Ever Increasing Visits to the ED, Really?

The other day there were a series of stories that some ED physicians were seeing a dramatic increase in ED visits nationwide.  Virtually, every news outlet carried the results of a survey that was conducted by asking 26,000 ED physicians their impressions as to the volume that they are seeing in their EDs.  Seventy-five percent of the 2,000 respondents indicated they were experiencing an increase in ED visits since the Affordable Care Act (ACA) took effect.

It is important to note that not all EDs are seeing increases in volumes; in fact of those surveyed, 5% saw a decrease.  At WMHS, we have seen a decrease over the last two fiscal years from 58,164 visits in 2012 to 52,555 visits in 2014.  We have achieved that intentional decrease by increasing primary care practices throughout the community, partnering with area urgent care centers, bolstering our own urgent care centers to keep the level 1 and 2 patients out of the ED and treat them in less intensive settings, delivering more care outside of the acute care setting, delivering much more care in the home, as well as paying more attention to the sickest of the sick and better addressing their chronic conditions in the primary care arena and within our Center for Clinical Resources.  

We continue to work with our ED partners, MEP, on our value-based care delivery model.  They support our ED, as well as manage our Observation Unit, provide practitioners for our SNFist Program (hospitalist type services in area skilled nursing facilities) and we are in discussions with them to provide coverage in other areas of the health system.  We work with them in partnership.  They understand the shift from volume-based care delivery to value-based care, and we are constantly exploring new opportunities to benefit them, our patients and WMHS.


The numbers may be increasing now nationally with so many more individuals being covered through the ACA and Medicaid, as has been the case in Maryland.  However, that will have to change going forward to achieve the objectives of the ACA through a new primary care infrastructure and a host of other initiatives in caring for patients in the most appropriate setting.  As the nation follows Maryland's lead in reducing care that is provided in the ED, as well as the acute care setting, you will see an overall decline in ED and other related utilization.