ER docs are key to reducing health care costs

Emergency physicians are key decisionmakers for nearly half of all hospital admissions, highlighting a critical role they can play in reducing health care costs, according to a new report from the RAND Corporation.

Hospital admissions from the ER increased by 17 percent over seven years, accounting for nearly all the growth in hospital admissions between 2003 and 2009. Hospital inpatient care is a key driver of health care costs, accounting for 31 percent of the nation’s health care expenses.

“This report tells policymakers and hospital administrators that they should pay closer attention to the role that emergency physicians play in evaluating, managing and preventing hospital admissions,” said Dr. Andy Sama, president of the American College of Emergency Physicians. “Clearly, emergency departments must be fully integrated in health care delivery systems for both inpatient and outpatient care.”

Hospital admissions grew from 34.7 million to 36.1 million, offset by a 10 percent decline in admissions from primary care physicians and clinical referrals. Nearly all of the increase was from “non-elective” admissions from the emergency department - a rate 3.8 times the rate of population growth. Increased admissions were highest among people ages 65 and older. Self-pay patients were less likely to be admitted to the hospital than patients with health insurance. The role ERs and emergency physicians play in deciding who to admit to the hospital is critical to hospital cost savings, since the average cost of an inpatient stay ($9,200) is roughly 10 times the average cost of a comprehensive emergency visit ($922).

The report also found that emergency care is important to physicians as well as patients. Four in five people who contacted a primary care physician or other medical provider before seeking emergency care were told to bypass their doctor’s office and go directly to the emergency room. The RAND team found evidence that primary care physicians are increasingly relying on ERs to evaluate and, if necessary, hospitalize their sickest and most complex patients.

“One of the most important elements of patient-centered care is deciding when individuals can’t be safely managed in community settings,” said Dr. Wes Fields, chair of the Emergency Medicine Action Fund, which sponsored the RAND research. “Emergency physicians are trained to rapidly evaluate a wide array of conditions that are complex or time sensitive, and facilitate observation or admission of the most acutely ill patients. The study also suggests that the biggest challenge facing most ERs is trying to meet the needs of the growing population of Medicare age. Whether you live in a big city or a rural area, trying to find the right level of care for seniors with not one but several medical conditions is an ongoing struggle that plays out nights, weekends, and holidays at the front door to the hospital. Emergency departments are as vital as medical homes in every medical community.”

Five ways to control expenses while protecting your health
1. Compare costs of several medical providers. The costs of procedures, treatments and medications can vary widely by provider. When your doctor recommends a treatment, ask how much it will cost you, and feel free to shop around or negotiate for a discount.

2. Familiarize yourself with your insurance plan. Whenever possible, choose providers that participate in your insurer’s network, including all members of your surgical or treatment team. Study carefully what is covered under your plan. If your physician suggests a test or treatment that isn’t covered, ask about alternatives that are. If you think you’re covered but your insurer rejects your claim and sends you a big bill, you have the right to appeal. Call your insurer to learn about the appeal process and any deadlines for filing your appeal, and make sure your appeal is well researched so you can substantiate your claim.

3. Consider a high-deductible plan. High-deductible plans offer lower premiums in exchange for higher deductibles. Preventive care is usually fully covered, and if you monitor your spending carefully you could save money overall. Many high-deductible plans feature Health Savings Accounts, which can provide considerable tax savings on your health spending: deposits may be tax deductible when contributed and are tax-free when withdrawn for qualified medical expenses.

4. Eat right and exercise. According to the Centers for Disease Control and Prevention, more than three-quarters of health care costs in America are due to chronic diseases such as heart disease, diabetes, cancer and arthritis. Fortunately, many chronic conditions can be prevented or minimized by eating right and exercising regularly - and thus reducing your overall health care costs.

5. See your doctor regularly. Your doctor can be an important partner in keeping you healthy over the long run. Regular physical exams can help identify problems before they become costly or disabling.

Lack of access to follow-up care is a top concern that influences the decision of emergency physicians to admit particularly fragile patients to the hospital, rather than take a chance that they will fall through the cracks and suffer harm.

ER docs are key to reducing health care costs
“The Rand report highlights the lack of follow-up care for many patients who come to the ER,” said Dr. Alex Rosenau, president-elect of ACEP. “Sometimes physicians can send people home if they know their patients will be able to get their medications, have support from family or friends and can schedule follow-up medical visits. Sometimes these resources don’t exist and we make decisions to admit. Emergency physicians coordinate transitions of care every day in hospitals across the country, filling the gaping holes in our health care system.”

The report recommends that hospital administrators, policymakers, payers and federal research agencies recognize the current reality in emergency department operations and the role they play in coordinating care for millions of patients.

The four percent of America’s doctors who staff hospital emergency departments provide;

  11 percent of all the outpatient visits in the United States,
  28 percent of all acute care visits,
  half of the acute care visits by Medicaid and CHIP beneficiaries and
  two-thirds of all acute care visits by the uninsured.

“Efforts to reduce non-urgent and non-emergency use of emergency departments oversimplify a complex problem, and should instead focus on increasing access to affordable options outside the emergency room,” said Dr. Sama.

Efforts to shift care into other facilities, such as retail clinics, have not always been successful because of the limitations of other facilities. For example, retail clinics lack diagnostic testing, are unable to admit patients to the hospital and won’t see uninsured patients who can’t pay cash.

Don’t pay double for a second opinion

As you make arrangements for a second opinion, ask your doctor to send copies of your medical records, x-rays, and lab tests to the second-opinion doctor. These tests don’t need duplication; your second doctor will have the information he or she needs – and you don’t pay double.
Take your dental x-rays to your next dentist

If you move out of town or need to switch dentists, your new dentist will want to have current x-rays of your teeth and gums. You may be able to eliminate the cost of taking new x-rays by asking your previous dentist to send your most recent x-rays to the new dentist. These x-rays can cost $20 for the bitewings and $50 for the whole mouth. Practicing good oral hygiene also can cut down the frequency of taking dental x-rays. By properly brushing and flossing and by having regular check ups, patients can reduce the number if x-ray visits to taking bitewing x-rays every two years and whole mouth x-rays every three to five years.
Make sure you’re covered . . . or begin to plan ahead.

If you are thinking of starting a family, contact your agent to make sure your insurance policy includes maternity benefits. . . or, it may be wiser to start saving for the cost of a routine pregnancy. The cost of a well-baby delivery may range from $2,000 to $5,000. If there are any complications, most insurance plans begin to pay the expenses. Check what your plan will cover. It may be more economical to forego full maternity coverage, which can cost $200 to $500 per month and has waiting periods. Then save the extra money each month and shop for the best, most effective care. But whatever you choose, don’t skip routine and regular visits to an obstetrician during pregnancy.

Get regular mammograms

Studies have shown that women over the age of 40 need yearly mammograms to detect cancerous masses or cists. The cost of mammograms is covered by insurance, and many hospitals offer incentives programs at lower rates to encourage women’s health. The early detection of a mass can avoid thousands of dollars in surgery and recovery. If a mass is detected, most offices/hospitals perform outpatient surgery, saving in overnight hospital fees. In addition to yearly check-ups, home breast exams are part of the process in achieving good health.

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