Emergency Visits Are Increasing, New ACEP Poll Finds; Many Patients Referred By Primary Care Doctors

/PRNewswire/ -- More than 80 percent of emergency physicians responding to an ACEP poll said emergency visits are increasing in their emergency departments, with half reporting significant rises, and more than 90 percent expecting increases in the next year. Almost all (97 percent) reported treating patients on a daily basis who were referred to them by primary care doctors, going against a widely-held assumption that people are choosing to go to the emergency department instead of seeking primary care.

At the same time, 97 percent of emergency physicians also report treating Medicaid patients on a daily basis who could not find any other doctor to accept their health insurance. If the new health care reform legislation provides insurance coverage that reimburses doctors at Medicaid rates, this could exacerbate a lack of access to medical care.

"This poll confirms what we are witnessing in Massachusetts — that visits to emergency rooms are going to increase across the country, despite health care reform, and that health insurance coverage does not guarantee access to medical care," said Dr. Sandra Schneider, president of the American College of Emergency Physicians. "Emergency medicine provides lifesaving and critical care to millions of patients each year and yet only represents 2 percent of the nation's health care expenditures. Emergency physicians command the resources of a hospital to provide the best care for patients, but we must be prepared for increasing numbers of patients, not fewer, especially given our growing elderly population."

ACEP conducted the poll from March 3 to March 11, 2011. E-mails were sent to 20,687 emergency physicians, and 1,768 responded. The survey has a theoretical sampling error range of plus/minus 2.23.

While 79 percent of responding emergency physicians said their emergency departments use resources efficiently, nearly half of respondents (44 percent) said the fear of lawsuits was the biggest challenge to cutting emergency department costs. More than half (53 percent) of emergency physicians reported that fear of lawsuits is the main reason for ordering the number of tests they do.

"Emergency departments need more resources, not fewer, and medical liability reform would help reduce overall costs by reducing the need for defensive medicine," said Dr. Schneider.

Two-thirds of emergency visits occur after business hours, when doctor's offices are closed and patients have nowhere else to turn. Visits to ERs reached an all-time high of nearly 124 million in 2008, according to the Centers for Disease Control and Prevention (CDC) and are expected to rise nationwide.

Physicians responding to the poll attribute the overall increase in emergency patients to patients without health coverage (28 percent) and a growing elderly population (23 percent) are seen by physicians as the most important reasons for the overall increase in ER patients.

An overwhelming 89 percent of physicians believe the number of visits to the emergency department will increase as health care reforms are implemented with 54 percent of them expecting to see a significant increase.

"Emergency visits have increased at twice the rate of the U.S. population, and less than 8 percent of those patients have nonurgent medical conditions, meaning the vast majority need to be there," said Dr. Schneider. "At the same time, hundreds of emergency departments have closed. The new health care reform law does not address these problems and with the elderly population and more emergency departments forced to shut down, this crisis will only get worse."

More than 1,400 (82.5 percent) responding to the poll said that lives were saved every day in their emergency departments. "Emergency medicine is critical at any hour of the day. It must be there when you need it," said Dr. Schneider.

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Doctors Recommend Different Treatments for Patients Than for Themselves

A patient who can't decide between two available treatments asks his doctor: "What should I do?" Another patient, torn between the same two treatments, asks: "Doctor, what would you do if you were me?"

Will those two patients get the same answer? That question, posed by researchers from Duke University and the University of Michigan in a national survey of physicians, found doctors often recommend different treatments for patients than they would choose for themselves.

The study, from professor Peter Ubel and post-doctoral associate Andrea Angott of Duke University's Fuqua School of Business and professor Brian Zikmund-Fisher of the University of Michigan, appears in the April 11 edition of the Archives of Internal Medicine. Funding for the study was provided by the American Cancer Society, the National Science Foundation and the National Institutes of Health.

In the study, the researchers conducted a randomized experiment asking some physicians to make a recommendation to a patient seeking advice, while other physicians were asked what they themselves would choose as a patient facing the same health care decision.

Doctors frequently advised patients to pursue treatments with higher rates of side effects and lower mortality rates, while choosing treatments with lower rates of side effects and higher mortality rates for themselves.

"Our research found that people felt living with a colostomy or being paralyzed was better than dying. From that perspective, the ‘right' decision is to take the risk of side effects and reduce the chances of dying," Ubel said.

However, emotions brought on by potential significant side effects often push people away from the "right" decision. Doctors -- free from the side effects of treatment -- can make more objective treatment recommendations to their patients.

"When making recommendations to patients, physicians can push aside any emotions that would lead them astray," Ubel said. "But those emotions may loom large when a doctor is deciding for him or herself. In other words, the act of giving advice to others may reset the balance between emotion and reason."

Ubel noted, "Many physicians are biased by their own backgrounds, valuing things that patients don't necessarily value, or they can even be influenced by financial and professional conflicts of interest that can skew judgment."

As a result, you might not always get the objective advice you seek, Ubel said. "Instead, the advice you get could depend on whether your doctor is thinking about what you should do, or instead thinking about what he or she would do in your situation."

A detailed report on the research is available at http://archinte.ama-assn.org/.

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Doctors Ask Congress for Freedom, Not Bigger Reimbursements

/PRNewswire/ -- Once again, the American Medical Association is begging Congress to postpone a fee cut for doctors under Medicare's "sustained growth rate" (SGR) method. Unless Congress acts, doctors' Medicare payments will be slashed 23% on Dec 1, then another 6% on Jan 1. The formula automatically kicks in when Medicare spending exceeds a certain amount.

On what the AMA calls White Coat Wednesday, Nov 17, doctors are urged to call Congress. But the Association of American Physicians and Surgeons (AAPS) advises a different message.

"The AMA and Congress have been playing this game of 'chicken' for more than 8 years," says Dr. Jane Orient, executive director of AAPS. [See: http://www.aapsonline.org/newsoftheday/001097] The AMA threatens doctors will quit seeing Medicare patients unless Congress stops the cuts.

"Meanwhile, the AMA and the government collude on a dictatorial system of price controls."

The values for thousands of medical procedures are set by a secretive 29-member panel called the RUC, the Relative Value Scale Update Committee, convened by the AMA. [See Wall Street Journal, Oct 26, 2010. http://online.wsj.com/article/SB10001424052748704657304575540440173772102.html?KEYWORDS=Relative+Value+Scale+Update] Once the RUC determines the formula for divvying up $60 billion for physician fees, the government accepts most of the recommendations and applies a "conversion factor" to give each fee a dollar amount.

Doctors who charge a different amount are heavily fined or sent to prison. Because of the price controls or ban on "balance billing," if the Medicare-allowed fee doesn't cover the cost, doctors simply can't provide the service. Patients who are willing and able to pay are not permitted to make up the difference. It amounts to a form of covert rationing.

"In a free-market system, patients and doctors decide on the fee," states Dr. Orient. "That is not necessarily the same as the insurance reimbursement."

Doctors who opt out of Medicare set their own fees, but patients cannot collect Medicare reimbursement for their services.

Instead of asking for more taxpayer money, AAPS asks Congress to restore the freedom of patients and physicians to make their own decisions, including the amount of the fee. Without all the expensive Medicare hassles, fees are often lower.

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