ED Coding and Reimbursement Alert

Record ED numbers may only be starting, Suter says

The president of the leading emergency medicine society says that emergency departments are seeing patients at alarming rates, and if Congress goes ahead with its planned decreases in Medicare spending, overcrowded EDs could become an epidemic.

According to a new report from the Centers for Disease Control, there were more than 113 million ED visits in 2003. While this was the high-water mark so far, the number will be much higher in coming years because of pending Medicare cuts, industry insiders fear.

Elderly Adults Behind ED Rise

The rise in ED visits is largely attributable to increased ED use by adults 65 and over, and those more likely to have chronic medical conditions that take longer to diagnose and treat, said Robert Suter, DO, president of the American College of Emergency Physicians, in a May 26 release.

 "As America's elderly population continues to grow, we expect to see even more elderly patients [in EDs] in the coming years. And if Congress does not act to avert the cuts in Medicare this year, elderly patients will find it increasingly difficult to be treated by their [primary-care] physicians, and even more elderly patients will be coming to the ED for medical care," Suter said.

The CDC report states that from 1993 to 2003, ED visits rose 26 percent while the number of hospital EDs decreased by 14 about percent. This created a monstrous strain on EDs, because when a patient reports to the ED for care, he must be "boarded" in the ED while waiting for an inpatient hospital bed - meaning other patients must wait for their ED care because of space limitations. On average, patients spent 3.2 hours per visit in the ED, according to the CDC.

When too many patients report to the ED for care at once, it compromises the ED's ability to care for patients, Suter said. "It is critical to understand why EDs are strained and what is causing this problem. The report clearly highlights one of the most significant contributors to overcrowding, which is the length of time patients are 'boarded' in EDs waiting for inpatient beds. When we can't move patients out of the ED and into their inpatient beds, we can't safely accept another ambulance patient or even a patient from the waiting room," Suter said.

ACEP Plans Action

Suter said that the CDC study underscored the need to address ED overcrowding on a more detailed basis. The ACEP president hinted that ACEP would hold a major stakeholder conference in July to examine potential answers to "boarding" and other ED overcrowding issues.

In the meantime, some hospitals have dealt with their overcrowded EDs by moving patients from the ED and boarding them on the floors they'll be admitted on. "This is helpful because it shifts the [overcrowding] burden throughout the entire hospital," Suter said.