OK So Which Is It? Are ED Visits Increasing or Decreasing?

Over the last two days, I have read two articles on ED Visits.  One article was in Modern Healthcare and the second was in a Pittsburgh newspaper.  Modern Healthcare is stating that ED visits are increasing nationwide as more people are eligible for care under the Affordable Care Act, but they still wait until they are really sick to seek care.  

The second article says that patient navigators are being especially effective in directing patients to the most appropriate care.  In western Pennsylvania, there was a study of the effectiveness of patient navigators funded by Highmark and, not only was there a decrease in ED visits, but also in admissions and readmissions.  The navigators were able to direct patients to access care more efficiently.  That doesn't seem to be the case for the busiest EDs around the country.  They are seeing increases due to patients who are now covered, physicians closings practices and other practices no longer taking Medicare or Medicaid patients.  

This is an interesting dichotomy, in that we have had the experience that is more like western PA, at least up until the current flu season.  If you take time to understand the changes needed for the successful delivery of value-based care, such as increasing primary care centers, dedicating patient navigators like the Pennsylvania study did, adding community health workers, expanding home care, growing hospital medicine programs to better accommodate physicians who want to focus on an office practice exclusively, identifying and caring for your high utilizers in a settings that is outside of acute care and the list goes on.  Until all hospitals are focused on transitioning away from volume-based care to value-based care, the busiest EDs are going to continue to experience this.  It is also important to note that these initiatives take time to really see a difference.  

At WMHS, in a little more than a year, we have saved $4.5 million with our high utilizers alone through our Center for Clinical Resources through a reduction in admissions, readmissions, non-emergent use of the ED, less ancillary testing and by providing more directed care in the most appropriate location.