Emergency Medicine – Where Do We Go From Here?

We cost too much. We take care of URIs and ankle sprains. We don’t coordinate care well. We use too many resources. We’ve all heard it in the media, even our President taking passing shots at the usefulness and cost effectiveness of emergency care.

Of course the reality is federal law requires us to see every patient. We cost 2% of the overall health care dollars (“Medical Expenditure Panel Survey,” Department of Health and Human Services, Agency for Healthcare Research and Quality, 2008). According to the CDC, 8% of patients we treat can afford to wait over 2-24 hours for care and would be considered truly non-urgent cases. No one denies, of course, that we remain the safety net for just about everyone and everything related to healthcare.

The debates will continue and no one can ignore the change that’s coming. So what are our choices as emergency medicine providers? Quite simple really. First option, we continue to do what we do and look for ways to become more efficient. The other option is to redefine what people think of as emergency medicine.

Increased efficiency means we see more patients. We evaluate and treat patients quicker. We monitor our utilization and reduce it where appropriate. We raise patient satisfaction levels so we can compete with urgent care centers. We make sure we are hitting our core measures and other quality markers. We are, after all, still one of the best overall bargains for what we provide.

Redefining emergency care means our care is no longer defined by the 4 walls of the ER. We act and claim the strategic position of experts in acute outpatient care. This involves the ED and it also involves observation care as well as transition points between inpatient and outpatients care.

The former means we keep doing what we are currently doing and do it better. In the short term ED volume will no doubt rise as more insured patients seek care and find a lack of primary care resources available to provide that care. The challenge we face is we continue to be seen as the high cost area. Incentives to move patients away from the ED through higher co-pays, to urgent care centers and more robust primary care will continue over time.

Redefining emergency care as the interface between the outpatient and inpatient worlds of health care allows us to claim the high ground of medicine. We are the experts in acute care. Our focus must expand one step beyond to become the experts in acute outpatient care assisting patients (and the system) as they move from an inpatient setting back to their primary care physician.

We have the skills to define our place as medicine changes. Will we seize the opportunity? It will require us to change our mindset about what we do and how we do it. The great thing about emergency medicine providers is that we are the experts in dealing with constant and rapid change. The choice is up to each of us.