(This article has been updated with a correction.)
More than 10% of Mount Sinai Hospital's 110,000 emergency department visits each year involve patients over age 65. Three years ago, the 1,048-bed New York City hospital—which is participating in a Medicare shared-savings accountable care organization—opened a dedicated geriatric ED designed to help coordinate care for these higher-risk patients.
“There's sort of a silver tsunami approaching,” said Dr. Denise Nassisi, director of geriatric emergency medicine at Mount Sinai. “We planned it because we knew that geriatric patients really do require special handling.”
Across the country in Newport Beach, Calif., Hoag Memorial Hospital Presbyterian last August introduced an obstetrics emergency department to serve the mini baby boom now underway, which is being fed in part by an uptick in the insured population. Many expectant mothers with complaints unrelated to pregnancy were still visiting the ED because they didn't yet have a primary-care physician.
“What we found was that many of the patients who came into the general emergency department came in for conditions unrelated to pregnancy,” said Dr. Allyson Brooks, executive medical director of the Hoag Women's Health Institute. But the staff in the general ED often felt uncomfortable treating pregnant patients. “The patient was caught in the middle.”
Patients now see an OB-GYN within 45 minutes, increasing their satisfaction and reducing unnecessary admissions. “It's more coordinated care,” Brooks said.
The major investments in specialty EDs at Mount Sinai and Hoag Memorial are part of a broader trend across the country. ED visits, which are the starting point for about half of all hospital admissions, are continuing to grow, despite the dramatic decline in the uninsured rate brought about by the Affordable Care Act's insurance and Medicaid expansions.
In part that's because the number of newly insured patients is growing faster than the number of primary-care physicians available to treat them. “With the stroke of a pen, we can increase the number of patients covered, but it takes time to increase the infrastructure for primary care,” said Raphe Schwartz, a director at the Chartis Group, a management consulting firm.