Emergency care centers are intended to handle crisis cases — but in practice, more patients walk in with primary care concerns than critical conditions. According to statistics provided by the Center for Disease Control, a full 32% of ER consults last for less than 15 minutes, and only 7.9% result in hospital admission. These numbers imply that while care centers are intended to handle crisis case, they tend to treat more patients with primary care concerns than those with critical conditions. Rather than serve as the place of last resort, they stand in as primary care facilities for walk-in patients.
This trend is particularly prevalent among those with chronic illnesses. Earlier this year, the healthcare improvement firm Premier found that six common chronic conditions (asthma, diabetes, heart failure, hypertension, behavioral health, chronic obstructive pulmonary disease)
accounted for roughly 60% of the 24 million emergency department trips recorded in 2017. Of these, the researchers noted that 4.3 million visits (30%) likely could have been prevented or addressed in a more affordable outpatient setting.
Why, then, are these seemingly preventable visits happening in the first place? There are several reasons, but the foremost is care fragmentation. According to researchers for Quest Diagnostics, two in three Medicare patients have “multiple chronic conditions that require ongoing medical attention and substantial resources from the healthcare system.” Someone with diabetes, for example, might need to consult with a primary care doctor, endocrinologist, dietician, and a certified diabetes educator on a semi-regular basis. The primary care provider might seem the most suited to care coordination; however, the survey for Quest found that 85% of surveyed providers lacked time to address all of their patients’ clinical concerns, and 66% couldn’t address behavioral or social concerns.
This lack of time and general siloing “fragments” a patient’s would-be team into individual providers and leaves the patient responsible for coordinating their own care. If they lack the time, energy, or inclination to do so and begin to experience health issues, they may opt to manage the short-term problem at the emergency room rather than reach out to their disconnected team to create a long-term care plan.
This stopgap approach is more common than one might think; researchers for Commonwealth Fund estimate that patients with one or two chronic conditions and highly fragmented care are 13% more likely to visit the emergency department and 14% more likely to be admitted to the hospital. Fragmented or ED-dependent care can ultimately lead to communication gaps between providers, less-cohesive treatment plans, unnecessary testing or treatment, higher rates of emergency visits, and poorer long-term health outcomes for the patients. The cost for unnecessary ED care, too, is significantly higher; according to the above-mentioned report for Premier, unneeded ED visits led to over $8.3 billion in additional costs for the industry.
The healthcare sector needs a better-coordinated solution for patients for chronic conditions, one that prioritizes long-term wellness of short-term fixes. Currently, the vast majority of providers adhere to a fee-based payment model. As the name suggests, this structure reimburses physicians based on the services they provide, without taking the wellness of the patient into consideration. Providers are not currently incentivized to help patients coordinate their treatment and prevent them from falling back on emergency services as a one-size-fits-all care solution — but with a value-based care system, they could be.
Unlike fee-for-service, value-based care does consider patient outcomes. Its reimbursement model pushes providers to be proactive about helping patients maintain their health, rather than simply solving problems as they arise. Under a value-based model, primary care physicians could place a greater emphasis on care coordination and collaborate with a network of specialists to support every facet of a patient’s care needs. The shift would further take some of the logistical burdens off of the patient, and ensure that no chronic care patient ever feels as though they need to go to the emergency room for routine care.