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Rehabilitating the Image of the Emergency Room


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Maligned over the last decade as places to avoid because of the price of the care they delivered, last week’s release of a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms (ERs). The ER price tag was too high for the insurance companies that paid the bills, so many of them tried to discourage ER use by designing policies with high coinsurance and copayments to make patients think twice before going to one.

The RAND study found that emergency rooms, however, have a vital role in the emerging health care delivery system and can even become partners in delivering appropriate care. A key finding of the study: doctors are actually sending patients to emergency rooms — a notion that contradicts the current inaccurate narrative that mostly uninsured patients are flooding ERs.

Dr. Arthur Kellermann, an ER doctor and a senior RAND researcher told me in a phone interview that “doctors said ‘the ER is my overflow valve. It’s where I send complicated patients. It’s becoming my diagnostic center.’” Today’s primary care docs may have little choice, Kellermann explained, because they are seeing more and more patients and have less time to spend with them and do complicated workups.

RAND researchers found that hospital emergency rooms have become a gateway for hospital admissions and are actually helping to reduce the number of preventable admissions. That could, of course, save money.

Kellermann said it’s a “fact-resistant idea that emergency rooms are inappropriate sites of care.” Researchers also discovered that people use them because they have no other options. They don’t use them instead of seeking care from “nine to five” doctor’s offices, a notion that has also become part of the national narrative about emergency rooms.

Hospitals seeking new ER patients are responding to demands for convenient health care by advertising, sometimes on billboards, how many minutes prospective patients have to wait. In many parts of the country, they are targeting upscale suburbanites who are more likely to have insurance and can boost the hospital’s bottom line. Emergency room care is still some of the most expensive care around.

Even though it’s costly care, ER services are not the cost villains that politicians and others have portrayed them to be. Kellermann told me that ERs account for between 3 and 6 percent of total health care spending compared to 31 percent for inpatient hospital stays. “The average cost of an ER visit is $900. It’s 10 times that for the average hospital stay,” he pointed out.

What’s the bottom line for patients in all this? If ERs are to play a greater role as partners in a redesigned health care system, will insurance companies redesign their policies to be less punitive and lower the financial barriers to using the ER? That policy seems to contradict the hospitals’ push to bring more patients through the ER entrance. And what about those busy doctors sending more patients to ERs for their highly skilled diagnostics and test equipment?

But then again, logic is not the coin of the realm in America’s increasingly for-profit health care system.

More Blog Posts by Trudy Lieberman

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Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website,, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.

Tags for this article:
Health Care Cost   Pay for your Health Care   Inside Healthcare   Medical/Hospital Practice  

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jim jaffe says
May 29, 2013 at 6:38 PM

ERs -- or EDs as some prefer -- are great places for people with life-threatening emergencies but are needlessly expensive alternatives those with less severe discomforts, which is why our physicians suggest we visit a walk-in clinic for many after-hours problems. service is quicker and a lot cheaper.

Paul A. Toth says
December 1, 2013 at 6:42 PM

I'm writing a book about precisely what your site describes...ER's perceived as sites of abuse and negligence. My site allows visitors to record their stories by voice or fill out a survey. The site is Perhaps you can help me get this site out there for responses and we can somehow work together. I will then begin researching the other side of the story, that being what ER's face. Check out the site and you'll see we're on the same page: The goal is to inform the public of a serious problem in ER's, not only in the U.S. but around the world. Thank you. Please contact me via [email protected]