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In part one of my interview with Dr. Sandra Schneider, we identified emergency department overcrowding as a symptom – rather than cause of – overall hospital overcrowding, while dispelling some long held myths regarding the true economic impact of this issue.
While yesterday’s interview provided more context, the fact remains that emergency department overcrowding is an issue all the same. And with the roll-out of health care reform, many expect it to continue to grow in severity.
In part two of my interview below, Dr. Schneider offers her take on how health care reform will impact our overcrowded emergency departments, and shares how better collaboration between the leaders of the medical imaging and emergency medicine fields can help to improve patient care in this new environment.
The American College of Emergency Physicians (ACEP) surveyed emergency physicians in 2011. The vast majority felt that the current crowding problem in the emergency department (ED) will be exacerbated if/when the new health law is implemented.
The Affordable Care Act is quickly becoming a reality and there remain a number of questions regarding how it will affect EDs, specifically and hospitals, in general. Can you elaborate on your belief that “coverage doesn’t equal access”?
SS: Massachusetts provides the best window into what will happen when the ACA is fully enacted. In Massachusetts, ED visits increased after the start of universal coverage. While there are many reasons for this, the literature would suggest that this occurred for 2 reasons.
First patients who were newly insured had chronic conditions for which they could now get care. This pent up demand has been seen internationally in countries which initiate coverage. Secondly Massachusetts lacked the capacity within the primary care practices to see all these patients.
As more patients get insurance coverage through Medicaid and exchange products, PCP practices will likely saturate, and access for these new patients may be strained. If this coverage does not prompt primary care physicians to engage these new patients, there will be more ED visits. Primary care providers and urgent care centers can limit their practice to patients with private insurance, which reimburses at a better rate than Medicare, Medicaid or any state run program. Coverage does not equal access.
There is also an increased tendency for patients to seek care. More conditions are being treated, there is more elective surgery and many patients’ lives are improved by this increase in care. Interestingly England recently attempted to control ED costs by building a large number of urgent care centers to offload busy EDs. However they found that ED visits continued to rise, and urgent care visits rose, and now they were simply providing more care, at a greater cost.
In discussing health care reform, cost savings and patient care seem to exist side by side. How can medical imaging technology lead the way in helping to improve patient care in a cost-effective manner?
SS: There needs to open and honest dialogue between the leaders of medical imaging and the leaders of emergency care. We need to work together to understand the needs of our patients and our workforce. We should examine new models of care, together. And we should invite to the table all of the stakeholders.
Recently quality measures were developed by the American College of Radiology and the AMA which included several specified for the ED. The input from the emergency medicine community was very limited. The entire process is now being revisited. Quality measures that involve imaging of emergency patients should have equal representation and input from both imaging science and emergency providers. In addition, other specialties should be at the table when appropriate, such as trauma, neurology, etc.
Guidelines for medical imaging should extend to outpatient practices as well as the ED to avoid a shift of services without a decrease in cost or utilization. The conversations should be transparent and collaborative, and the focused on the patient.
Read the third and final part of my interview with Dr. Sandra Schneider tomorrow to learn more about the evolutions to patient care and medical imaging technology that will be crucial in our new healthcare environment.
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