Helping Emergency Rooms be Emergency Rooms
By Earlexia M. Norwood, M.D. Physician- In-Charge, Henry Ford Health System
Emergency rooms are facing an overcrowding problem. This problem is not the result of a dramatic increase in medical emergencies that truly warrant emergency room treatment. Rather, it is the result of more and more people with non-emergent medical care needs that go to the emergency room for treatment instead of a primary care physician.
According to NEHI – formally known as the New England Healthcare Institute - 56 percent of emergency room visits are potentially avoidable. Here lies the root of the problem: many patients insured and uninsured are using the emergency room as their primary care center.
Emergency room overcrowding costs around $38 billion annually, according to NEHI. It’s a significant cost with a broad impact that includes higher premiums and co-payments, longer waits, and patient care occurring in inappropriate and high cost structure settings. The public, private, and non-profit sectors are well-aware of this problem and implementing solutions that are helping to make a positive difference.
For example, the national dialogue about healthcare reform and ultimate passage of the Affordable Care Act invigorated a renewed appreciation for and emphasis on primary care. As healthcare becomes more affordable and accessible to millions of Americans who are currently uninsured, primary care physicians should be a patient’s first stop – not the emergency room.
More importantly, these newly insured Americans should “doctor shop” to find the primary care physician who they feel most comfortable with. I’m not the only one who thinks so. When Consumer Reports surveyed primary care physicians, over three-fourths of them said a long-term relationship with a primary care physician is the most important thing a patient can do. This is the basis and premise of the medical home where the patient is provided with the proper care, from the most appropriate provider.
Consider this fact from the Centers for Disease Control and Prevention (CDC): “Chronic diseases are the most common and costly of all health problems, but they are also the most preventable.” People who regularly go to their primary care physicians for checkups and preventative screenings are more likely to have control of their chronic diseases which increases longevity and decreases further complications. Their primary care physicians have a much better handle on their health and lifestyles and are therefore much better equipped to make recommendations that keep them healthy and out of the emergency room.
In addition to the nation’s renewed appreciation for and emphasis on primary care, hospitals are taking actions to address the overcrowding problem. For example, some hospitals post emergency room wait times on their websites. This information allows people who have non-emergent situations to look for alternative options such as making evening or weekend appointments with their primary care physician, which is being encouraged in the marketplace.
Another action that hospitals and insurers are taking is charging an upfront emergency room fee for providing non-emergent care. The Healthcare Financial Management Association says “at least half of all hospitals nationwide now charge upfront ER fees.” These fees and policies promote care to occur in the primary setting where there is a lower cost structure and continuity of care can be provided. As a result, hospitals will have more of the resources they need to provide the best emergency care possible.
Emergency room overcrowding is a problem we can overcome. Encouraging a greater emphasis on primary care – and providing much-needed access to preventative care to millions of uninsured Americans – is a significant step in the right direction. Other solutions from the private, public, and non-profit sectors should be encouraged too and examined through a lens of the broader picture: the status of healthcare in our country. We are moving in the right direction.
Earlexia M. Norwood, M.D. is the Physician- In-Charge, Henry Ford Health System.
With all do respect, your article is flat wrong when sizing up these issues surrounding emergency care. First off, you are correct that emergency rooms are facing a serious overcrowing problem. A growing elderly population combined with more emergency departments closing down are only making matters worse. Emergency visits have increased at twice the rate of the nation's population. But this is caused by emergency department boarding, not by nonurgent patients seeking primary care, as you state.
Less than 8 percent of the 136 million emergency visits in the U.S. are considered nonurgent, according to the CDC. The government also specifically points out that "nonurgent does not mean unnecessary." Two-thirds of emergency visits occur after business hours, on weekends and during holidays when doctors' offices are closed. This alone goes against the widely held assumption that people are choosing to seek primary care in the emergency department. It's just not true and numerous, reputable statistics back that up. A federal report states that ninety-two percent of emergency visits were from very sick patients who needed care within 1 minute to two hours. According to an ACEP poll of emergency physicians, 97 percent of them said that they treated patients on a daily basis who were referred to them by primary care doctors.____Now, on the issue of cost. That NEHI study you site is inaccurate and has been discredited by the ACEP. Emergency care in its entirety is just 2 percent of the nation's $2.4 trillion dollar health care expenditure – which comes out to a total of approximately $47.3 billion dollars.
The nation's emergency physicians support a strong primary care system that is in everyone's interest. I welcome a debate of ideas regarding emergency care, but first we must all have the same understanding of what the real issues are. 1) health coverage does NOT equal access, as we are currently seeing. 2) emergency visits are going to continue to rise, despite health care reform 3) it's time to stop focusing on ways to cut emergency visits and instead focus energy and attention on finding ways to improve this valauble resource.____Thanks very much for your time.____
Thanks for the article. I do have some concerns that have not been addressed either in or out of the Affordable Care Act (ACA).
While it might be ideal for all newly covered ACA patients to have a primary care physician, the fact is that there not nearly enough of these doctors to see these patients in any semblance of a timely fashion, if at all.
Further, I believe that most primary care physicians will not be interested in opening their practices into after hours or weekend times unless they are significantly financially incentivized to do so when many people actually seek acute care. That increased reimbursement prospect appears extraordinarily unlikely.
Today, even during weekday business hours, it is very common for me to hear in my emergency medicine practice that the patient called the primary doctor and was told to come to the ER because they had no availability.
Finally, it's important to note that there are other statistics out there (namely from CDC) that "non-urgent" ED visits are only 8% of an emergency department volume. The expense of an ED visit depends greatly on the acuity of the patient. Those patients with relatively minor ailments that do not need testing in the ED, are actually not particularly costly because the overhead is fixed. And, in fact, ED care accounts for 2% of US healthcare expenditures.
I certainly agree that part of the emphasis in reimbursement has shifted to reduce hospital readmissions. The question is how do we get there. Primary care is an option, however it is my opinion that the gap in available physicians will take years to improve access.
In the meantime, the EDs are ready and willing to fill this need as the safety net. Further, we should be looking at innovative home healthcare options as a partial interim solution.
There are 2 reasons to visit an emergency room: Serious injuries or life threatening symptoms. Many people use emergency room services because they may not have insurance, desire or require immediate care. We must first provide education to patients that serious injuried include a cut that requires stitches vs a paper cut which can be treated at home. A life threatening emergency may be chest pains from a person with or without a history of heart problems. A stomach ache from over-eating is not a reason to visit the emergency room So education first.
Second, as Dr. Norwood states there should be more 24 hour non urgent care facilities available for patients. Physicians should have financial incentives for after-hours care.
If these 2 recommendations are implemented, we will see more appropriate use of emergency care hospital services. Thank you for this informative and interesting article.
Dr Norwood, anyone who works in an emergency room or in claims for a health insurance company knows that your article and the stats are spot on.
[...] health care insurance with health care access. Why are emergency departments so overcrowded? Dr. Earlexia Norwood from the Henry Ford Health System seems to think it is because patients would r…. Maybe that’s because there aren’t enough primary care physicians available. The other points [...]
Mr. Baldyga and Mr. Ross thank you for giving a more accurate assessment of the situation. I am an ED nurse of 20 years. Our ED saw over 43000 visits last year. While I don't have the exact statistics for our ED, I can confirm that many patients call their PMD and are told to go to the ED even during office hours. Last year i called my daughter's peditrician office when she woke up ill, probably with strep and they couldn't see her til the next week! Calling my physician for an appointment, even for a check up means a wiat to see him of 2-4 weeks.
My brother has healthcare coverage but it is expensive, does not cover annual labs, etc. So it is cost-prohibitive for him to go anywhere on a routine basis.
Access to PMD's is limited by their office hours which means taking off from my job to see him. This means I must use my PTO time or work with my manager to rearrange my hours.
Urgent Care centers are great but many have decreased and changed their hours, so the only option becomes the ED.
Until we correct the access and cost issues, ED visits will increase. Healthcare Reform is a great idea in theory but are the right people working on it?!
[...] Click for More Info This entry was posted on Thursday, August 23rd, 2012 at 7:41 pm and is filed under Updates. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site. [...]
[...] Physician-in-Charge of Henry Ford Health System Earlexia M. Norwood, however, said giving patients this kind of public information might actually push them to seek nonurgent care elsewhere. “This information allows people who have nonemergent situations to look for alternative options, such as making evening or weekend appointments with their primary care physician, which is being encouraged in the marketplace,” Norwood wrote last month in Politics365. [...]
[...] Hospitals in recent years have been bragging about wait times with website emergency department (ED) clocks and billboard advertisements, but the marketing practice can be a double-edged sword. "[M]ember hospitals have mixed emotions about marketing emergency rooms," Linda Quick, president of the South Florida Hospital and Healthcare Association, told the Sun Sentinel. "The good news is you can advertise and get more people in the door, and the bad news is you can get people you wish didn't come." With one out of eight visits resulting in a hospital admission, attracting more ED patients could mean more dollars for the hospital pocketbook. Nevertheless, one in 10 ED visits are nonemergent cases, the newspaper noted, suggesting the resources could be otherwise spent on real emergencies. Physician- In-Charge of Henry Ford Health System Earlexia M. Norwood, however, said giving patients this kind of public information might actually push them to seek nonurgent care elsewhere. "This information allows people who have nonemergent situations to look for alternative options, such as making evening or weekend appointments with their primary care physician, which is being encouraged in the marketplace," Norwood wrote last month in Politics365. [...]
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