Managing the future of inpatient care will mean focus on the emergency department – and a lot more of it, according to Mark Mackey, MD, MBA, vice chairman of clinical affairs at the University of Illinois Hospital and Health Sciences System and John G. Holstein, director of Zotec Partners, in their talk at the Becker's Hospital Review 5th Annual Conference in Chicago on May 16.
"The ED is the nexus of care for the whole healthcare continuum," said Mr. Holstein, who noted around 130 million patients and between 68 and 75 percent of all hospital admissions come through the ED, whose physicians on average are worth $1 million each in hospital revenue each year.
Dr. Mackey commented on the concurrent decrease of resources allocated to the concept of the ED. "The number of EDs has decreased. We think that'll probably continue, due to terms of the Affordable Care Act and Expanded Medicaid eligibility," he added.
Despite what the Obama administration had hoped, he predicted ED visit rates will increase. "It happened in Massachusetts, after 95 percent of the population got insured. ED rates rose around 9 percent, mostly for after-hours routine care. Fifty-five percent of that increase was because of patients' inability to get an appointment," he said.
Only 15 percent of care in the ED is immediate or urgent, according to the Centers for Disease Control and Prevention, and the ED physician, 11 percent of the physician population, provides 26 percent of all acute care in the United States, as a result, said Dr. Mackey.
Low payment rates for Medicaid patients, the small amount of money spent on ED care and a myriad of other factors going against the business and care sides of the ED will need to be managed carefully in order to keep control of the inpatient side of care, as emergency physicians are the primary decision-makers for about half of all inpatient admissions, he said, adding that a large opportunity for emergency care is creating a model for care that effectively segments populations based on the emergency care they are likely to need.