Clogged emergency departments highlight need for alternative fees

Emergency departments were never meant for routine visits for people with chronic conditions, but in the absence of coordinated care, confused patients have turned to them when they don’t know where else to go.

Now, people with six common chronic conditions make up about 60 percent of all emergency room visits, according to a report released this year by Premier. Of those visits, about one third of them were likely preventable and accounted for $8.3 billion in additional costs for the industry.

This information came as no surprise to industry experts but highlights the need for the healthcare industry to rethink its service environment as a way of managing costs. Currently, about 90 percent of providers use a fee-for-service payment structure, which means that most people, especially those with chronic conditions, receive health services from a variety of providers with no single party coordinating care.

This style of care is not only confusing for patients but can also be dangerous and expensive. Fragmented care is associated with communication gaps, more hospital admissions, poorer outcomes and higher costs.

The problem only becomes worse for people with more than one chronic condition. Patients with one to two chronic conditions and highly fragmented care were 13 percent more likely to visit an emergency room and 14 percent more likely to require a hospital admission.

Fixing the issue would require a shift to a value-based model, in which a chronically ill patient receives care in a coordinate way that helps manage disease progress and promotes wellness. That way patients are guided through the management and/or treatment process rather than having to guess or piece together a picture of how ideal care would look.

“More and more providers are convinced that the future is going to be value-based payment, said Joe Damore, senior vice president of population health consulting at Premier, who produced the report.

The study looked at data from 24 million emergency department visits at 747 hospitals within Premier’s database.

Until the model changes, however, it’s important patients be their own advocates and consider the cost of an emergency room visits before going. Remember that managing a chronic condition is a learning process. There is no shame in asking questions.

We recommend to our members to ask their physicians as much as they can about what to do when a complication or issue arises. Try to remember that the emergency room was never meant to be a go-to first step in receiving care. They are set up for urgent visits when treatment is needed immediately. That can sometimes mean being proactive and aware of a provider’s regular hours.

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