Emergency department overcrowding is nothing new, and is often pointed to as a symbol of healthcare’s dysfunction.
In Boston, it has been decreed that emergency departments are no longer able to go on diversion. Apparently when EDs close, it causes more problems than it solves. Makes sense on one level, as patients are shuttled to hospitals who have no records of them.
This is a mere band-aid solution, since the underlying mechanism of overcrowding isn’t addressed.
Over at Slate, there is a nice article describing the allure of emergency care. One reason is that primary care physicians have little incentive not to suggest the ED for their patients:
Assume a patient calls his doctor about a new symptom. Ideally, after listening on the phone and deciding that it’s probably nothing serious, the doctor arranges an office visit for the next day, offers reassurance, and averts an unnecessary late-night E.R. visit. But doctors don’t get reimbursed for that call. And what if they tell a patient to wait and something bad happens? Then malpractice lawyers have a field day.
Another reason is the convenience of emergency care. You can conceivably receive STAT blood tests, imaging scans, and specialist consultation in one (albeit long) visit.
Even with a high co-pay, it’s still a bargain for the patient:
In the E.R., a single $100 co-pay may feel like a relative bargain compared with the alternative: fees for multiple trips to the doctor and testing centers, hours on the phone arranging the whole process, and days of missed work.
The solutions are obvious to regular readers here, and it deals with re-aligning the financial incentives:
We also should restructure the payment system for primary-care doctors so they won’t go belly up if their schedules aren’t 100 percent booked, given how little they’re paid per patient. They should get paid for those after-hours calls.
Primary care physicians need to find ways to optimize their schedules for same-day, urgent care appointments. Some do, many don’t. Converting all office schedules to a hybrid open-access/fixed-appointment format should be a minimum step to help relieve the emergency department burden.