Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How safety net ERs can save health care reform

Andrew G. Lim
Policy
March 15, 2014
Share
Tweet
Share

Safety net emergency departments are frequently blamed for being the source of rising health care costs. After all, they care for the millions of underserved and un-insured Americans forced by a variety of circumstances to visit ERs for their primary care and low-acuity concerns.

With the Affordable Care Act (ACA) reforms initiated in January, demand for emergency services will rise significantly. Medicaid already covers over 50 million individuals – most of whom are vulnerable low-income children and their mothers, or medically complex elders. Now that Medicaid has been expanded to those earning up to 138% of the federal poverty level in many states, new research predicts that previously uninsured patients will use emergency services even more frequently. Further, the Center for Medicare & Medicaid Services will reduce disproportionate share hospital funding (a major revenue source for safety net providers) from now until 2020 to accompany the ACA expansion. States that did not expand Medicaid coverage will likely struggle to provide services to their underserved patients.

However, recent evidence highlights the ER’s success in making one of the most cost-effective decisions in health care — whether or not to admit patients to the hospital. By streamlining diagnosis and treatment of critical illness and the complications of chronic disease, ERs can prevent unnecessary admissions — where inpatient costs such as basic maintenance and diagnostic imaging rise rapidly.

Safety net ERs can be important driving forces in increasing health care value and improving patient care — but in order to do so, they must tailor cost-saving strategies to their communities’ most pressing needs. This can be achieved with regionally focused ER-based research that explores the social determinants of illness, alongside a multi-disciplinary approach to emergency care that tackles non-medical factors contributing to adverse health outcomes.

ER-based research can expose the social issues — such as food insecurity, unstable housing, and local violence — that are at the root of patients’ illnesses leading to ER visits and hospitalizations. For example, the Levitt Center for Social Emergency Medicine — a collaboration between the University of California, Berkeley School of Public Health and emergency physicians at Alameda Health System in Oakland — explores how unemployment in California affects patterns in ER and ambulance use. The researchers have found that when populations lose their housing, employment, or health care as a result of economic downturn, there are increased patient visits for substance abuse, psychological stress and chronic disease care. They hope to leverage their research to affect local policy and influence upstream primary care interventions.

In the delicate transition towards health reform, safety net ERs can serve as hubs for access to essential non-medical services such as housing assistance, social work, mental health, and legal advocacy for lower-income individuals. It is well established that interventions that address personal behavior, social circumstances and environmental factors affect a greater proportion of poor disease outcomes compared to medical care alone.

The Highland Health Advocates (HHA) in Oakland started a patient help desk in the waiting room of their busy county ER, facilitating enrollment in health coverage plans and providing social services and legal counsel to patients who are often undocumented and uninsured. Other health resource desk models around the country have shown success in resolving crucial unmet needs for patients and their families. Until patient-centered systems are streamlined, safety net hospitals and programs like HHA may be best positioned to address the social and behavioral issues that prevent patients from accessing the services that they qualify for, but that require complicated paperwork and long wait times to access.

Emergency departments occupy a unique position in American health care — so close to the poorest communities, yet at the doorway to the most expensive interventions of modern medicine.  In the coming years of health care transition, county hospitals will continue to be the first refuge for America’s marginalized and vulnerable populations.  They must evolve to become coordinating centers for society’s health needs and champions of cost reform, or underserved patients will continue to fall through the cracks of the current system. Without addressing social needs, health care access, and payment reform in parallel, America simply cannot bend the health care cost curve.  Emergency rooms are a good place to start.

Andrew G. Lim is a medical student and can be reached on Twitter @AndrewGLim.

Prev

Radiologists aren't the only ones criticizing the new mammogram study

March 15, 2014 Kevin 6
…
Next

3 concerns about the legalization of marijuana

March 15, 2014 Kevin 1
…

Tagged as: Emergency Medicine, Public Health & Policy

Post navigation

< Previous Post
Radiologists aren't the only ones criticizing the new mammogram study
Next Post >
3 concerns about the legalization of marijuana

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More in Policy

  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How safety net ERs can save health care reform
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...