ED Physicians Key to Half of Hospital Admissions

John Commins, for HealthLeaders Media , May 21, 2013

Hospital inpatient care is a key driver of healthcare costs, accounting for 31% of the nation's healthcare expenses. Because of that the role emergency physicians play in deciding who to admit to the hospital is critical to hospital cost savings, since the average cost of an inpatient stay ($9,200) is roughly 10 times the average cost of a comprehensive emergency visit ($922), RAND said.

"Use of hospital emergency departments is growing faster than the use of other parts of the American medical system," Art Kellermann, MD, the study's lead author and a researcher at RAND, said in prepared remarks. "While more can be done to reduce the number of unnecessary visits to emergency rooms, our research suggests emergency rooms can play a key role in limiting growth of preventable hospital admissions."

Kaplan says RAND shows that office-based physicians are directing some patients to the ED who they previously would have admitted themselves. The study also found that EDs perform complex diagnostic workups that cannot be done in primary care physicians' offices, and that EDs supplement primary care providers by handling overflow, after-hours cases and weekend call.

"Patients who come to the ED are coming either because they have been sent there by their private doctor, or they have no other healthcare provider to turn to," Kaplan says. "Even those who have primary care doctors, when they call them for an appointment, they say 'go to the ED.'"

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