR's "time to se pt" are improved.. I went into see the pt to do my assessment and found that he had a rash on the left side of his scalp. .clinically consistent with shingles which was the diagnosis after all the thousands of dollars of un needed testing. It makes me sick. The bottom line is that that CEO's of these hospital corporations  are making multi million dollars at the expense of throwing pt's into bankrupcy as well as making the insurance companies multi millions and making the RN's into "ditch diggers" stressing the nurses by overwork and impacting their families due to bringing this stress home. it is criminal what is happening !
May 24, 2013 3:56PM
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what a dysfunction system? people paid insurance couldn't afford, but these paid nothing could.

May 24, 2013 10:49AM
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We can fix the system if we stop chasing only dollars. We can fix the system if we stop fighting among ourselves and start working together.
May 24, 2013 1:52PM
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We use the urgent care clinic when it's not major but someone in the family might need stitches or an xray.  Perhaps if these were made more accessible to people without insurance minor emergencies could be handled in a more cost effective way.

May 24, 2013 2:46PM
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As one old coot of 70 I've been to an ER just once over the last decades, and that was for being stung on my right hand which swelled up before my lower forearm did the same.  I think we are getting to the place where a mantra will become "DON'T GET SICK AND DON'T GET HURT".....I've had just two operations in my life so far---a tonsillectomy at 12 and a removal of a thumb cyst at age 35. 

May 24, 2013 3:33PM
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Forever the same; costs rise for the working folks who pay so more non workers can get free care. The sicolists have about taken over this Country. The collapse (due very soon) will be worse than that of USSR because we do not have seperate states with seperate language and culture. There will be warfare in the streets within a few years.
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