Primary care physicians rely more on ER docs to evaluate their patients

Hospital admissions from the emergency room increased by 17 percent over seven years, in part because primary care physicians often rely on the emergency physicians to evaluate and hospitalize their most complex and sickest patients, according to a new report from the RAND Corporation.

The report found hospital admissions rose from 34.7 million in 2003 to 36.1 million in 2009, offset by a 10 percent decline in admissions from primary care physicians and clinical referrals. Nearly all of the increase was from "non-elective" admissions from the emergency department--3.8 times the rate of population growth. Increased admissions were highest among people ages 65 and older.

Both physicians and patients rely heavily on emergency care offered at hospitals. The report found four in five people who contacted their primary care physician or other medical provider before seeking emergency care were told to go directly to the ER. Primary care physicians are relying more and more on ER doctors to evaluate and, if necessary, hospitalize their sickest and most complex patients.

"Emergency physicians are trained to rapidly evaluate a wide array of conditions that are complex or time sensitive, and facilitate observation or admission of the most acutely ill patients," said Wes Fields, M.D., chair of the Emergency Medicine Action Fund, which sponsored the RAND research.

"The study also suggests that the biggest challenge facing most ERs is trying to meet the needs of the growing population of Medicare age," Fields added. "Whether you live in a big city or a rural area, trying to find the right level of care for seniors with not one but several medical conditions is an ongoing struggle that plays out nights, weekends, and holidays at the front door to the hospital. Emergency departments are as vital as medical homes in every medical community."

The report confirms similar findings found last week in a study released by George Washington University School of Public Health and Health Services (SPHHS) and published in the journal Academic Emergency Medicine. The study examined admissions to the intensive care unit at hospitals across the nation and found nearly 50 percent came from emergency departments.

But hospitals shouldn't discount the role primary care physicians play in hospital admissions. A Merritt Hawkins report released earlier this month found primary doctors generate more revenue for their hospitals than specialists--$1.57 million versus $1.42 million, respectively.

The RAND report recommends hospital administrators, policymakers, payers and federal research agencies understand the critical role the emergency department plays in coordinating care for millions of patients.

The 4 percent of America's doctors who staff hospital emergency departments provide:

  • 11 percent of all the outpatient visits in the United States
  • 28 percent of all acute care visits
  • half of the acute care visits by Medicaid and CHIP beneficiaries and
  • two-thirds of all acute care visits by the uninsured

To learn more:
- read the RAND report