RAND: All hospital admissions growth came from the ED

Findings raise questions about ED's effect on health care costs

EDs were responsible for nearly all hospital admissions growth between 2003 and 2009, according to a RAND study released Monday, but researchers suggest a positive surprise: EDs also are preventing costly hospitalizations.

According to the researchers, EDs drive about 50% of all U.S. hospital admissions, and there was a 17% increase in unscheduled ED admissions from 2003 to 2009. In contrast, there was a 10-percentage-point decrease in admissions to hospitals from doctor's offices and other health care provider settings, the study found.

According to researchers, patients typically visit EDs:

  • Because they lack health insurance;
  • To receive nighttime and weekend care; or
  • After being referred by their primary physicians to receive tests.

The report noted that EDs have long been a source of care beyond emergency treatment. "It is not just an emergency department," according to Arthur Kellerman, one of the study's authors and an emergency physician, "and it hasn't been for 20 years."

According to The Hill's "Healthwatch," the report points to a trend in which ED physicians are gaining more power as "major decision maker[s]" for a majority of hospital admissions. That power likely will increase as the shortage of primary care physicians worsens, the report adds.

Study questions long-held beliefs about EDs' effect on rising health care costs

The study provides contrast to a "powerful narrative" about EDs—that they provide costly care and contribute heavily to rising health care spending, "Healthwatch" reports.

The report concludes that EDs' contribution to rising health care spending is unclear, according to the New York Times. Researchers discovered that a greater number of patients with asthma and diabetes visited EDs between 2000 and 2009 but that the number of related hospitalizations did not increase, suggesting that EDs might prevent unnecessary hospital admissions.

The study findings "offer early evidence, albeit inconclusive, that EDs are already having a positive impact," the authors wrote.

Furthermore, while ED care might cost more than primary care, patients could benefit from diagnostic testing when compared with receiving care from several doctors or undergoing multiple tests to determine their illness (Abelson, New York Times, 5/20; Viebeck, "Healthwatch," The Hill, 5/20).

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