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Emergency Rooms Overused For Routine Care

The Patient Protection and Affordable Care Act (our government’s name for healthcare reform) may make our already crowded emergency rooms swarm with more patients.

A new study from Health Affairs shows that more than a quarter of patients who currently visit emergency departments in the U.S. are there for routine care and not an emergency. New complaints like stomach pain, skin rashes, fever, chest pain, cough or for a flare up of a chronic condition should not be treated in emergency rooms. They are best worked up and treated by an internist or family physician, preferably one who knows the patient. So why are these patients waiting for hours and spending up to 10 times as much money for emergency department care?

The study shows it is a problem of limited access to primary care services. Patients can’t get in to see a primary care doctor or it’s on a weekend when they’re not open. Two thirds of the minor acute care visits to emergency departments (EDs) took place on weekends or on a weekday after office hours.

Nationwide there is a shortage of primary care physicians and many have closed practices, limit Medicare patients and take no Medicaid at all. When a patient has stomach pain and is told the next available appointment is in two weeks, it is no wonder they head for the ED. Once there they will likely get a battery of tests that may not be needed and even CAT scans before they are told to go home with a diagnosis of “gas.”

The good thing about the Patient Protection Act is that millions of new people will get insurance of some type. The bad thing is that unless we address the primary care shortage in a real meaningful way, it may just lead to more expensive care in emergency rooms across America.

Robin Weinick of the RAND Corporation and a coauthor of the study said that urgent care centers could potentially manage between 14 percent and 27 percent of all emergency department visits and save $4.4 billion — or .2 percent of national healthcare costs annually. 

We need to expand the capacity and weekend hours at community health centers. We have already passed the window to increase the supply of primary care physicians by ignoring the crisis. But it is not too late to change the incentive structure for payment and try to lure more young doctors into primary care. It worked for radiology and anesthesiology and urology. The nation would be the beneficiary.

*This blog post was originally published at EverythingHealth*


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