The next paragraph was sent to me by The Missouri Hospital Association. I have talked about health care reform several times in this blog and one of the aspects of hospital care that I believe will become more problematic as health care reform takes hold is care in the Emergency Department.
More than one-quarter of outpatient visits for new health problems or chronic condition flare-ups are made to emergency departments, according to a study published today in Health Affairs. Between 2001 and 2004, primary care physicians treated 42% of these “acute-care” visits, while emergency departments treated 28%, specialists 20%, and hospital outpatient departments 7%, the study found. Two-thirds of these ED visits took place on weekends or after office hours. “Primary care doctors have packed schedules and their offices are typically closed in the evenings and on weekends,” said lead author Stephen Pitts, an associate professor at Emory University School of Medicine. “Too often, patients can’t get the care they need, when they need it, from their family doctor.” The study used three federal surveys to analyze nearly 354 million annual outpatient visits for newly arising health problems.
The Emergency Department is a strange animal in a rural hospital and an even stranger animal in an urban hospital. My point of reference is the rural hospital so that’s where my focus will be.
There is a segment of health care consumers who seek primary care through the Emergency Department. Right or wrong it happens and we are not going to change the practice and in many cases the individual does not have any alternative.
Care in the Emergency Department is expensive so the person seeking routine medical care in this setting is paying a whole lot more than he or she needs to. It’s like going to McDonald’s and ordering from the dollar menu but paying ten dollars for each item. The other problem created when primary care services are rendered through the emergency room is the back log created for others.
The person visiting the Emergency Department for a sore throat because he or she doesn’t have access to primary care causes the person with the broken arm or laceration requiring stitches to wait even longer.
As the excerpt to the article above pointed out the person in the Emergency Department with the sore throat may not have a good alternative so it’s not fair to expect that person to do something that might be more cost-effective. Back to the McDonald’s comparison; it’s like the person who is hungry and would eat a hamburger but the only thing available for the next hundred miles is steak. You’ve paid for a lot more than you need but in the end you at least got something.
At GVMH we are trying to alleviate the ED Burden by providing choices. We have initiated a walk-in clinic at GV Medical in both Clinton and Warsaw. Patient’s with minor illness and injury can be seen without appointment Monday through Friday. The benefit of the walk-in clinic is two-fold. First, it reduces the burden on the ED by providing an alternative care site. Second, it reduces wait times in the primary care physician’s offices because patient’s with minor illnesses do not have to be “squeezed” because when doing so creates longer waits for those who are already scheduled to be seen.
As more and more people are eligible for Medicaid and other insurance programs through health care reform the burden on the ED will grow. GVMH is ahead of the game in providing alternatives to care for our community.