Monday, November 7, 2011

Missing the Point?

I guess this counts as a meta-blog as I am commenting on an article over at Kevinmd.com.  Dr. Riner, an Emergency Medicine physician, former president of the American College of Emergency Physicians, and payor consultant reports on the limited utility of trying to keep patients out of the emergency room as a form of cost containment.  He presents data that suggest that deferring emergency care is dangerous, ineffective and does not save any money.  I have no grounds to disagree with his argument as presented.  But as an internist and hospitalist on the receiving end of the Emergency Room, I think he misses the point.  The savings is not in keeping people out of the Emergency Room, it is in keeping them out of the Emergency Room as a way of keeping them out of the hospital.

Given the unique financial incentives and horrid liability that ED doctors face, they have a very strong incentive to admit patients to the hospital.  The hospital is the dangerous, expensive vortex patients enter which drives such high cost in our society.  The Emergency Room is merely the largest portal into that vortex.  The problem, then, lies not with the Emergency Room, but rather with a primary care system ill equipped to care for complex patients outside of the hospital.

I cannot speak for others, but when I refer to keeping patients out of the Emergency Room, it is always in conjunction with keeping them out of the hospital as well.

I do agree with the Dr. Riner that trying to save money in the Emergency Room (like trying to save money in a primary care office) misses the point entirely.