The rising complexity and cost of emergency care has been a frequent target of policy makers and clinical leaders over the past decade, with some experts worried about the cascading effect of subsequent healthcare spending once the patient leaves the emergency department. However, new research suggests that high quality emergency care not only saves lives but also saves money, especially for Medicare beneficiaries.
“Too often discussions of the cost of emergency care fail to consider the bigger picture—that spending on emergency care can save lives, alleviate suffering and in some instances avoid the need for a more expensive hospitalization,” said Laura Burke, MD, MPH, FACEP, emergency physician at Beth Israel Deaconess Medical Center and lead study author. “Emergency physicians treat anyone, anytime and serve as the safety net for the nation’s acute care system. Our research suggests that outcomes improved for Medicare patients using the ED, and that emergency physicians are finding ways to safely send patients home by providing care that is patient-centered and cost-saving.”
Declines in 30-Day Costs
The study, conducted by The Emergency Medicine Foundation and published in the JAMA Network Open in August, found that while the average cost of ED visits increased during the period from 2011 to 2016, along with overall national healthcare costs, the total 30-day costs of care for all ED visits decreased during that same period. The decreases were largely due to declines in spending on postacute care and subsequent inpatient care.
In fact, the total number of inpatient admissions fell by more than 5 percent during this same time period. Even after accounting for small increases in observation care and transfers, discharges to home increased by 3 percent, leading researchers to conclude that “more intensive ED spending up front is associated with reductions in total costs of an acute episode.”
“While the 8% relative decline in total 30-day costs during the 6-year study period may be considered modest, this represents substantial savings to Medicare and stands in contrast to the overall increase in health care spending more broadly during the same period,” write the study’s authors, Burke; Ryan C. Burke, PhD, MPH; Stephen K. Epstein, MD, MPP; et al.
Mortality Rate Also Fell
Perhaps even more notable, researchers also found that the mortality rate of Medicare beneficiaries who use the ED also fell during the same period, supporting the authors’ claim that “the decline in total spending on ED episodes of care appears not to have occurred at the expense of patient outcomes.”
The study examined more than 14 million emergency visits by Medicare beneficiaries between 2011 to 2016 at 4,730 emergency departments. “Total cost of care” includes the initial and subsequent emergency visits and physician costs, observation care, outpatient care outside the emergency department, and post-acute care.
COVID-19’s Impact on ED Efficacy
These findings highlight the urgency of another study conducted by Yale University this summer examining the impact of the COVID-19 Public Health Emergency on emergency department use. Consistent with earlier findings, the Yale study found that ED visits plummeted in March and April, tracking closely with spikes in COVID-19 cases in each state the authors examined. In areas where COVID-19 cases were high, inpatient admissions from the ED also spiked.
“This is a case where public messaging appears to have worked too well,” said lead author Dr. Edward R. Melnick, associate professor of emergency medicine. “We said, ‘stay home,’ and what people heard was: ‘Stay home at all costs to avoid COVID-19.’”
New Rallying Cry: “Hospitals Are Safe”
According to Yale News, after their initial findings were released researchers have continued to analyze the data to look at more states, find underlying causes for avoiding the ER, and examine outcomes.
“We want to understand what happened to people who didn’t make it to the hospital and the barriers to seeking and receiving care,” Melnick said. “Our new rallying cry is that hospitals are safe.”
Researchers also looked at data from May, June, and July, and while ED visits did increase, they have not returned to baseline. If high quality ED care saves lives and money, then it’s possible that the absence of that care means more lives and money are being lost as a result of the pandemic and not just from COVID-19 itself.
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