Why the Consumer “Loves” the Emergency Department

The article US Emergency-room Visits Keep Climbing posted in the Wall Street Journal reports the not unexpected rise in Emergency department visits.  This was an easily predictable event.  Despite the official pronouncements that the Affordable Care Act would limit such events, there are multiple reasons for the rise:

1. Lack of access.  With the addition of multiple new Medicaid patients, without the adequate primary care infrastructure, these patients are voting with their feet.
2. High deductible health insurance plans that are de facto catastrophic self-pay policies.  The consumer cannot afford both the premiums and the deductible on their salaries.  They make the choice of care, which the Emergency department provides without mandatory upfront payments.
3. The Emergency departments, in general with all their technology, access to specialists, convenience, and board certified/experienced physicians, make an attractive package.
4. Private practice phone trees start out with call 911 and then, go to the Emergency department.
5. The Emergency department has the capacity to do an extensive medical evaluation that might take 4-6 weeks with multiple appointments in under 4-6 hours.
6. Immediate gratification of the consumer.
7. Emergency departments advertise wait times- patients will be seen in under 30 minutes and special Fast-track aka Urgent care areas for low acuity patients.
8. Call ahead or online appointments in the Emergency department.
9. Primary physicians' use of the expertise and technology of the Emergency department as an extension of their practices.
10. Emergency department 24/7 hours of operation.

 

The problem is the cost associated with the ED visit.  The consumer is paying for the 24/7 infrastructure, which is massive.  These include the staff, physicians, Nurse practitioners, Physician assistants, techs of various types, on-call consultants, etc.  The prices are a reflection of the disconnect between charges and costs that are rampant in hospitals and insurance company contracts.  With an appropriate cost and charging scheme, the Emergency department could be quite cost-effective because everything and everybody is already there.

Hospitals and EDs compete for business because they are the main driver of hospital admissions where the money is.  The Fast-Track low acuity patients help pay the freight to generate more admissions. 

One of my prior blogs offers the suggestion that the Emergency department become the center of health care with primary care, specialists and urgent care as the spokes of a wheel.  This would provide constant direct interaction directing the consumer to the best logical point of care.  This is controversial, but reality is when the family member is ill, the first impulse is to go to the Emergency department.