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Report Highlights Emerging Role of Emergency Departments in U.S.

Emergency physicians are key decision makers for nearly half of all hospital admissions (June 6)

According to a recent report from the RAND Corporation, emergency departments (EDs) have become an important source of admissions to U.S. hospitals and are being increasingly used by primary care physicians to perform complex diagnostic work-ups.

The new study was conducted to develop a more complete picture of how EDs contribute to the modern U.S. health care system.

Researchers reviewed recently published literature regarding ED use; analyzed datasets compiled and maintained by the U.S. Department of Health and Human Services; assessed data from the Community Tracking Study, a decade-long effort that describes changing patterns of health care use and delivery in 60 communities nationwide; conducted three focus groups with emergency medicine and hospital physicians; and interviewed 16 practicing primary care physicians who work in a variety of communities.

The report notes that, between 2003 and 2009, inpatient admissions to U.S. hospitals grew at a slower rate than the population overall. Nearly all of the growth in inpatient admissions was due to a 17% increase in unscheduled admissions from EDs. In comparison, admissions from doctors’ offices and other outpatient settings decreased by 10%. According to the authors, this pattern suggests that office-based physicians are directing to EDs some of the patients they previously admitted to the hospital.

The report also finds that, in addition to serving as an increasingly important portal of hospital admissions, EDs support primary care practices by performing complex diagnostic workups and by handling overflow, after-hours, and weekend demand for care. Almost all of the interviewed physicians — both specialists and primary care practitioners — confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patients themselves.

As a result of these shifts in practice, emergency physicians are increasingly serving as the major decision-makers for approximately half of all hospital admissions in the U.S., the authors say. This role has important financial implications, not only because admissions generate most of the revenue for hospitals, but also because inpatient care accounts for 31% of national health care spending.

The report’s other key findings include:

  • Most patients who visit an ED for a non-emergent health problem do so because they were sent by a health care provider, believed that they had a serious condition, or perceived that they lacked a viable alternative.
  • Hospital admissions of Medicare patients are growing faster than any other group.
  • Medicare beneficiaries covered by a Medicare Advantage plan are less likely to be hospitalized from the ED compared with beneficiaries covered by traditional Medicare Fee-for-Service.
  • Hospital EDs may be playing a constructive role in constraining the growth of potential preventable hospital admissions.

Source: RAND Corporation; 2013.

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