Soaring ER use adds more pain to health costs

About half of all patient admissions come through emergency rooms, creating yet another spending problem.

By Bruce Kennedy 

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In another sign that America's health care system needs healing, a new study suggests that overworked hospital emergency rooms have evolved into the main entrance point for most patients and that the ER is where most hospitals need to work on controlling costs.

The Washington Post notes that trips to U.S emergency rooms have soared in recent years, from 67 million in 1996 to 119 million in 2008. The Agency for Healthcare Research and Quality estimates emergency department costs account for up to 5.8% of total health care spending -- or up to $151 billion.

"The ER has become increasingly important as a place where people go for acute unscheduled care," Michael Lee, an assistant professor of emergency medicine at Brown University's Warren Alpert Medical School, toldBusiness Insider. "However, there has been little rigorous analysis of its cost structure."

A new study by Rand finds emergency departments take about half of all hospital admissions nationwide. Inpatient admissions and treatment make up 31% of all national health care spending, which means emergency departments can have a major impact on determining overall costs.

"Use of hospital emergency departments is growing faster than the use of other parts of the American medical system," Dr. Art Kellerman, a senior researcher at Rand and the study's senior author, said in a press statement. 

"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."

One of the biggest factors behind the rise of ERs' importance is the economic downturn. Between 2001 and 2008, according to the study, ER use grew at about twice the rate of population growth. At the same time, the number of hospitals nationwide contracted -- with the loss of nearly 200,000 beds -- leaving ERs "crowded with admitted patients who could not be transitioned into inpatient care."

ER doctors, meanwhile, have become more aggressive in their use of costly technologies to diagnose an increasingly older and sicker population. The Rand study quotes a team of Harvard analysts who determined Medicare charges related to emergency medicine were second only to radiation oncology when it came to rising costs. 

According to the study, emergency departments "often feel obligated to repeat tests because they cannot get access to the patient's medical record."

Another important factor: Emergency rooms "are the only place in the U.S. health care system where the poor cannot be turned away," the study notes. "As a result, they are disproportionately used by low-income and uninsured patients who cannot reliably get care in other settings."

The researchers say their findings suggest efforts to reduce nonemergency ER visits should focus on finding ways to provide patients with better and more timely access for such care, which in turn would reduce costs by minimizing duplicate tests and cutting down on unnecessary hospital admissions.

"We believe there needs to be more effort to integrate the operations of emergency departments into both inpatient and outpatient care systems," noted lead author Kristy Gonzalez Morganti.