Soaring ER use adds more pain to health costs
About half of all patient admissions come through emergency rooms, creating yet another spending problem.
In 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.
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".
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?
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.
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
what a dysfunction system? people paid insurance couldn't afford, but these paid nothing could.
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.
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