A recent study by the RAND Corporation found emergency physicians are key decision-makers for nearly half of all hospital admissions, highlighting the critical role they can play in reducing health care costs. ACEP issued a press release on the study during last month’s Leadership and Advocacy Conference in Washington, D.C., drawing attention to the fact that hospital admissions from the emergency department increased by 17 percent from 2003-09.
The study, commissioned by the Emergency Medicine Action Fund, pointed out that hospital inpatient care is a key driver of health care costs, accounting for 31 percent of the nation’s health care expenses.
“This report tells policymakers and hospital administrators that they should pay closer attention to the role that emergency physicians play in ordering and preventing hospital admissions,” said ACEP President Dr. Andrew E. Sama. “Clearly, emergency departments must be integrated in health care delivery systems for both inpatient and outpatient care.”
Hospital admissions grew from 34.7 million to 36.1 million, offset by a 10 percent decline in admissions from primary care physicians and clinical referrals. Nearly all of the increase was from “non-elective” admissions from the emergency department – a rate 3.8 times the rate of population growth. Admissions increased the most among people aged 65 and older. Self-pay patients were less likely to be admitted to the hospital than patients with health insurance.
The role emergency departments and their physicians play in deciding whom to admit to the hospital is critical to hospital cost savings because the average cost of an inpatient stay ($9,200) is roughly 10 times that of a comprehensive emergency visit ($922).
Four in five people who contacted a primary care physician or other medical provider before seeking emergency care were told to bypass their doctor’s office and go directly to the emergency department. The RAND team found evidence that primary care physicians are increasingly relying on emergency departments to evaluate and, if necessary, hospitalize their sickest and most complex patients.
“Primary care physicians need emergency departments to see their patients after hours, perform complex diagnostic workups, and facilitate admissions of acutely ill patients,” said Dr. Wes Fields, chair of the Emergency Medicine Action Fund. “Emergency departments have become a hub for medical issues that come up suddenly and urgently. We generally are the only facility in a community that remains open after hours, and we provide a disproportionate share of acute health care on weekends, holidays and non-business hours.”
Lack of access to follow-up care is a top concern that influences the decision of emergency physicians to admit particularly fragile patients, rather than take a chance that they will fall through the cracks and suffer harm.
“The RAND report shows a serious need for follow-up care in our health care system,” said Dr. Alex Rosenau, President-elect of ACEP. “Physicians can’t in good conscience send people home when they know their patients won’t be able to get their medications, don’t have any support from family or friends, and can’t get follow-up medical visits. Emergency physicians coordinate transitions of care every day in hospitals across the country, filling the gaping holes in our health care system.”
The report recommends hospital administrators, policymakers, payers, and federal research agencies recognize the current reality in emergency departments and the role they play in coordinating care. The 4 percent of America’s doctors who staff hospital emergency departments provide;
- 11 percent of all the outpatient visits in the United States,
- 28 percent of all acute care visits,
- half of the acute care visits by Medicaid and CHIP beneficiaries and
- two-thirds of all acute care visits by the uninsured.
The RAND Corporation is a non-profit, non-governmental research organization.