Four Steps Necessary To Keep Non Emergency Patients From Using the ED

With the passage of healthcare reform and coverage being provided to many folks who have been uninsured for years, it is assumed that they will now seek primary care and not inappropriately use Emergency Departments. This may happen over time but will not occur by itself. In fact, based on what happened in Massachusetts some years ago when insurance coverage suddenly became available to many who did not have it before, quite the opposite happened. Patients were used to going to the ED for primary care and minor issues. Now that they had insurance coverage they were even more prone to visit the ED.

This is a terrible way to deliver this kind of care for a number of reasons. First and foremost it is extremely expensive. A typical ED visit costs about 5 times what a clinic visit would cost. Secondly the care in an ED is episodic. The ED physician has no established relationship to the patient and no history to work from. This often leads to overtreatment and rediagnosing established chronic conditions of the patient.

So as we prepare for the addition of many new patients who will have insurance coverage for the first time, it is important that we take steps ahead of time to ensure that that are treated in the appropriate setting. We can not sit back and expect that this will happen by itself. The Washington Post recently published an article written by a San Francisco ED physician, Dr. Jennifer Brokaw, who lists 4 steps that should be occurring now.

1) Establish more offices, clinics and urgent care centers, particularly in medically indigent areas.

2) Invest in more allied health professionals and physician extenders. It is clear that we will not have a sufficient number of primary care physicians. We need to be ready to delegate some of this works to others.

3) Start coordinating the various delivery systems that currently do not communicate with each other. We know a great surge in demand is coming. Providers need to work together to make sure the supply of providers and support modalities is adequate.

4) Take advantage of the internet and social networking sites that are used by practically everyone. Medical information about diseases and conditions can be disseminated as well as directions to the nearest and most appropriate venue for care.

We know this is coming and can even predict the outcome if we are not adequately prepared. So lets head this advice and make this transition as smooth as possible.

More on this later.

Mark Brodeur