Rand Study Shows Emergency Departments' Growing Importance in U.S. Health Care System While Complementing Primary Care
May 29, 2013
A new study by the nonprofit RAND Corporation finds that emergency rooms are playing a growing role in preventing unnecessary hospital admissions, engaging in preventive care and providing vital diagnostic workups that many primary care doctors don't.
The study's findings indicate that office-based doctors are directing to emergency departments (EDs) some patients they previously would have admitted to hospitals themselves. Emergency rooms accounted for almost all growth in hospital admissions between 2003 and 2009 while admissions from doctors' office and other outpatient settings dropped by 10 percent.
According to RAND, EDs increasingly support primary care doctors by performing diagnostic workups that cannot be done in physician offices. In additions, EDs handle patient overflow from primary care providers, take after-hours cases and manage weekend demand for medical care.
"As pressure builds to constrain further growth of healthcare spending, EDs are likely to come under greater scrutiny," the RAND study noted. "Whereas policymakers and third party payers have largely focused on the cost of ED care relative to treatment in other outpatient settings, the role of EDs in either facilitating or preventing hospital admissions may be a bigger story."
Patients with conditions like asthma and diabetes who visited EDs did not result in an increase in related hospitalization, which suggests that emergency room doctors are helping to prevent unnecessary admissions.
Because emergency doctors serve as a "major decision maker" for a sizeable share of U.S. hospital admissions, EDs are likely to play a more important role in U.S. health care by sorting through possible admissions and complementing the work of primary care doctors. Given the growing shortage of primary care doctors, emergency physicians will assume a greater role in deciding admissions.