So for my work in the hematology lab, I have to get 12 hours of education on pertinent topics every year. I get most of my opportunities from speakers the hospital hosts, live or by video. Today I watched one online about changes in healthcare as the affordable care act goes into effect. Changes include focus on ACOs and ‘medical homes’. ACO stands for Accountable Care Organization and they are like networks of different medical professionals. A medical home is a primary care location/doctor. The dual focus is supposed to provide lower cost. ACOs make medical records easier to share and specialized services easier to find. Having a medical home means patients have a single doctor who oversees their results and hopefully can compare it all for best care. Another area of focus needs to be patient involvement. With so much information available it only makes sense to have patients paying attention to their own results. I’ve already seen some of this in my own care. Rather than a “you’re fine” I actually got a list of my chemistry panel and complete blood count.
So long story longer, a really big thing that stood out to me was a mention of patients choosing to utilize the emergency department as their primary medical home. Hospitals want to discourage this because the care in an emergency room setting is more expensive to provide than at a primary doctor office. I was curious as to why anyone would use the ER this way. ER visits can be all day events. I did a quick google search and found a great article describing a study on just this question.
Here is a link to the study I found:
ER is better
Basically there were lots of reasons for choosing the ER
1) Appointment making- it’s actually quicker to walk into an ER and wait rather than trying a walk-in at some primary care locations. And it’s more convenient to go to the ER for same-day treatment versus trying to fit in a primary care schedule that is already packed. Some offices do not have immediate openings and you wait for an opening with potentially very little notice.
2) Transportation- through Medicaid rides are arranged 72 hrs in advance. An ambulance will come right away if you say you need one.
3) Late hours- primary doctors often close at or near 5pm. ER is around the clock.
4) Cost- all kinds of specialists are available in a hospital and one has to pay only once versus multiple specialists with multiple copays.
I think this info is super interesting and could be of use to fixing the problem of ER care in non-emergent situations. There are clearly some obstacles to tackle before alternatives can become more attractive than ER care.