The emergency department and managed care: A synergistic model

Managed care organizations (MCOs) have recently focused on the high cost of patient visits to the emergency department (ED). MCOs emphasize preventing the access low-acuity patients have to the ED, believing that billions of healthcare dollars will be saved. A review of ED studies, however, suggests a different outcome. Combined with new ED service lines, perhaps another-rather paradoxical-approach to managing healthcare costs in the ED is more patient focused and more cost effective in the long term. This approach is more comprehensive and offers more, rather than fewer, services. The ED is an important community resource and entry port to healthcare. It is the only place open 24 hours per day, seven days per week, with no appointment necessary and all lab and radiology services available. The very claim that it is overutilized is an indication of its success. In large-volume EDs, certain patient populations may be more specifically served with pediatric emergency, industrial medicine, and fast-trade physicians. Special facilities for chest pain patients or for observation enable physicians to treat patients more quickly and to keep them out of hospital beds, thus lowering costs. In smaller hospitals, the well-rounded ED physician can treat patients of all acuities. In the most rural communities, the ED can become the local 24-hour clinic with short-term stay beds. EDs are fixed costs to hospitals. Extracting low-acuity patients from the ED will raise costs for emergency patients and leave the facility underutilized. By appropriately raising prices for emergencies and decreasing low-acuity patient charges to reflect their marginal expense, hospitals can make the ED a cost-friendly environment for the low-acuity patient.