Huge ED admission spike is evidence of a much larger healthcare problem

Aug. 19, 2013

Recent findings by the RAND corporation reveal that more than four out of five (81.8 percent) unscheduled admissions to U.S. hospitals now come through the emergency department (ED), a huge jump from the previous decade, when only 64.5 percent of unscheduled admissions came through the ED. A study, “Changes in the Source of Unscheduled Hospitalizations in the United States,” published in June in the journal Medical Care, reconfirms the findings.

“Although generally sicker, patients admitted to the hospital from the ED had lower mortality and shorter hospital stays than patients admitted directly from the community,” says lead study author Keith Kocher, M.D., MPH, of the Department of Emergency Medicine at the University of Michigan in Ann Arbor, Mich. “The emergency room was the source of admission for a wide variety of clinical conditions, from medical and surgical disease to mental illness. It was also the source of admission for more vulnerable populations like the elderly, minorities and the uninsured.”

Dr. Kocher and his team compared hospital admissions over a 10-year period, from 2000 through 2009, using the Nationwide Inpatient Sample. Admissions through the ED increased at the expense of admissions from clinics and/or doctors’ offices, which declined to 14 percent from 31 percent of unscheduled admissions.

Medical costs have skyrocketed to the point where those without insurance who face serious medical problems often cannot afford to pay for the healthcare they require. Even those with insurance are often confronted with medical bills so ridiculously inflated compared to most other countries that they are left destitute and, in some cases, homeless.

Case in point: I have health insurance. It costs me about $300 a month, even though my employer pays half. And that’s just for me; I have no spouse and no children. The cost to insure an entire family is beyond ridiculous; many families simply cannot afford it. And even with insurance, the insurance companies pick and choose what they will cover and when they will cover it. What percentage will be covered? What is your allowable amount? Is your doctor or lab in your network or out of your network? What are your deductibles? What are your out-of-pocket maximums?

Even with full coverage, I’m facing about $1,000 in medical bills supposedly not covered by my insurance. Despite many calls, I haven’t been told why, or what exactly it is I’m expected to pay for. In one case, an in-network doctor used an out-of-network lab. In another, a local hospital charged me $300 for a procedure I didn’t have, on a day I wasn’t there. All this … and I’m relatively healthy, save a bum neck.

Now imagine some of the nightmare scenarios for those people who are not healthy.

Those without insurance who wait until they are so sick they have to go – or be taken – to the emergency room often can’t pay, which only serves to inflate the cost for medical services further.

Just thinking about it turns my stomach. How can we consider ourselves world leaders if we treat our own citizens this way? Sometimes it seems so cold, as if our best healthcare is solely for the wealthy, while the rest of us are left to die in the street.

Now that we can use healthcare IT, specifically big data and analytics, to identify these endemic problems – really a big part of what is destroying the middle class in this country – we need to utilize healthcare IT to begin solving them.

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