Emergent Care Utilization

Emergent Care Utilization
Student’s Name
Institution
Abstract
There has been an increase in non-urgent patient visits to EDs in the recent past. Lack of an insurance cover is one of the major reasons for the visits. The EDs are viewed as a last resort for the uninsured and those, not a position to pay for the various outpatient services in the community. This situation is largely due to the EMTALA act of 1986 which holds that patients have to be given the necessary evaluation and screening as well as stabilization treatment once they check into the ED no matter their ability or inability to pay. The other reasons include the convenience and accessibility associated with the ED. Many patients also believe that their conditions are severe when they are not. The consequences of the increased visits include high medical costs; increased overcrowding which leads to increased waiting times for the patients, impaired treatment, and evaluations, and decreased confidentiality and privacy protection; and reduced quality of care.
Keywords: ED, EMTALA
The emergency departments (ED) are a critical aspect of any health care system. Predominantly used for emergency services to those at risk of suffering permanent health damage or losing their life, their role has evolved with time (Shi & Singh, 2014). They are usually at the forefront in supporting communities’ efforts in solving public health emergencies arising from various communicable diseases, and responses to mass-casualty events, defined as the visits for sickness levels or conditions where a few hours’ delay would not be life-threatening (Pines et al.

, 2013). According to Pitts et al., (2008), there were over 100 million patient visits to the EDS in 2006 which translated to around 40 visits per person, with a majority of the visits being non-urgent. This increase has raised concerns as to their ability to provide effective and timely care to the most deserving patients. Many reasons have been given for this increase with lack of insurance, improved accessibility due to the 24-hour open policy, and erroneous self-assessment being the major reasons.
Factors Associated with ED visits
Insurance coverage is one of the major determinants of the usage of ED for non-urgent conditions. Gooding et al. (1996) argue that Medicaid patients are usually on the high-end in the usage of ED services for non-urgent conditions, followed by the uninsured. Those with preexisting insurance covers with service providers record very low non-urgent visits to the ED. The EDs are viewed as a last resort for the uninsured and those, not a position to pay for the various outpatient services in the community. This situation is largely due to the EMTALA act of 1986 which holds that patients have to be given the necessary evaluation and screening as well as stabilization treatment once they check into the ED no matter their ability or inability to pay (Cunningham et al., 1995). The ED is also quite convenient and accessible as compared to other units as it is always open 24-hours a day. Some people may have busy schedules during the day and the only time they may have is during the night. These people may, therefore, see it as more convenient to visit the ED during the night as most of the other units may not be operational. Pines et al., (2013) argues that around 60% of ED visitors find them more convenient as compared to the other primary care areas. Many other patients frequent the EDs due to the belief that they were more likely to receive better care there as opposed to other primary care centers. This may be due to the belief that EDs have more skilled and capable physicians and diagnostic equipment as opposed to other treatment points. Perceived severity is the other factor that leads to an increase in non-urgent visits. Many people erroneously misdiagnose themselves, believing that their conditions are very severe and therefore the only place they can receive urgent care is in the ED. All these factors lead to more patients than is necessary for the EDs.
Consequences
There are many negative consequences associated with an increase in non-urgent visits to the EDs. The first is crowding in the departments. Since the uninsured and Medicaid patients among others feel that this is the only option they have and can’t find treatment elsewhere, the EDs end up receiving all types of patients, even those suffering from minor conditions and needs such as medical prescriptions, colds, and ankle sprains among others. The outcome is increased overcrowding which leads to increased waiting times for the patients, impaired treatment, and evaluations, and decreased confidentiality and privacy protection. If the process of care is not time-effective, the condition ends up becoming worse.
The other consequence is a reduced quality of care. There are a number of factors that contribute to the undesirable quality of care in EDs especially for non-urgent conditions. One major reason is the infrequent nature of the treatment (Moskop, 2010). The treatment is usually one-time based and has, therefore, no provisions for follow-ups. The lack of continuity in treatment means that no relationship can be established between the doctor and patient and that these are usually strangers to each other. It also means that there is no opportunity to keep or gather patient data, to adjust treatment nor monitor serious conditions. Medical relationships are usually crucial in the realization of quality care in that reaction to various treatments, changes in condition among other things can be monitored. Long waiting times also end up inconveniencing patient care. Patients with minor conditions may be made to wait for quite long durations before treatment depending on the number of visits to the department during the day. The most urgent conditions are usually treated first. Some strategies can be applied to decrease wait times and improve care which may include electronic patient tracking systems, fast-track services for minor conditions, and immediate referral to treatment beds (Moskop, 2010). Overtreatment may also jeopardize the quality of care in EDs for non-urgent conditions. As the departments are designed to make the most effective diagnosis and treatment for a one-time visit, the physicians may end up over-emphasizing on various aspects of the treatment. They may end up recommending too many checkups for even the slightest of symptoms which may end up complicating the health of the patient instead of curing the patient (Cunningham et al., 1995). A patient may end up receiving a CT scan, MRI checks among other invasive treatments which may lead to iatrogenic complications and a deterioration in health. Better communication between the patient and physicians on the risk and benefits as well as need for various treatments may eliminate the need for overtreatment.
Finally, non-urgent visits to EDs is associated with high-cost care which can be attributed to various factors. One of the reasons is too many checks during diagnosis to ensure that the one-time visit is as successful as possible. The physicians may end up recommending various CT and MRI scans before out ruling a specific condition that had been suspected. Berger (2010) narrates an example of a doctor, Colehan who ended up with a $9,000 bill for a shingles diagnosis after going to the emergency department to confirm his self-diagnosis. He ended up having to go through a CT scan and two MRI checks even though these were not necessary. Physicians often recommend the many checks mainly to avoid medical liability. In emergency care unlike other types of care, physicians approach treatment on the basis of what could kill you unlike in other forms of care where physicians look at the most likely cause of an illness (Berger, 2010). The hospital may, therefore, be subjected to various lawsuits if the physicians did not treat a certain condition that later causes death when they were in a position to treat it. High costs may also be because the departments have high fixed costs that result from the high staffing requirements due to the 24-hour operations. There is also a need for high-end medical equipment to cater for the various conditions experienced there. Bamezai and Melnick (2006) argue that the marginal costs associated with ED visits are in fact higher than is believed and that the costs paid by non-urgent care patients should, in fact, be higher than they are currently. They argue that the long run marginal cost for a visit to the ED should be $419.24 adjusted to 2010 dollars which is way higher compared to the $192.26 for other outpatient units. Many patients who visit the EDs are also usually uninsured or with a Medicaid cover. The EDs, therefore, do cost shifting to recoup the unpaid costs.
References
Bamezai, A., & Melnick, G. (2006). Marginal Cost of Emergency Department Outpatient Visits. Medical Care, 44(9), 835-841. http://dx.doi.org/10.1097/01.mlr.0000218854.55306.a8
Berger, E. (2010). A $9,000 Bill To Diagnose Shingles?. Annals Of Emergency Medicine, 55(2), A15-A17. http://dx.doi.org/10.1016/j.annemergmed.2009.12.012
Cunningham, P., Clancy, C., Cohen, J., & Wilets, M. (1995). The Use of Hospital Emergency Departments for Nonurgent Health Problems: A National Perspective. Medical Care Research And Review, 52(4), 453-474. http://dx.doi.org/10.1177/107755879505200402
Gooding, S., Smith, D., & Peyrot, M. (1996). Insurance coverage and the appropriate utilization of emergency departments. Journal Of Public Policy And Marketing, 15(1), 76-86.
Moskop, J. (2010). Nonurgent Care in the Emergency Department—Bane or Boon?. Virtual Mentor, 12(6), 476-482. http://dx.doi.org/10.1001/virtualmentor.2010.12.6.pfor1-1006
Pines, L., Pines, J., Kellerman, A., & Gillen, E. (2013). Deciding to Visit the Emergency Department for Non-Urgent Conditions: A Systematic Review of the Literature. Am J Manag Care, 19(1), 47-59.
Pitts, S., Niska R., Xu J., Burt E. (2008). National Hospital Ambulatory Medical Care Survey: 2006 emergency department survey. Natl Health Stat Report. 2008;(7):1-38.
Shi, L., & Singh, D. (2014). Delivering Health Care in America: A Systems Approach (6th ed.). Burlington: Jones & Bartlett Learning.