Excited about the future of healthcare in the emergency department

by William Schumacher, MD

Am I the only one excited about the future of healthcare?

With all the prevailing pessimism about America’s “dysfunctional” health” system, optimists (and I am one) sometimes feel stranded on our own lonely islands.

It’s not that we don’t know what the challenges are.  I have been practicing emergency medicine for over 30 years, and there is no better place to absorb the myriad obstacles to delivering quality, cost-effective care than a hospital emergency department.

Shrinking budgets, rising costs, an aging population, escalating patient morbidity, an inadequate supply of clinicians, and the swirling changes brought about by health reform are all legitimates causes for concern.

Yet to me the arc of the last 30 years is encouraging. Despite every curve ball that has been thrown their way, healthcare administrators and clinicians today are delivering increasingly better care in a more cohesive environment. With more emphasis on quality, on reducing errors, and on working in coordinated clinical teams, I would rather be a patient today – particularly in a hospital – than at any time in the past.

And there is an opportunity now to take another major step forward.   Until recently, providers as a general rule have claimed quality as their turf and payers have laid claim to costs.

But as care delivery becomes more complex, and as communications systems improve, there is a chance for both parties to reach across the aisle. Indeed, managed care organizations and other payers already are sharing data with providers that are leading to quality and cost improvements.

Clinicians in the emergency department today are educated using evidence-based drug data supplied by managed care organizations and are recommending drugs that are both effective and budget-conscious.    These data resources are expanding into areas such as high-cost imaging, allowing clinicians to confidently pursue treatment options that may be more appropriate for the patient and more financially sustainable than high-dollar pictures.

In addition, information technology now employed in medical home pilot projects (some of them sponsored by insurers) features search engines that can scan a patient’s medical records to identify tests or processes that are missing or late. Information systems now prompt physicians to ask for particular procedures or tests when a patient presents with an abnormal lab result or other anomalous condition.   Unlike the last go-around of health reform, quality measures now can be tracked and an appropriate balance between cost and quality can be achieved.

As a physician, I am excited about the new analytic, evidence-based tools now at my disposal because they allow me to exercise my training and judgment to make better decisions on behalf of my patients.   Particularly exciting is the ability to track treatment patterns of high-risk patients — cases in which outcomes and costs often are problematic – and to modify treatment when necessary.   Improved technology, and enhanced cooperation between providers and payers, allows for closer tracking of these patients once they leave the hospital, reducing the need for readmissions that cost the system and demoralize the patient.

I am also seeing great strides being made on the more prosaic, but important, business processing side of healthcare. Patient data input, something that used to be a laborious and disjointed task, is becoming considerably more streamlined.   Merely getting a bill out to the right person at the right time used to be a major challenge for many facilities (and still is for some).   But processing improvements are being made and the administrative costs of medicine will subsequently go down.

Health reform is going to accelerate these efficiencies through its various advisory boards, readmission reductions programs and related cost containment and quality improvement prods. Of course, for an administrator worried about evolving payment systems, or for a physician with a line of patients out the door, or for a managed care executive fretting over new insurance regulations, the day-to-day challenges can obscure the big picture.

But forget the trees for a minute.   Look at the forest.   It’s becoming a more manageable, habitable place, and in the future it will be better still.

William Schumacher is an emergency physician chief executive officer of Schumacher Group.

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  • soloFP

    Very positive article, but what about the ER currently? My local ERs order CTs to protect themselves, around 25-35 CTs per ER in 24 hours. ERs are frequented by self pay and medicaid patients who receive charity care. My local hospitals setup foundations to help cover some of the charity care, but the docs on call for the ER rarely get bed by the uninsured. Often ERs are known as loss leaders, as the profits come from the admissions of Medicare and insured patients. My local ERs have 4 hour average wait times. The overhead is very high at the ER with RNs, EMTs, CNAs, secretaries, etc. Overhead is at least as high a primary care clinic. Unde current rules, nonurgent conditions cannot be turned away from the ER. I have seen patients go to the ER for school physicals, sinus infections, an infected toenail, cough for less than a day, and other outpatient office conditions. The insured patients are thinking twice about using the ERs with $250 copayments for 2011, but the self pay and Medicaid in my state end up being seen mostly for free.

  • http://natickpediatrics.net Rob Lindeman

    I’m with soloFP on this one. Dr. Schumacher, this is PURE FANTASY. I don’t know where you practice, but none of this sounds remotely like any ED near where I work. Evidence-basis? Medical Home? I’d laugh out loud if this all weren’t so damn serious!

  • Marc Gorayeb, MD

    Typical rhetorical trick. ‘I’ve been in the business for over 30 years, so I know what I’m talking about.’ Well, some of us have also been in the business for 30 years, including stints as attending in a university teaching hospital and at least 8 community hospital ED’s over the years. And some of us have no idea what the author is talking about. So readers, please discount the experience thing.

    Until the author provides specific examples to support the generic ideological platitudes he repeatedly expresses, I would not believe any of it.

  • buzzkillersmith

    The content of the post is curious to say the least, but I’m impressed with the enthusiasm after 30 years. Can I have a transfusion from you? 22 years and I’m draggin’ tail.

  • paul

    we’re doing a better job of handling our increasingly crowded department? it’s becoming a more manageable, habitable place that will be even better in the future?

    i myself am definitely becoming a better ED physician. ever since i decreased my clinical time by 1/3, i have fewer complaints from patients, fewer complaints from doctors in other departments, fewer cases with bad outcomes, and presumably fewer cases where patients and their families hire a lawyer to come after me. some day i’ll reduce my clinical time to zero and by then i’ll be the best ED physician in the world!

    something tells me your optimism is similarly related to your being CEO keeping you out of the trenches.

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