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Preventative Emergencies

Characteristics of Patients Presenting to an Large Urban Academic Medical Center Emergency Room
by

Eric Clarkson

on 19 June 2010

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Transcript of Preventative Emergencies

EMTLA Emergency Medical Treatment and Active Labor Act
Not Funded Estabilshed under the Consolidated Omnibus Budget Reconciliation Act of 1985 C BRA 1993-2003 23% increase in ER Visits
Closure of 425 Hospital ER's Background THE P[L]AYERS PRIVATE INSURANCE
34.6% MEDICAID
21.6% MEDICARE
20.2% UNINSURED
17.7% November 2009
1 Week
880 Patients
Admissions: 174
Fast Track: 206
435: Clinic Appropriate 445: ER Appropriate 284: After Hours and weekends 151: Regular Clinic Hours 435: Clinic Appropriate 72: Extended Clinic Hours When? Who? Ages 0-9
Ages 10-19
Ages 20-39
Ages 40-59
Ages 60+ 70 33 172 122 38 16% 8% 40% 28% 9% 435 Patients 5:00-9:00 pm 8:00-5:00
Weekdays 8:00-5:00
Weekdays 47 51 39 48 6 38 11 9 Where? Kansas: 344
Missouri: 87
Elsewhere: 4 39% 58% 28% 36% 16% 22% 8% 3% 2% 1% THE COST 452 367 Uninsured Insured Rate of ER Presentation Why? Medical Home:
234 Medical Homeless:
201 45 Million Uninsured= 16% of the US Population Usual Source of Care 18.4% report no "Usual Source of Care
Age 19-24 most frequent
Reason?... "I'm seldom sick." (17%) (67%) AHRQ National Data (2001) S Uninsured use of ED for
Ambulatory Care Visits
(1996-2000)
Increased from 17% to 25%
Physician office visits declined 40% High fixed cost
+ Large Volume
_________________ Low Marginal Cost
Flawed Assumption for Emergency Departments Average Marginal Cost of treating an additional patient in the ED is between $300-$400 Conclusions:
Overutilization of the ER is an inefficient use of limited resources bankrupting hospitals and our Health care system.
It is not the cause of but rather a symptom of a sick healthcare system
So now what? $135.08 $46.46 $65.32 $32.20 $66.83 $99.86 Outpatient Consult Emergency Department Office Visit Strengths Access to all
Disaster Preparedness
24/7 readiness
Quick Weaknesses Expensive
Continuity
Inequality
Inability to limit access to emergencies and minor injuries Opportunities Patient Protection Affordable Care Act 2010
After-hours
increased revenue
Resident learning /moonlighting Nearly everyone gets insurance
First dollar coverage for preventative Health Services (medicare/medicaid)
Strengthening Community Health Centers
Expanding Medicaid
10% increase in Medicare Payment
Medicaid pays same as Medicare

Characteristics of patients presenting to an urban academic medical center with clinic appropriate conditions Threats Poor Quality?
Patient inconvience
Moral Hazard
Information Asymmetry Clinic Hours? Characteristics of patients presenting to an urban academic medical center with clinic appropriate conditions Eric Clarkson DO, MBA
PGY3 University of Kansas
Family Medicine Residency Adding Extended Clinic Hours 151: Regular Clinic Hours 223 284 ? 1996-2004, low income adults reporting no usual source of care increased from 28.0 to 33.1 percent
Having no usual source of care and relying on EDs for care is associated with worse health outcomes and higher costs. 0.17% 0.32% 0.27% 0.19% 0.18% 0.16% 0.08% 0.07% References:

1.Pancholi M. Reasong for Lacking a Usual Source of Care: 2001. In: Statistical Brief #32; 2001.
2.Newton MF, Keirns CC, Cunningham R, Hayward RA, Stanley R. Uninsured adults presenting to US emergency departments: assumptions vs data. JAMA 2008;300(16):1914-24.
3.Bamezai A, Melnick G. Marginal cost of emergency department outpatient visits: an update using California data. Med Care 2006;44(9):835-41.
4.Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007; (386):1-32.
5.Institute of Medicine (U.S.) Committee on the Future of Emergency Care in the United States Health System. Hospital-based Emergency Care: at the Breaking Point. Washington, DC: National Academies Press; 2007.
6.AHRQ. Medical expenditure panel survey. http://www.meps.ahrq.gov/mepsweb/. Accessed October 16, 2008.



Average Wait time(Nash, Zachariah et al. 2007)
Fast Track: 2:07 (1.97 in study)
ER: 4:34 (4.36 in study)
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