For patients, emergency departments within acute-care hospitals are one of the most important components of a community. EDs are there 24 hours a day, seven days a week, and they give a sense of calm that if the worst-case scenario happened, patients can rely on that resource.
For hospitals, EDs can be one of the most stressful areas. Car accidents, unexpected injuries and other unfortunate mishaps keep physicians, nurses and staff working round-the-clock. EDs also have a major impact on a hospital's finances, as well, as hospitals must treat every patient in need of emergency care regardless of citizenship, legal status or ability to pay due to the Emergency Medical Treatment and Active Labor Act.
John Everett is CFO of Cogdell Memorial Hospital in Snyder, Texas. The 49-bed rural hospital has roughly 8,400 ED visits per year, and it pumps a great amount of resources into the ED to make sure it is high-performing — from competitive physician salaries to the helicopter service.
"I don't know of any ED that makes money in a hospital, but they are so essential," Mr. Everett says. "That's why it's important to run efficient EDs."
Here, Mr. Everett explains two problems Cogdell Memorial's ED and other similar hospital EDs have experienced over the past several years and how executives can find solutions to those problems.
1. Problem: Non-emergent patients. While the ED takes care of the most acutely-ill patients in a community, a growing trend cited by hospital executives and clinicians alike has been patients utilizing the ED without an "emergent" condition.
For example, earlier this year, Washington state officials attempted to pass a measure in which the Medicaid program would no longer pay hospitals for any emergency room visit deemed as "unnecessary."
Overall, roughly 500 different conditions would not have justified a Medicaid payment — ranging from obvious non-emergencies such as diaper rash to potential emergencies such as asthma attacks and chest pain. Instead, the state and healthcare providers agreed to a "Seven Best Practices" program to reduce Medicaid ED visits. Mr. Everett says the same scenario of limiting Medicaid payments for non-emergency visits is floating through Texas as well.
Solution: Creating walk-in clinics and educating your service area on primary care. Non-emergency ED visits can be a drain on a hospital's finances because the ED is one of the most expensive areas of care. Mr. Everett says Cogdell Memorial has adopted several of Washington state's best practices to reduce unnecessary and costly ED visits, including the active dissemination of patient educational materials, and encouragement of patients to seek primary care providers.
Cogdell Memorial plans to open an on-site walk-in clinic, staffed with physician assistants, next to its main facility to help treat patients in a lower-cost setting, and PAs will also work with the hospital's ED physicians and primary care physicians to ensure patients receive the right care in the right setting. The most challenging component of this, Mr. Everett says, is actually reaching patients to teach them more about an efficient emergency care system.
"Getting patients educated is big piece of this," Mr. Everett says. "Educate them on primary care, walk-in clinics and how important it is for them to go get primary care."
He adds that hospitals must be diligent and determined in this effort because educating a patient base is a long process. "This is not going to happen over night," Mr. Everett says. "Old habits die hard."
2. Problem: Finding quality, highly-trained physicians and staff. It's no secret there is a nationwide physician shortage, and it is expected to worsen over the next several years. According to recent data from the Association of American Medical Colleges, there may be a shortage of 130,000 primary care physicians by 2025.
Because Cogdell Memorial is a rural hospital, Mr. Everett says attracting well-trained physicians, nurses and staff is even harder than organizations in larger, metropolitan areas. The problem also extends to the ED, and as ED physicians become harder to find, "their salaries go up with that," he says.
Solution: Recruit, recruit, recruit — and focus on working "smarter." Hospital executives must remain diligent in their efforts to recruit as many new physicians to their regions as possible. Cogdell Memorial is in a "health professional shortage area" — which the HHS' Health Resources and Services Administration defines as regions specifically in need of primary medical care providers — but Mr. Everett says Cogdell Memorial remained aggressive and are in pursuit of recruiting two physicians, one of whom is a resident, to work in both the clinic and ED.
For hospitals that continue to struggle in their ED physician recruitment efforts, Mr. Everett suggests they focus on what's immediately in front of them, or what he calls "working smarter." For example, this means utilizing more nurses, PAs and other physician extenders to help out when possible. Hospitals must also emphasize reducing costs in the ED. This may include flex scheduling during less hectic times, more judicious usage of supplies and a general focus on doing more with less.
"Try and staff the ED appropriately," Mr. Everett says. "It's about trying to get everyone to work smarter, not harder, on what they are doing."
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