Daily Editors' Notes

Engaging ER physicians the way to go for long-term care

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor

Healthcare journalists may have fallen inadvertently into triggering a Pavlovian response in our readers: We write “hospital readmissions” and you click.

That's because of the focus over the past two years on accountable care organizations and bundled payments, specifically how skilled nursing providers can be partners with hospitals in keeping chronically ill seniors from being “frequent flyers” in the hospital inpatient area. There's a lot of room for improvement in how skilled nursing facilities provide care and keep residents comfortable and healthy without going to the hospital.

Still, a new report from RAND suggests that we have been leaving out a key partner in hospital admissions: the hospital emergency department/emergency room staff. (You can think of this column as “We Read The Report So You Don't Have To,” but if you want to read the full 79-page report, it's here.)

Like it or not, reducing ER visits has been a focus of the Obama administration. There's a lot of additional beating up on ER staff these days: Lawmakers like to complain that they are providing the most expensive care; long-term care dislikes that ER physicians do things like overprescribe antibiotics for urinary tract infections; and it's rare for any patient to feel like she or he has developed an intimate relationship with a provider in the emergency room. I doubt any of your residents have said to you, “You know who I just loved? The ER nurse who did my IV.”

The emergency department is, in most people's minds, the place where you go when you've had an injury or accident, or when you suspect a heart attack or other health problem putting you in imminent danger. In other words, it's the place where they take care of emergencies.

But long-term care providers dismiss the ER's role in treating residents at their own peril.

That's because “emergency physicians are increasing serving as major decision makers for approximately half of all hospital admissions,” the RAND report says.

Yet what's interesting is that ER care is not the most expensive care — while it accounts for 11% of outpatient visits, it is only 2% to 4% of healthcare costs, according to the report.

What's less of a surprise is Medicare beneficiaries are 3.4% more likely to be admitted to the hospital at the end of their ER visit than the privately insured, the report says.

Long-term care knows hospitals are under pressure to prevent readmissions. But it's easy to forget that ER nurses, technicians and physicians are often ruling out major problems before that admission, such as whether chest pain requires an immediate jog to surgery or going home with heartburn medication. ER staff can be the “final line of defense,” the report says.

Beyond the hospital admission data, the report illustrates where ER's are discharging patients once there is a diagnosis or assessment. If you are a SNF operator, you obviously want more of those patients who need follow-up care.

All of which is to illustrate the final point: When you create your bundled payment roundtable, err on the side of including the ER.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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