Thursday, September 9, 2010

Primary care visits to the ER up. Surprised?

It's been a frequent theme on these pages (see here, here and here): ER usage is up and that's not a good thing.  Costly, frustrating for everybody, and the care that's given is often designed to stabilize and move people along, not necessarily fully treat underlying or longer-standing ailments.  The old gatekeeper model was designed to allow primary care physicians to quarterback the entirety of a person's treatment and to take a longer view, with an eye toward preventative care even.  But, something happened along the way.  We all decided we need maximum choice (rationing... bad) and medical students decided they would rather become specialists than primary care physicians.

Health Affairs is publishing a study this month indicated that 28 percent of all ER visits are for routine care that could (i.e., should) be taken care of in primary care medical offices.  The study, conducted by Stephen Pitts, professor at the Emory University School of Medicine, points out that expanded health care coverage that is not met with a proportional increase in primary care access could spell trouble in the form of longer ER waits and higher costs.  He points specifically to the Massachusetts experience as the proof.

See the summary here.

The health reform good news is expanded access for more Americans.  The trick will be in developing strategies to more effectively manage costs and, as this study demonstrates, expand primary care access as needed.

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