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ER’s Account For Half Of Hospital Admissions, Study Says

Tue, 05/21/2013 - 9:32am
Reed Abelson

Emergency rooms account for about half of the nation’s hospital admissions and accounted for virtually all of the rise in admissions between 2003 and 2009, according to a study released on Monday.

Although emergency rooms are widely considered expensive places for diagnostic care, physicians are increasingly relying on them to determine whether a patient needs to be hospitalized.

The study’s findings raise important questions about how emergency rooms contribute to high health care costs in the United States and what their role will be in the future as the nation undergoes fundamental changes in health care delivery. One goal of the Obama administration’s health care law was to reduce reliance on costly emergency room care.

The report by the RAND Corporation, a nonprofit research group, was done for a consortium of emergency medicine physician organizations. RAND, which says it was chosen for its independence, says the sponsors had no say in the report’s findings.

Emergency rooms have long been a source of medical care beyond treating people with immediate life-threatening conditions, the report notes. “It is not just an emergency department, and it hasn’t been for 20 years,” said Dr. Arthur L. Kellermann, a senior RAND researcher and emergency physician who is one of the study’s authors.

The emergency room serves as a place to get immediate care in the evenings and weekends, he said, and where patients can get “complex, time-efficient diagnostic workups.”

The RAND researchers, who studied hospital admissions in the United States from 2003 to 2009, said increasing numbers of patients were being admitted through emergency rooms. “They are the entryway for the hospital for unscheduled admissions,” Dr. Kellermann said.

Nearly all of the increase in hospital admissions during that period was because of a 17 percent increase in unscheduled admissions made from emergency rooms, according to the report. Over the same period, there was a 10 percent decline in admissions from doctors’ offices and similar settings.

Doctors are sending patients to the emergency room when they are not available to see a patient or when someone needs sophisticated tests to determine quickly whether they are seriously ill. Patients frequently go to the emergency room because they feel they have no alternative, and the researchers also noted that emergency rooms served as a medical safety net for patients without health insurance.

While some hospital executives may be pressing physicians to admit patients to fill beds, Dr. Kellermann predicted that changing the payment system so hospitals were no longer rewarded for the volume of tests and treatments they provide would change the dynamic. “I think you’ll see a 180” degree turn in their attitude, he said.

The study did not reach a definitive conclusion about whether patients in managed care plans who came to the emergency room were less likely to be admitted than those who were not enrolled in such plans.

The report concludes that it is not clear exactly how emergency rooms contribute to the nation’s health care costs. “The real money,” Dr. Kellermann said, is in the care provided for patients admitted to the hospital, which accounts for almost a third of the nation’s health care bill.

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