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Emergency medicine healthcare professionals lack understanding of costs of ER care, survey finds

The authors tout education as the most prudent means of addressing the issue.

Jeff Lagasse, Associate Editor

If efficiency and lower costs are to be achieved in healthcare, emergency medicine healthcare professionals will need a better understanding of the costs associated with the care that's provided in the emergency department, finds a new study in the Journal of the American Osteopathic Association.

Many of those professionals lack such understanding, at least according to the authors' survey, which gathered data from 441 ER clinicians. The survey presented each participant with three distinct scenarios -- a 35-year-old obese woman with abdominal cramping, a 57-year-old man with dyspnea, and a 7-year-old boy with a persistent sore throat -- and ranked their responses on how well they understood the associated costs of their interventions.

The results were lacking. In the three cases presented, correct costs were determined by 43, 32, and 40,1 percent of respondents, respectively.

[Also: Emergency departments, physicians forced to re-examine philosophies, operations as elderly patients present challenges]

This is problematic when it comes to controlling costs of the broader healthcare system, according to the study. Unlike many other medical disciplines, emergency departments operate within a strict system of finite resources. And legally, they have to provide care. Emergency healthcare professional in turn have to dictate a lot of tasks, such as conducting screening examinations in triage, ordering tests or transferring patients to higher levels of care. That means patients get the care they need, but it also means they'll be billed, and commonly this burden is transferred to taxpayers or to the hospital itself.

Another concerning statistic is that the understanding of costs hasn't improved much in the past several decades. The authors point to several studies dating as far back as the 1970s showing a similar lack of understanding. That's problematic, but it also reveals an opportunity to improve cost control, they said.

The authors tout education as the most prudent means of addressing the issue. Displaying the costs of diagnostic tests in the electronic health record, and computerized physician order entry, could be a useful way to educate emergency professionals, with past studies of that strategy showing a modest decrease in the rate of ordering pricey tests.

[Also: Pre-hospice program saves health system millions in emergency care, improves care quality]

Additionally, while a physician may learn about the costs of various interventions throughout the course of his/her career, there are other fees not in their control: room fees, nursing fees and radiology fees among them, which can make up a big chunk of a patient's bill. Education about those fees, the study said, could inform healthcare professionals' decisions and improve communication within the ED.

Those steps would likely improve efficiency and decrease costs to both patients and the healthcare system, the authors said, and none too soon. The most recent projection by the Centers for Medicare and Medicaid Services shows that national health expenditures will nearly double from $2.9 trillion to $5.5 trillion in 2025. That rate will outpace national gross domestic product by 1.2 percent per year over that time.

Twitter: @JELagasse

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