This article was originally published in the June 2011 issue of Atlanta Hospital News.
Emergency department use has increased over the last several years, with the General Accountability Office ("GAO") recently citing a survey statistic that noted from 1997 to 2007, emergency department per capita use increased 11%. With the implementation of the Patient Protection and Affordable Care Act more people will be able to obtain health insurance coverage, potentially further increasing emergency department use. Given the increased use of emergency departments, the GAO issued a report on April 1, 2011 entitled Hospital Emergency Departments: Health Center Strategies That May Help Reduce Their Use (GAO-11-414R) ("GAO Report"), to address the use of health centers in reducing the use of emergency departments.
Health centers are facilities that provide primary care and other services to individuals in communities they serve regardless of the individual's ability to pay. Health Centers are required to provide comprehensive primary health care services including preventive, diagnostic, treatment and emergency services, as well as enabling services that facilitate access to health care. Health centers are funded in part through grants from the Department of Health and Human Services' Health Resources and Services Administration.
The GAO Report noted that in 2007, approximately 8% of the 117 million visits to emergency departments were classified as non-urgent. Given that the average amount paid for a nonemergency visit to the emergency department was seven times more than that for a health center visit, increasing the use of health centers for these non-urgent medical issues may reduce costs and improve care.
The GAO Report focused on three types of strategies that health centers have implemented to reduce emergency department use: i) emergency department diversion, ii) care coordination and iii) accessibility of services.
Emergency Department Diversion
Emergency department diversion strategies included focusing on educating emergency department patients on the appropriate use of the emergency department; informing patients about services offered at the health center; and arranging appointments at, or referrals to, the participating health center. Most commonly, the diversion strategies aimed at preventing future visits to an emergency department by interacting with patients after those patients were seen by the emergency department physicians.
The GAO Report stated that the emergency department diversion strategies were usually implemented in collaboration with a hospital, and communication between the health center and the hospital administration and staff was important. The GAO Report also noted that cooperation or a "buy-in" by the hospital administration and emergency department staff was essential because hospitals and emergency department physicians may face financial disincentives to divert patients.
Care Coordination
The care coordination strategies noted in the GAO Report included establishing a plan of care that is managed jointly by the patient and the health care team, anticipating routine needs, and actively tracking progress toward patient care goals. In the report, the health centers described two care coordination strategies: the medical home model and the chronic care model. Both of these strategies focus on continuous patient care through the health center, usually through a primary care physician.
Accessible Services
The GAO Report identified strategies to make health center services more accessible to the community, including expanding the health center hours; providing same-day or walk-in appointments; providing transportation to health center locations; and locating health center sites in convenient places. In addition, health centers have adopted strategies to assist patients outside of the health center including telemedicine, home visits and mobile clinics, and may use translators to reduce linguistic and cultural barriers to care. Health centers have also engaged in outreach activities to increase awareness of their services.
The health centers cited agreed there was limited data about the effectiveness of the strategies noted above. However, one system noted that a countywide emergency department diversion program resulted in a decrease of 63% in participating patients one year after the patients enrolled in the program. Therefore, a hospital may consider the potential advantages of aligning with a health center to help reduce the non-urgent use of their emergency departments.
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