Hospitals Go Proactive to Stem Non-Urgent Emergency Department Care

Hoping to attack bad dept expense and charity care cost where they begin, some hospital emergency departments are taking steps to move non-urgent care patients to outpatient clinics soon after they are seen or divert them to other care providers before they arrive.

Indeed, some hospitals are scheduling appointments for patients at their outpatient clinics, according to “Safety Net Hospital Emergency Departments: Creating Safety Values for Non-Urgent Care,” a recent study from the Center for Studying Health System Change (HSC).

The study found that hospitals are proactively managing the use of their emergency departments (ED) use after a sharp rise in visits by non-urgent care patients (“Emergency Room Visits Rise as Primary Care Access Drops,” June 9). Total emergency visits classified as non-urgent conditions, or those that should have been treated in two to 24 hours, increased from 10 percent in 1997 to 14 percent in 2005, the report said. 

Patients with private insurance account for most of the increase.  But low-income uninsured, underinsured and Medicaid patients rely more on hospital emergency departments because they can’t get timely access to outpatient care, and EDs can’t turn patients away without screening them.

This has led to greater debt load at health care providers. Lehman Brother’s equity research predicts that bad debt and charity care expense for the for-profit hospital industry will rise 15 percent to 17 percent in 2008, reaching $14.6 billion. 

Hospitals have shifted nurse practitioners to screen patients for life threatening ailments and added staff to schedule appointments, HSC said.  Hospitals also are targeting those patients with numerous visits to the ED to create care plans and direct them to primary care centers. 

“A Greenville ED added a nurse to serve as a patient advocate to help patients establish a medical home in the community by linking them to private physicians, free clinics and community health centers for care,” the report said.

By using nurse practitioners and extra staffers to make appointments, one Miami ED referred an average of 50 patients a day to clinics over 18 months. That was almost double what it initially expected and 15 percent of its total ED volume, HSC said. The hospital also placed posters around the hospital and clinics to educate patients about the types of ailments that can be treated in a clinic instead of an emergency department.

The Center is a non-partisan research organization based in Washington, D.C. It conducts site visits to 12 nationally representative metropolitan communities as part of its Community Tracking Study to interview health care providers about the local market, how it has changed and the effect of the changes on its patients.