Study finds jump in ER-related admissions

(Story updated at 3:45 p.m. ET.)

Efforts to shift patients to lower-cost healthcare settings appear to flounder as the emergency department continues to play a larger role in where and how care is delivered.

A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009.

During that time, hospital admissions grew only 4%—not even keeping pace with population growth. But ER-related admissions jumped 17%.

With inpatient admissions accounting for 31% of healthcare expenditures, ERs are key to both hospital bottom lines as well as reining in rising costs.

Healthcare providers like Grady Health System, Atlanta, whose flagship facility is 660-bed Grady Memorial Hospital, have already been making changes to help streamline processes in

emergency room care.

In a February interview, Dr. Leon Haley, chief of emergency medicine, noted that the system had just finished a 12-week engagement with a consulting firm on its emergency department.

With fewer emergency rooms across the country handling a greater volume of patients, Haley said, the increase in ER visits has been across the board for both low- and high-acuity conditions.

Earnings reports also show rapid growth in ER volume even as inpatient admissions have risen more slowly.

For-profit system HCA, Nashville, the largest investor-owned chain, reported a 12.5% increase in ER volume in 2013 compared with 2012, with a 7.4% increase in admissions.

Not-for-profit systems reported similar findings. At the University of Pittsburgh Medical Center, which has a June 30 fiscal year-end, ER visits increased 12.7% in fiscal 2012 compared with the previous year. Inpatient admissions increased 6.1%.

Englewood, Colo.-based system Catholic Health Initiatives, also with a June 30 year-end, saw a 6.6% increase in outpatient ER visits and 3.9% for inpatient ER visits. Admissions increased just 2.1%.

Yet despite pushback to move patients away from ERs, the study's authors suggested that emergency departments also have helped prevent avoidable admissions: They found that even though patients show up to the ER with chronic conditions such as asthma and heart failure, admissions for these conditions remained flat.

Also, the study found that even

primary-care doctors are directing more people to the ER—where they can be seen at all hours and where sophisticated diagnostic equipment can help form quick diagnoses—rather than admitting these patients themselves.

The growth in ER-related admissions occurred alongside a 10% drop in admissions from other outpatient settings, including doctors' offices.

RAND developed the study for the Emergency Medicine Action Fund, a consortium of groups that represent emergency medicine physicians.

“This report tells policymakers and hospital administrators that they should pay closer attention to the role that emergency physicians play in evaluating, managing and preventing hospital admissions,” Dr. Andy Sama, president of the American College of Emergency Physicians, said in a news release.

The group highlighted that emergency medicine physicians now handle 11% of all outpatient visits and 28% of acute-care visits, including half of the acute-care visits for Medicaid beneficiaries and two-thirds for the uninsured.

Follow Beth Kutscher on Twitter: @MHbkutscher