Putting Research Into Action
JOUR3421 R52: Writing for Public Relations
The State of Emergency Health Care
Emergency medicine is a complex and costly industry. Navigating the web of legislation, policies, and procedures requires armies of well-trained administrators, physicians, and lawyers. Physician behavior, malpractice litigation, and patient behavior all contribute to the extraordinary costs of emergency medicine.
Becoming an emergency medicine physician isn’t easy. It takes four years for a bachelor’s degree (the current average is five), then four years of medical school, and then years of ongoing training after that. Once one becomes an emergency physician, it doesn’t get much easier. Physicians face many internal and external stressors that can negatively impact their behavior. This in turn, affects everyone around them including co-workers and patients. Some of these stressors include age, gender, personality, school debt (which currently averages about $200,000), the threat of malpractice litigation, training, etc. The most significant unintended consequence of negative physician behavior affects patient safety. Unhappy physicians and staff are more likely to suffer communication issues, judgement errors, or delays in critical care. These communication issues can create combative, moody, apathetic staff who are less productive. Worst case, errors in care can lead to malpractice litigation. Institutions that focus on addressing physicians’ stressors have seen reduced costs by increasing staff morale and performance, as well as reducing employee turnover. (Rosenstein, 2015)
Malpractice litigation in the emergency health care industry is another significant contributor to costs. It is estimated that approximately $210 billion is spent annually on defensive medicine in fear of malpractice litigation. (Waxman, Greenberg, Ridgely, Kellermann, & Heaton, 2014, ¶ 1) It has been generally accepted that malpractice reform is an important step in reducing cost, but more and more voices are beginning to dispute that assumption. A study conducted by Dr. Waxman and colleagues examined three states pre and post tort reform. Their results indicated that reform would have less impact on costs than previously projected. There are alternatives currently being used that are lowering malpractice costs more significantly. For example, Griffin Hospital in Derby, Connecticut, saw its malpractice insurance costs drop 61% in 2012. This was due in part to a new apology and disclosure program that was implemented. The program requires physicians to be upfront with patients when a mistake happens. According to Todd Liu, assistant to the president at Griffin Hospital, “malpractice lawsuits are more likely when patients don’t get a full picture from a doctor about a complication or medical error.” (Bordonaro, 2014) One medical specialty has experienced significant reductions in malpractice-insurance premiums: anesthesiology. In the 1980’s, the American Society of Anesthesiologists completely revamped their procedures, training, & equipment. The death rate from anesthesiology administration fell from 1:6,000 to 1:200,000 over the next 10 years. (Duenwald & Sample, 2013) Other medical specialties have been slow to follow suit. Institutions continue to explore new avenues, apart from tort reform, to reduce malpractice costs.
Another contributing factor to emergency medical costs is patient behavior. In 2012, there were 136.3 million recorded emergency room visits, but only 11.9% of visits resulted in hospital admission. (Centers for Disease Control [CDC], 2015) According to federal law, hospital ERs are required to provide care to all patients, regardless of their ability to pay. More and more frequently, patients without insurance or little-to-no funds, are using emergency rooms as primary care facilities. (Fey, 2012) The top ten reasons for an emergency room visit between 2006-2008 included sprains and strains, headaches, back problems, upper respiratory infections, and urinary tract infections. (Caldwell, Srebotnjak, Wang, & Hsia, 2013) All of these conditions can be handled by urgent care facilities or primary care physicians for a lower cost. Also, with an increase in the number of uninsured, patients are often waiting longer to have medical problems addressed. Once they visit the ER, they require more advanced care, which is more expensive. If these patients do not pay, the hospital must absorb the cost and figure out a way to make up the difference. The Affordable Care Act of 2010 attempted to make insurance more affordable for Americans, in part to fix this deficiency. The debate over the success or failure of the ACA continues.
Many options have been proposed to help address the problem of costs in emergency medicine, in medicine in general. Malpractice is expensive, physicians have their own set of problems and insurance has created patient behavior that relies on ERs as primary care facilities. Institutions, of their own accord, are attempting to address the problem in a variety of ways, but until such time that the system receives a major overhaul, we will continue to see high medical costs across the board.
Bordonaro, G. (2014, April 28) Hospitals Battle Medical Malpractice Costs. Hartford Business Journal. Retrieved February 13, 2016, from http://www.hartfordbusiness.com/article/20140428/PRINTEDITION/304249935/hospitals-battle-medical-malpractice-costs
Caldwell, N., Srebotnjak, T., Wang, T., Hsia, R. (2013, February 27) “How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department. PLoS ONE 8(2): e55491. doi:10.1371/journal.pone.0055491. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055491
Centers for Disease Control (2015, April 29) Emergency Department Visits. Retrieved from http://www.cdc.gov/nchs/fastats/emergency-department.htm
Duenwald, M. (Ed.) & Sample, B. (Ed.) (2013, August 25) Do Big Malpractice Awards Really Increase Medical Costs? Insurance Journal. Retrived February 14, 2016, from http://www.insurancejournal.com/news/national/2013/08/25/302803.htm
Fay, B. (2012) Emergency Rooms vs. Urgent Care Centers: Differences in Services & Costs. Debt.org Retrieved February, 13, 2016, from https://www.debt.org/medical/emergency-room-urgent-care-costs/
Rosenstein, A.H. & Winston, T. N. (Ed.) (2015) The Downstream Effect of Physician Stress and Burnout. Handbook on Burnout and Sleep Deprivation: Risk Factors, Management Strategies and Impact on Performance and Behavior (pp. 55-67). New York: Nova Publishers. Retrieved from http://www.physiciandisruptivebehavior.com/admin/articles/53.pdf
Waxman, D.A., M.D., Ph.D., Greenberg, M.D., J.D., Ph.D., Ridgely, M.S., J.D., Kellermann, A.L., M.D., M.P.H., & Heaton, P., Ph.D. (2014, October 16) The Effect of Malpractice Reform on Emergency Department Care. The New England Journal of Medicine. 371:1518-1525. Retrieved February 14, 2016, from http://www.nejm.org/doi/full/10.1056/NEJMsa1313308#t=articleTop