Emergency rooms should not be treated as neighborhood clinics, and one of the goals of the Affordable Care Act was to break the cycle of repeated use by patients who had no other health care home.
Early signs are promising, but billboards advertising short ER wait times at Deaconess and Valley hospitals may be flashing a signal not in sync with the law’s objectives.
In March, the Washington State Health Care Authority reported a 9.9 percent drop in ER use in 2013. Frequent visitor use fell 10.7 percent, visits for more minor diagnoses 14.2 percent, and visits that resulted in a prescription 24 percent.
Oregon visits fell 13 percent the first nine months of 2013. A January report from that state that showed an increase in use by Medicaid recipients since 2008, though seized on by ACA foes, did not reflect – or anticipate – incentives for hospitals to discourage ER recidivists, and encourage referrals to outside medical providers.
Emergency room care is expensive, and should be the last resort, not the first. The reduced ER use in Washington can be attributed, in part, to savings imposed by the Legislature, but an authority spokesman says the cuts did not lead to a reduction in the quality of the care patients received.
The medical community responded to the new ACA requirements by forming a new partnership, ER is for Emergencies, that includes the Health Care Authority, and the Washington State Hospital Association, Medical Association and Chapter of the American College of Emergency Physicians.
The partnership developed a list of goals that, for example, encourage all emergency rooms to share information, to identify and educate repeat users about the difference between emergency and non-emergency care, and to develop ways of referring non-emergency patients to doctors outside the hospital within four days.
All 98 state emergency rooms are participating. Only two are publicizing wait times: Deaconess and Valley.
The ACA measures patient satisfaction, and adjusts reimbursements accordingly. Quick access and proper care are bound to help make people happy, and the two Spokane hospitals say speedy access is an element in the efficient triage and treatment of patients, admission to the hospital for further care, or referral to other providers.
But the appeal of short wait times and excellent treatment in a modernized facility – Deaconess and competitor Providence Sacred Heart Medical Center have spent heavily on expansions and upgrades – sends what Washington’s state medical director called a “challenging message.”
And the Emergency Physicians regard short wait times as a marketing tool.
Happy patients become patients who return and do not build the long-term relationships that create a health care home away from hospital.
Billboards that say, in effect, “We can see you now,” do not help.