A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department

Smulowitz, Peter B.; Honigman, Leah S; Landon, Bruce E.

doi:10.1016/j.annemergmed.2012.05.042

Cited by 78 publications

(66 citation statements)

References 35 publications

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“…Peter Smulowitz and colleagues estimated that greater savings could be achieved through avoided inpatient admissions than through avoided ED visits (1.0-2.5 percent versus 0.24-0.8 percent reductions in US health expenditures). 26 In a separate analysis of our data, we estimated that the cost savings from avoided inpatient admissions using type 1 units would be two to four times more than the savings from avoided ED visits (for details of this analysis, see Appendix Exhibit 4). 9 Type 1 observation units also have benefits under current alternative payment schemes.…”

Section: Resultsmentioning

confidence: 99%

“…24 Eligibility for this more selective list was based on conditions reported in prior studies of observation unit conditions, conditions managed at the Atlanta hospitals we studied, published estimates of avoidable ED admissions, and our own experience. 20,25,26 Study Results According to estimates based on the Nationwide Inpatient Sample data, there were more than thirty-nine million inpatient encounters in 2010. Half of those admissions began in the ED (Exhibit 4).…”

Section: Impact On Avoidable Inpatient Admissionsmentioning

confidence: 99%

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Protocol-Driven Emergency Department Observation Units Offer Savings, Shorter Stays, And Reduced Admissions

et al. 2013

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Many patients who seek emergency department (ED) treatment are not well enough for immediate discharge but are not clearly sick enough to warrant full inpatient admission. These patients are increasingly treated as outpatients using observation services. Hospitals employ four basic approaches to observation services, which can be categorized by the presence or absence of a dedicated observation unit and of defined protocols. To understand which approach might have the greatest impact, we compared 2010 data from three sources: a case study of observation units in Atlanta, Georgia; statewide discharge data for Georgia; and national survey and discharge data. Compared to patients receiving observation services elsewhere in the hospital, patients cared for in "type 1" observation units-dedicated units with defined protocolshave a 23-38 percent shorter length-of-stay, a 17-44 percent lower probability of subsequent inpatient admission, and $950 million in potential national cost savings each year. Furthermore, we estimate that 11.7 percent of short-stay inpatients nationwide could be treated in a type 1 unit, with possible savings of $5.5-$8.5 billion annually. Policy makers should have hospitals report the setting in which observation services are provided and consider payment incentives for care in a type 1 unit.

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Section: Resultsmentioning

confidence: 99%

Section: Impact On Avoidable Inpatient Admissionsmentioning

confidence: 99%

Protocol-Driven Emergency Department Observation Units Offer Savings, Shorter Stays, And Reduced Admissions

et al. 2013

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“…17,18 Since the last conference, there has been increasing pressure from payers and consumers for cost transparency and a focus on resource stewardship. 19,20 Defining the value of emergency care services and creating a means to compare EDs across the country are important first steps in understanding the national emergency medical care landscape, as well as potential opportunities to improve care delivery. Given the rapidly changing landscape of health care delivery, the Emergency Department Benchmarking Alliance (EDBA) organized a third summit in February 2014 to review and update this critical terminology, once again convening national leaders in ED operations, research, and health policy.…”

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confidence: 99%

Emergency Department Performance Measures Updates: Proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit

Wiler

Welch

Pines

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations.Methods: Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus.Results: A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency.Conclusions: Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.ACADEMIC EMERGENCY MEDICINE 2015;22:542-553

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“…Finding alternatives to hospital admissions by EDs may be one way of achieving significant cost savings. 27 Just one such alternative, widely used in Europe but facing payment challenges in the United States, is "Hospital at Home." This disruptive innovation, where home-based acute care substitutes for the traditional inpatient admission, has been shown to be well received by patients, effective, and less costly than comparable inpatient admissions.…”

Section: 22mentioning

confidence: 99%

The Affordable Care Act and Emergency Care

et al. 2014

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The Affordable Care Act (ACA) will have far-reaching effects on the way health care is designed and delivered. Several elements of the ACA will directly affect both demand for ED care and expectations for its role in providing coordinated care. Hospitals will need to employ strategies to reduce ED crowding as the ACA expands insurance coverage. Discussions between EDs and primary care physicians about their respective roles providing acute unscheduled care would promote the goals of the ACA.

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A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department

Cited by 78 publications

References 35 publications

Protocol-Driven Emergency Department Observation Units Offer Savings, Shorter Stays, And Reduced Admissions

Protocol-Driven Emergency Department Observation Units Offer Savings, Shorter Stays, And Reduced Admissions

Emergency Department Performance Measures Updates: Proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit

The Affordable Care Act and Emergency Care

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