The Emergency Room Balancing Act

There seems to be an undercurrent of debate going on with regard to emergency room wait times. I’ve come across a number of articles and blogs lately having to do with the growing trend of hospitals advertising the wait times of their ERs to the surrounding community. Healthcare IT is helping many to go mobile with these timely messages. Patients in need of emergency care can text their zip code to 4ER411 and receive a list of area hospitals and their ER wait times from Miami-based ER Texting. Hospitals themselves are developing smartphone apps that help patients find ERs in their area, with provide turn-by-turn directions based on GPS location.

My thankfully limited experience with the emergency room (See “Mobile Solutions Key to Evolving Emergency Care”) leads me to believe that these types of technologies are meant to benefit the patient in need of the closest, quickest emergency care. Why drive further than necessary? Why wait longer than you have to?

“We know that information in the hands of patients helps drive satisfaction,” said Jeffrey Finkelstein, Chief of Emergency Medicine at the Hospital of Central Connecticut, in a recent Mobiledia.com report. Central Connecticut participates in the ER Texting program. “This service helps us to be transparent to our patients, even before they arrive at one of our campuses,” he adds.

It’s this “transparency” that some in healthcare, particularly the folks at Medicaid, are finding fault with. The fear is that as hospitals market their ERs, the general public will use them for primary care rather than emergency care. After all, if a patient knows they have just a 5-minute wait at the ER down the street, why would they wait 25 minutes at an urgent care center further down the road?

As the Washington Post recently reported, “Efforts to reduce unnecessary ER visits by patients in Medicaid … are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals’ aggressive marketing of ERs to increase admissions and profits.” Medicaid officials in Washington State have even gone so far as to issue rules making it harder for hospitals to qualify for Medicaid bonus payments if they promote their ER for primary care.

So what’s a hospital to do? It’s no secret that a patient’s satisfaction (or dissatisfaction) with their experience in the ER can have a direct impact on a hospital’s bottom line, as Rene Letourneau recently pointed out in a recent HealthcareFinanceNews.com report.

“When you look at patient flow, patients who left [the ER] without being seen or without being treated for whatever reason, usually because of the wait, have a financial impact on a hospital,” explained Christy Dempsey in the report. Dempsey is Senior Vice President for Clinical and Operational Consulting Services at Press Ganey, which recently released the results of its annual emergency department patient satisfaction survey. “When you reduce rates of patients leaving, there is a direct financial effect,” she added.