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The ED’s Expanding Role in Hospital Admissions

Although research has focused heavily on increased use of EDs, little attention has been paid to the changing role that these facilities play in the entire healthcare system. In a study published in the New England Journal of Medicine, Arjun Venkatesh, MD, MBA, and I examined the proportion of hospital admissions that came through the ED to determine trends in general use and to confirm the experiences of emergency physicians and hospital administrators in these situations. ED Admissions on the Rise Focusing on the 13 conditions for which patients are most commonly admitted to the hospital, our analysis revealed that hospital admissions increased by 15.0%, rising from 34.3 million in 1993 to 39.5 million in 2006, but admissions from the ED increased by 50.4% (rising from 11.5 million to 17.3 million) during that same timeframe. The proportion of all inpatient stays that came through the ED increased significantly, rising from 33.5% to 43.8%. Only one of the 13 conditions studied in our analysis—coronary atherosclerosis— had a proportion that didn’t increase. More and more patients are being evaluated for coronary atherosclerosis in the ED and not admitted thanks to newer rapid “rule-out” protocols and ED-based chest-pain observation units. Our observation that more admissions are coming through the ED is likely due to several factors, most notably the advancing diagnostic and treatment capabilities of EDs and the convenience that EDs offer. As rapid and accurate diagnoses and treatments become standard, evaluating symptoms like chest pain and shortness of breath have become de facto reasons for ED referral. It has also become more difficult for outpatient providers to admit people directly to...

Younger Doctors, Bigger Spenders?

Younger, newer doctors tend to run up a higher healthcare tab for their patients than their more established colleagues, according to a new study published in the November 2012 issue of Health Affairs. A study, sponsored by RAND Corporation, examined insurance claims filed by more than 12,000 physicians in Massachusetts between 2004 and 2005. Those filed by doctors with fewer than 10 years’ experience generated 13.2% higher costs for “comparable episodes of care” (eg, diagnosing and treating a breast lump), compared with costs incurred by doctors with 40 or more years of experience. There was no association found between costs and other characteristics such as malpractice claims, board certification status, or practice size. Nor did less experienced doctors order proportionately more imaging or other tests. Researchers surmise that less experienced (and younger) doctors may be more aware of — and more likely to use — newer and costlier treatments than are older counterparts. Another theory is that a lack of experience makes doctors more wary about legal responsibility so they consult specialists more often, order more tests, and retain patients in a hospital longer. Physician’s Weekly wants to know…why do you think younger doctors are bigger spenders? Click here to view the study...
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