Hospital emergency departments, urgent care clinics and other acute-care providers take on the most challenging cases in healthcare, but the acute-care episode is also one of the most expensive to manage.
In a recent Health Affairs article, four physicians with backgrounds in emergency medicine outlined how hospitals and other providers can better contain costs in the acute-care setting.
1. Input: minimizing demand and costs. Reducing costs in the ED or other acute-care settings can occur from two initial mechanisms, the authors wrote. Hospitals can either take steps to avoid the visit, such as advocating for public health interventions like vaccination programs or disease management programs, or they can move encounters from the expensive ED to lower-cost settings, like clinics.
2. Throughput: making cost-conscious decisions during acute care. Acute-care episodes will inevitably occur, so hospitals can also take steps to reduce costs during that episode of care. For example, decision support technology in electronic health records, evidence-based care and care pathways and ED palliative care models can curb overuse of unnecessary tests and may improve patient experience and outcomes, the physicians said.
3. Output: coordinating care to avoid hospitalization. "One of the most costly decisions in acute care is the decision to hospitalize a patient," the authors wrote. The most progressive health systems are working on this by closely monitoring and managing patient care in the post-acute period so there is not a relapse.
The article also mentioned that although healthcare is moving to a value-based reimbursement system, a hybrid fee-for-service setup may work best for acute care.
"We argue that a better long-term model for payment reform, which uses the existing backbone of fee-for-service, is modified fee-for-service payment based on new measures of acute-care quality and resource use," the authors wrote. "In short, this would involve continuing to pay providers and hospitals based on volume, while also creating and using new measures to reward providers who safely deliver care that minimizes the use of high-cost testing and hospital admissions."
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