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Is the U.S. Failing at ER Medical Care and Can We Reverse the Trend?

failing emergency careEarlier in 2014, the American College of Emergency Physicians released its five-year “report card” on the state of emergency medical care in the nation, and the findings weren’t encouraging for policymakers and emergency care providers.

After having scored an overall C- on its last report card in 2009, the US made no strides (and in some cases lost ground) in every measured category:

  • Access to Emergency Care
  • Quality and Patient Safety
  • Medical Liability Environment
  • Public Health and Injury Prevention
  • Disaster Preparedness

Overall, our nation’s scored a D+ in 2014. One state, Wyoming, failed altogether.

What do near-failing grades mean for health care consumers?

As the study had many variables, it does not necessarily reflect a large dip in the quality of medical care provided to individual patients. While Quality and Patient Safety did backslide from its 2009 grade of C+ to a C in 2014, the change was only demonstrative of quality of care at a system level — indicative, the study’s authors point out, of a continuing failure to provide the resources and facilities that would make emergency care delivery efficient.

Access to Emergency Care, which was scored at a D- in 2009, remains so today. In an interview with Forbes, Dr. Jon Mark Hirshon, the chair of the ACEP’s Report Card task force, stated that the continued low state of access comes with, “19 more hospital closures in 2011, and [available] psychiatric care beds have fallen significantly, despite increasing demand.”

“People are increasingly reliant on emergency care,” he told the magazine, “and primary physicians are advising their patients to go to the emergency department after hours to receive complex diagnostic work ups and to facilitate admissions for acutely ill patients.”

With projected increases in ER volumes following implementation of the Affordable Care Act, the ACEP and emergency care providers are rightly concerned. For a country in which average door-to-doc times are increasing, additional volumes and fewer resources increase the likelihood that care will be delayed for individuals who need life-saving interventions.

What is the problem?

There is shared culpability. Aside from a lack of appropriate resources supporting ER care, society needs to uphold its end of the bargain.  

Many American consumers, accustomed to instant gratification, become patients with minor illnesses and injuries who are unwilling to wait a day or so before visiting a physician.

The insecure, work-a-day climate in which many Americans labor doesn’t help matters. Many workers feel they cannot take time away from their jobs to visit family doctors, and primary care offices don’t have many evening or weekend hours.

Consumers feel driven to visit emergency rooms for even the simplest medical needs — a fact which is especially true in urban core areas where residents are hourly wage earners with less paid sick leave and less robust benefits packages.

c2b solutions market research has also found a psychographic segment among consumers who were most likely to exhibit this behavior. We call this segment the Willful Endurers, and at 27% of the population represent a significant challenge to the medical community. They are the least likely of five segments to change their habits, but we have shown that their behavior can, in fact, by modified.    

How can we combat the problem?

The ACA is, as yet, the government’s best effort to drive patients toward primary care, but the legislation is too new to judge whether it will actually be effective. The solution, then, may be for providers to break the current primary care paradigm and start approaching medical care on the American health care consumer’s terms: by providing care when, and where, patients want it. Note the word want, as opposed to “need.” Welcome to consumerism in health care.

EMTALA (Emergency Medical Treatment & Labor Act) prevents us from turning away from the emergency room patients who have not been triaged by a provider qualified to evaluate the necessity of lifesaving intervention. But what would happen if all emergency rooms staffed one physician, or a midlevel provider like a nurse practitioner or physician’s assistant at triage? What would happen if that triaging provider had the option of sending a patient through to one of two doors: one leading to the emergency room proper and the other to urgent primary care?

Better yet, for the sake of following long-term trends in a patient’s disease progression, what would happen if primary care practices (at least in urban areas where the need is arguably greatest) were staffed 24-7?

In an environment of cost-cutting, strained resources and limited ability to innovate, this may seem a little idealistic. It might also be a hard sell to providers, but as more primary care practices yield to economic pressures and allow themselves to be absorbed by hospital systems, receptiveness to such an arrangement may grow. The ACA provides funding for demonstration pilots (Regionalized Systems for Emergency Care Pilots: Sec. 3504) so a limited test of these ideas could be feasible.

Targeting these patients — current and potential — with segment-specific education on the appropriate use of the ER, designed to appeal to their attitudes and motivations, may also relieve some of the issue.

It would certain be better for consumers and may make better financial sense for provider systems over the long run.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change

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