RAND Report

[deleted109597]

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Good reading.
Warning, 79 page .pdf ahead.
http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR280/RAND_RR280.pdf

Of course, reading it isn't the same as hearing Art Kellerman talk about it for an hour, but not everyone gets to do that.

 

[emd123]

Good reading.
Warning, 79 page .pdf ahead.
http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR280/RAND_RR280.pdf

Of course, reading it isn't the same as hearing Art Kellerman talk about it for an hour, but not everyone gets to do that.

Summary, please

 

[deleted109597]

The research described in this report was performed to develop a more complete picture of how hospital emergency departments (EDs) contribute to the U.S. health care system, which is currently evolving in response to economic, clinical, and political pressures. Using a mix of quantitative and qualitative methods, it explores the evolving role that EDs and the personnel who staff them play in evaluating and managing complex and high-acuity patients, serving as the key decisionmaker for roughly half of all inpatient hospital admissions, and serving as "the safety net of the safety net" for patients who cannot get care elsewhere. The report also examines the role that EDs may soon play in either contributing to or helping to control the rising costs of health care.

Also, a cliff's notes on ACEP's site.
http://newsroom.acep.org/2013-05-20-ER-Docs-are-Key-to-Reducing-Health-Care-Costs

 

[gman33]

They quote ER admissions increasing 17%.

Is some of this from the lack of primary care and docs not doing direct admits?

Crazy how often patients get sent in from a primary office for "evaluation".
Aren't you a doctor? Order tests and admit your own patients.

 

[BADMD]

They quote ER admissions increasing 17%.

Is some of this from the lack of primary care and docs not doing direct admits?

10% decrease in direct admission from PCPs

Crazy how often patients get sent in from a primary office for "evaluation"..

The report notes that 4/5 PCPs send their patients to the ED for afterhours care.

 

[la gringa]

not that we didn't already have an idea of this, but here are some interesting numbers:
The 4 percent of doctors who staff America's EDs manage:
- 28 percent of all acute care visits in the United States
- half of all the acute care provided to Medicaid and Children's Health Insurance Program (CHIP) beneficiaries
- two-thirds of the acute care provided to the uninsured (Pitts, Carrier, Rich, & Kellermann, 2010).

and, on a related note...
Nationwide, about 55 percent of emergency services are uncompensated (American
College of Emergency Physicians, 2012)

I don't want to be labeled a martyr or anything, but i long have thought that there should be some tax benefit given to physicians who can document doing more than a certain &age or amount annually of uncompensated care. EP's and on-call specialists, under EMTALA, do so much uncompensated care it isn't even fathomable. all i'd ask for is a freaking income tax break, as we never get most of the breaks available to individuals and families due to being in school/residency then BAM, high tax bracket. then there's that pesky 6 figure student debt...

i'm just on page 3!

 

[Birdstrike]

i long have thought that there should be some tax benefit given to physicians who can document doing more than a certain &age or amount annually of uncompensated care. EP's and on-call specialists, under EMTALA, do so much uncompensated care it isn't even fathomable. all i'd ask for is a freaking income tax break..

I agree with you. However, this is a political issue, that would require widespread public support. Actually achieving this in the current environment, with the current administration, would be next to impossible. Currently, the political "winds of change" blow in the direction of raising taxes on high earners, and to have them "finally pay their fair share." Actually carving out a tax break to a special group of high earners such as EPs is not politically useful to those in power, currently. In fact, demonizing physicians as overpaid, greedy and the source of high healthcare costs, is much more politically expedient. It never hurts to try, though

 

[la gringa]

I agree with you. However, this is a political issue, that would require widespread public support. Actually achieving this in the current environment, with the current administration, would be next to impossible. Currently, the political "winds of change" blow in the direction of raising taxes on high earners, and to have them "finally pay their fair share." Actually carving out a tax break to a special group of high earners such as EPs is not politically useful to those in power, currently. In fact, demonizing physicians as overpaid, greedy and the source of high healthcare costs, is much more politically expedient. It never hurts to try, though

i think if the #'s and facts were better publicized, that it may garner support. obviously it would have to be tagged onto another bill, and we'd probably have to get more to a point where people won't go into EM, BUT... there ARE lots of issues w/ specialists taking call.

i think it could get through as a "compensation for unreimbursed care", not EM specific, and not so much "tax break for wealthy" so much as "ACA can't and won't pay enough so this is a compromise"

another example of physician's weak place in DC 🙁

 

[John Lannister]

not that we didn't already have an idea of this, but here are some interesting numbers:
The 4 percent of doctors who staff America’s EDs manage:
- 28 percent of all acute care visits in the United States
- half of all the acute care provided to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries
- two-thirds of the acute care provided to the uninsured (Pitts, Carrier, Rich, & Kellermann, 2010).

and, on a related note...
Nationwide, about 55 percent of emergency services are uncompensated (American
College of Emergency Physicians, 2012)

I don't want to be labeled a martyr or anything, but i long have thought that there should be some tax benefit given to physicians who can document doing more than a certain &age or amount annually of uncompensated care. EP's and on-call specialists, under EMTALA, do so much uncompensated care it isn't even fathomable. all i'd ask for is a freaking income tax break, as we never get most of the breaks available to individuals and families due to being in school/residency then BAM, high tax bracket. then there's that pesky 6 figure student debt...

i'm just on page 3!

This data just goes to show how important EM services are to America. It's like the reticular activating system of the healthcare brain.