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Rapid Change in the ED

Business media outlets frequently highlight the importance of businesses being agile enough to adapt to changes in the market quickly. “Adapt Or Die — Businesses Must Embrace Change To Remain Relevant,” published by Forbes, is a prime example of this widely accepted message.

Hospital emergency departments have had to adapt to transformative change over the last 10 years. These have not been changes in the market because of competition or new technology, but massive changes in demand for a product unlike any other in the world: healthcare. Emergency departments are our communities’ frontlines in a constant battle against life-threatening illnesses and injuries, serving nearly 146 million people in 2016.

All sources indicate a continuing rise in emergency department visits in the United States. Clearly the healthcare needs of our population continue to rely on the critical resources provided by our nation’s emergency departments. According to the CDC, between 2007-2016, the number of people utilizing hospital emergency departments rose nearly 25% (not including the patients who utilized stand-alone emergency departments).

Besides the increase in patient volume and demand, the medical services required to help patients have become much more complex. From 1992 to 2002, Medicare patients made up about 15% of patients visiting emergency departments annually. That number has increased continuously, rising to more than 18% in 2008, and representing nearly 20% of all U.S. emergency department visits in 2013.

Emergency departments have also had to adjust to changes in payer systems. This represents a unique challenge; normal businesses do not contend with a third party that has the leverage to determine the value of the services they provide. Doctors and hospitals must negotiate reimbursement and payment rates for the healthcare services they provide with the health insurance providers. Since the Affordable Healthcare Act was signed into law in 2010, there has been a significant increase in the percentage of patients with Medicaid and CHIP coverage, and a decline in the percentage of patients with commercial insurance and no insurance. For the third year in a row, Medicaid and CHIP make up the highest percentage of patients. This represents an enormous overhaul in the administrative and reimbursement process for hospitals and physicians nationally.

What will be the next change that emergency departments must survive so they can continue to save millions of lives each year? What type of impact could the “Surprise Billing Act” or the Lower Health Care Cost Act of 2019 have on emergency departments? Emergency care is complex; healthcare is complex. There is no other product or service remotely like it in the entire world. Whatever we do to help patients with the high-cost of healthcare, let’s do it thoughtfully with both short and long-term consequences in mind. Healthcare is not an issue we can afford to be haphazard about. Despite the constant challenges our emergency departments face, they have proven that they can adapt again and again, against all odds, and continue to save lives. Stay tuned as Admin-EM unpacks the facts about Emergency Medicine in the United States.

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