News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

University of Maryland Study Determines Nearly 50% of All Healthcare in America is Delivered in Emergency Departments, Validating What Hospital Medical Laboratories Have Long Known

Meanwhile, some insurance payers are dropping coverage for certain medical treatments they consider “unnecessary,” leaving hospitals and their medical laboratories to wonder if they will be reimbursed for the tests they perform

Hospital-based medical laboratories and anatomic pathologists are well aware that the emergency department (ED) in their hospital is their single largest customer and that reporting test results within required turn-around times (TATs) is a non-stop battle. Thus, it will not be a surprise to learn that EDs provide nearly half of all hospital-related medical care in the US. That’s what a study by the University of Maryland School of Medicine (UMSOM) reports.

The UMSOM researchers claim their study, which was published in the International Journal for Health Services (IJHS), is the first ever to quantify the contribution EDs make to US healthcare. According to an UMSOM news release, they determined that 47.7% of all hospital-associated medical care between 1996 and 2010 was delivered by EDs.

Results Show EDs Critical to Healthcare Delivery

This a remarkable revelation. “I was stunned by the results,” David Marcozzi, MD, Associate Professor and Assistant Chief Medical Officer for Acute Care, UMSOM Department of Emergency Medicine, told Becker’s Hospital Review. Marcozzi led the study, which involved researchers from Thomas Jefferson University and other academic institutions.

“This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system,” he continued. “Patients seek care in emergency departments for many reasons. The data might suggest that emergency care provides the type of care that individuals actually want or need.”

As Becker’s Hospital Review explained, there were about 130-million visits to hospital EDs as compared to 101-million outpatient visits, and 39-million inpatient visits during 2010, the most recent year analyzed by UMSOM.

Quantifying the EDs Contribution to Healthcare

The researchers studied the role EDs play in caring for Americans, as compared to hospital outpatient and inpatient sectors. They were motivated, in part, by the apparent extra attention healthcare decision-makers pay to inpatient services and costs. As an emergency medicine and population health specialist, Marcozzi (who also works in the UM Medical Center Emergency Department) challenged that focal point.

In the first study to quantify the contribution of emergency department care to overall US healthcare, researchers at the University of Maryland School of Medicine (UMSOM) have found that nearly half of all US hospital-associated medical care is delivered by emergency departments. In this video, David Marcozzi, MD, MHS-CL, FACEP, talks about why this is happening and what the ramifications are for healthcare delivery in the US. Click on image above to view video. (Video and caption copyright: University of Maryland School of Medicine.)

The researchers cited National Center for Health Statistics data suggesting just 12% of ED encounters led to hospitalizations. This seems to counter claims of up to 50% of all healthcare being delivered in EDs. However, the researchers note that EDs also serve the uninsured and poor, many of whom are not admitted to the hospital.

“Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered [medical] homes, managed care resources, and accountable care organizations. The use of EDs has not been given much consideration in these models,” the authors wrote in their paper.

ED Visits Jump Nearly 44% over 14 Years

Researchers analyzed ED patient, outpatient, and inpatient data from these sources:

  • National Hospital Ambulatory Medical Care Survey
  • National Hospital Discharge Survey
  • Electronic data files (sources of patient demographics and medical information) from commercial organizations, state data systems, hospitals, and hospital associations

They discovered that 3.5-billion healthcare encounters occurred over the 14-year period studied (1996 to 2010), representing a 43.7% increase in ED visits during that time.

During that period, ED utilization resulted in:

  • 1.6-billion ED visits or 47.7%
  • 1.3-billion outpatient visits or 37.6%
  • 5.2-million hospital admissions or 14.8%

The UMSOM study also found EDs were increasingly being used by African Americans in the south and west and by Medicaid beneficiaries, Fierce Healthcare reported.

“When considering the isolated ED case mix, Medicaid as a course of payment showed a major increase in its contribution, shifting from 19.4% to 27.5% of all emergency care,” the researchers noted.

What’s needed, according to the study authors, are solutions to address non-urgent conditions often seen in EDs. However, they acknowledge, that the topic has drawn controversy.

Insurers Respond to Trend by Dropping Coverage of ‘Unnecessary’ ED Treatments

Some insurance companies on the hook for increasing ED costs have devised a novel approach to the increased cost—stop paying for it.

A Dark Daily e-briefing recently covered one such “solution” involving letters sent to Anthem Blue Cross and Blue Shield (BCBS) of Georgia members informing them that ED services deemed “unnecessary” by BCBS would no longer be paid. (See Dark Daily, “Anthem Blue Cross Blue Shield of Georgia Drops Coverage for Non-Emergency ER Visits; Medical Laboratories Could See Drop in ER Clinical Lab Test Orders,” July 14, 2017.)

These new guidelines, which created quite a stir in Georgia before they went into effect July 1, 2017, are mirrored at BCBS affiliates in New York, Missouri, and Kentucky, noted sources in the Dark Daily report.

Non-avoidable Healthcare Events and ‘Connecting the Care’

In apparent response to this trend, a study published in the International Journal for Quality in Health Care, found that just 3.3% of ED visits are actually “avoidable.”

“Despite a relentless campaign by the insurance industry to mislead policymakers and the public into believing that many ER visits are avoidable, the facts say otherwise,” stated Becky Parker, MD, President of the American College of Emergency Physicians (ACEP), in a news release.

UMSOM’s Marcozzi says the aim should be to “connect the care” delivered in EDs with other care offered by the healthcare system.

“Restricting EDs to patients classified as having critical illness does not seem a feasible or humanitarian option, as many individuals would not be able to find care elsewhere. In addition, many people do not have the knowledge to determine which symptoms indicate an emergency,” the researchers note.

Clinical Laboratories Can Download the UMSOM Full Study for Future Reference

At this point, it’s not clear how increasing ED costs and decreasing insurance payments will impact medical laboratories and anatomic pathology groups. Nevertheless, the UMSOM study is a good resource. ED volume and test orders will likely increase as more people go to EDs for treatment.

As a special to Dark Daily readers, Sage Publications is granting full access to UMSOM’s study through March 31, 2018. After that date, only the abstract will be available to non-IJHS subscribers. Click here to reach the full study article or place this URL into your browser: http://journals.sagepub.com/stoken/default+domain/JG8RNXfhAf7fuhFRIUIV/full.

—Donna Marie Pocius

Related Information:

Trends in the Contribution of Emergency Departments to the Provision of Hospital-Associated Health Care in the USA

University of Maryland School of Medicine Study Finds That Nearly Half of U.S. Hospital-Associated Medical Care Comes from Emergency Rooms

Nearly 50% of US Medical Care Occurs in EDs

ERs Provide Nearly Half Medical Care in U.S., Study Finds

Avoid Emergency Department Visits: A Starting Point

Only 3.3% of ER Visits Are Avoidable

Anthem Blue Cross Blue Shield of Georgia Drops Coverage for Non-Emergency ER Visits; Medical Laboratories Could See Drop in ER Clinical Lab Test Orders

 

Vitals Study Shows Consumers Using Cost Transparency Tools Select Clinical Laboratories with Low Test Prices

Researchers find shopping for medical laboratory tests increased by nearly 50%, and people are saving more than a million dollars annually by shopping for blood tests

Each year, more consumers use online healthcare price-shopping tools to find hospitals, physicians, and clinical laboratories that have the lowest prices. And medical laboratory tests is among the top services on their lists!

Researchers at Vitals of Lyndhurst, NJ, a company that publishes online physician ratings, analyzed how consumers were using its price and quality transparency tools. They confirmed that shopping for medical laboratory tests/blood work is one of the top healthcare procedures checked by consumers.

According to a recent Vitals press release, approximately 46% more people shopped for blood tests in 2015 than the year before, and they saved $1,149,682 by doing so. That’s because their health plans reward them for selecting good quality and low-price providers, as well as adopting healthy behaviors, such as losing weight, exercising more, and lowering high cholesterol scores. (more…)

Ongoing Shift from Inpatient to Outpatient Care Shows Up as Revenue Loss in Boston’s Partners Healthcare’s QTR2 Report and Includes Decline in Outpatient Clinical Lab Services

Even this premier academic center is experiencing a reduced volume of inpatient discharges, signaling to pathologists that efforts to keep people out of hospitals are succeeding

What does it mean when a prominent healthcare system like Partners HealthCare of Boston, Massachusetts, reports a decline in revenue and operating profit? After all, as one of the nation’s premier academic health centers, it is reasonable to expect that it would enjoy strong demand for its inpatient and outpatient services.

That is why pathologists and clinical laboratory managers will find it interesting that Partners experienced a decline in patient volumes during its second quarter ending March 31, 2014. Similar to other hospitals throughout the nation, fewer inpatients are showing up at hospitals operated by Partners HealthCare. (more…)

Kaiser Identifies and Ranks 10 Highest-Price Markets for Health Insurance and Determines that Lack of Competition Is One Contributing Factor

Pathologists may be surprised to learn that the nation’s highest-cost markets for health insurance include Colorado ski resorts and rural regions

What do the 10 most expensive U.S. health insurance markets have in common? According to a story published by Kaiser Health News, the 10 highest-priced markets are characterized by lack of competition among doctors, hospitals and insurers.

That will probably not be a surprise to most clinical laboratory managers and pathologists, particularly if they work for a health system that has lots of market clout in their community. That’s because concentration of market share by just a few powerful hospitals or health systems is associated with higher prices for healthcare. However, there are exceptions. (more…)

Kaiser’s Ranking of 10 Least Expensive Markets for Health Insurance Contain Surprises and Show Where Prices for Pathology and Clinical Laboratory Testing May be Cheapest

Study by Kaiser Health News and NPR shows that Minnesota, Northwestern Pennsylvania, and Tucson, Arizona are among the least expensive health insurance markets in the United States

Are you lucky to live in one of the nation’s 10 lowest-cost markets for health insurance? Researchers at the Kaiser Family Foundation published a study that identifies the 10 regional markets in the United States where health insurance costs are the cheapest.

Pathology groups and medical laboratories serving these 10 regions are thus probably getting paid less fee-for-service reimbursement than in other more expensive regions of the United States. The study shows how variable the cost of the same healthcare insurance plan can be from one city to the next across the nation. (more…)

;