Emergency department directors want to offer more preventive services

Call it mission creep. As the ongoing debate about the proper role of emergency departments rages, it turns out most EDs offer preventive services (90 percent), according to a survey written up in the Annals of Emergency Medicine.

But the menu of services offered varies widely. Intimate partner violence screening was the most common of 11 services, available in two-thirds of 277 EDs surveyed. The least common preventive service was HIV screenings (19 percent), perhaps because they add to unreimbursed costs and have been associated with longer patient wait times.

A system to link ED patients with primary-care providers topped the wish list for ED directors who didn't already have such a system, followed by tobacco cessation counseling, and a system to cover uninsured patients with some form of medical insurance.

While three in four emergency department directors surveyed favor offering preventive services, the same share worries that those services could financially harm their departments. Because the government and insurers do not reimburse EDs for the cost of most preventive services, cost will likely continue to pose an obstacle to offering more preventive services in EDs.

"Our findings imply that more widespread dissemination of ED preventive services will likely be contingent on improved reimbursement," M. Kit Delgado, the study's lead author and a postdoctoral scholar at Stanford's Center for Primary Care and Outcomes Research, said in a statement. Did you hear that, CMS?
To learn more:
- read the Annals of Emergency Medicine article
- here's the press release from Stanford University Medical Center

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