Monday, April 11, 2011

Should Emergency Departments Turn Away Nonurgent Patients? - TIME

A few weeks ago, the American College of Emergency Physicians (ACEP) launched a campaign to derail proposed policies to reduce the use of emergency departments (EDs). ACEP's problem with the campaign is the logic that underpins it: policymakers think that ED use, in aggregate, is a costly problem and a major driver of unnecessary health care costs in the U.S. ACEP claims that rather than delivering unnecessary care, EDs treat many patients who have no alternative when they need comprehensive medical care in a timely manner; that is, EDs deliver altogether necessary care.

ACEP has challenged reports from South Carolina and Massachusetts suggesting that a high percentage of ED use is unnecessary and that reform efforts — particularly payment incentives — will reduce "inappropriate" usage. In South Carolina, a state legislator, Representative Bill Herbkersman, even recommended that special call boxes be placed in the homes of more than 3,000 Medicaid patients to give them 24-hour access to nurses who could diagnose them over the phone and reduce costly and unnecessary ED visits. Blue Cross Blue Shield of Georgia has also increased the co-pay on ED visits from $100 to $200 and has been steering its members away from EDs to urgent-care centers and retail clinics (with the help of a Google Maps application, soon be available as an app for members' mobile phones).

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