Should emergency departments handle more urgent care cases?

Many emergency departments are expanding to incorporate “fast-track” patients, meaning those who present with less emergent symptoms.

As this emergency doctor puts it, hospitals like these quick cases, “by turning a 99203 into a 99283 plus a several hundred dollar facility fee, level three patients are easy money for ERs which are already open anyway.”

This type of cost-shifting simply games the current system, which pays several hundred dollars to treat a cold, for instance.

But again, that’s just the playing field that the government has given the hospitals. Perhaps someone should be looking at fixing the rules, rather than blaming the players.

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  • thecountrydocreport

    No, no, no. Fast-tracks may be good for the ER, but bad for the health care system and cost is just one of the reasons why. Patients with acute minor illnesses are better funneled into primary care where these illness are treated less expensively and where continuity of care is promoted.

    Fast-tracks are a symptom of a health care system with limited and underdeveloped primary care capacity, not a cure for it. I posted on Fast-tracks a couple of weeks ago at: http://thecountrydocreport.wordpress.com/2008/12/15/er-fast-tracks-promote-the-wrong-kind-of-medicine/.

  • physasst

    Agree with Country Doc…..Fast Tracks are essential right now because of the problems with primary care. There was a recent study/survey of 12000 practicing primary care physicians that to a tune of 54% have said that within the next 3-5 years, they will either cut back on patients seen, go part time, leave medicine altogether, or retire outright.

    I was at a policy meeting recently in DC, and one suggestion was made, that eventually, primary care clinics will almost exclusively be staffed by PA’s and NP’s with one or two MD/DO’s supervising and helping with the more challenging cases. I believe this to be true.

    Fast Tracks are there because of a lack of access…either due to financial reasons, personal reasons, and/or primary care provider shortages.

    Kevin, if you are interested in more…

    physasst.blogspot.com

  • Anonymous

    “Urgent care” facilities are almost nonexistent in my area. The “places formerly known as convenient care” have cut hours back almost to the point of “wait until tomorrow and try for a triage appointment at your regular doctor’s office” (assuming those appointments aren’t already oversubscribed and your doctor belongs lo a large group practice, which somewhat increases your chance of being seen on a timely basis). If you can’t get to the “not very convenient care” before 8 pm, you have to decide whether or not your problem is one that can wait. Is it any wonder that the number of inappropriate ED visits keeps going up?

  • Anonymous

    I have worked in ER’s as part of my medical training and have been shocked by the experience. Emergency Rooms are bad medicine for anything but dire emergencies. ER doctors practice no followup care, yet treat patients that should require followup care. They have very little experience practicing preventative medicine. Most ER patients are not emergencies and are usually people who refuse to make the effort to followup with a provider. Studies have shown this is not because they cannot afford primary care. This behavior should never be condoned, nor should crappy ER doctor care.