A borderline admission from the ER, or not


A woman on Medicaid is newly diagnosed with lung cancer in the emergency department. Although medically stable, should she be admitted to facilitate the coordination of the care she will require?

That’s a question emergency physician Jesse Pines asks in a recent WSJ op-ed. In the end, despite the resistance of the admitting hospitalist, he admitted the patient. Dr. Pines writes that, “Without expert help, arranging a timely, multi-step outpatient work-up for something serious can be a full-time job even for patients with private insurance. For those with Medicaid, it’s an even greater challenge. Some doctors will not treat Medicaid patients, which pays less than private insurance, and those who do often have long waiting times for appointments.”

He notes, correctly, that primary care doctors often do not have the time or incentive to properly coordinate care with specialists. So the words, “discharge from the emergency room, follow-up with your PCP,” can be largely meaningless to patients, and “sometimes puts them in the same position they were in when they arrived: adrift, with no doctor steering the ship.”

So, although admitting these patients is more expensive than advising an outpatient follow-up, sometimes it’s money well-spent to ensure proper patient care.

What that says about our broken health care system, however, is a different matter altogether.


✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories