Emergency departments across the U.S. are doing everything in their power to reduce wait times – the time a patient has to “wait” to see a provider. A reduction in wait times increases patient satisfaction, which can also result in better payment thanks to certain value-based reimbursement systems. Increasingly, these systems emphasize quality of care and the patient’s experience of care, not just the quantity of services provided. And if dissatisfied patients complete a patient satisfaction survey indicating they were not “satisfied”, these scores can have a direct impact on revenue.
ED Visits Rising Despite ACA Provisions
Despite provisions of the Affordable Care Act intended to reduce dependence on emergency departments as a significant source of health care, patients are flocking to ERs at a rate that, according to a 2015 ACEP poll, is significantly higher than before its implementation.
More than one-quarter (28 percent) reported significant increases in all emergency patients since the requirement to have health insurance took effect, in 2014. Also, more than half of poll respondents (56 percent) said the number of Medicaid patients was increasing.
"The reliance on emergency care remains stronger than ever," said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP. "It's the only place that's open 24/7, and we never turn anyone away. Rather than trying to put a moat around us to keep people out, it's time to recognize the incredible value of this model of medicine that people need."
This data correlates with another report issued by Health Policy Alternatives, a health policy advisory group, which found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments and into primary care are not working.
More than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees, despite a provision in the ACA boosting pay to primary care physicians treating Medicaid patients. The median wait time was two weeks but over one-quarter of providers had wait times of more than a month for an appointment.
Average ED Wait Times
In a November 2015 article, Governing.com, a resource for news on state and local government, said that emergency department wait times had barely changed from before ACA’s individual mandate went into effect.
"In 2014, state-by-state average ER wait times ranged from 16 minutes in Colorado and Utah to 46 minutes in Maryland and 55 minutes in the District of Columbia," the article said. "Other states with more than 30-minute average wait times in 2012 and 2014 include Alabama, Delaware, Georgia, Massachusetts, North Carolina, New Jersey, and Rhode Island — a near even mix of states that chose to expand Medicaid and states that rejected it."
Another source, ProPublica, a non-profit organization focused on topics related to the public interest, said in its "ER Wait Watcher" tool that the national average for “waiting time” — the time patients spend in the emergency room before being seen by a doctor — was 24 minutes and the time until being sent home was 135 minutes.
Reducing ED Wait Times in ACA Era
Despite rising ED visits, hospitals are innovating around a range of approaches to reduce wait times. Here are five such approaches currently underway:
Specialty EDs. Some hospitals are tackling their ED volume by service line, offering specialty emergency departments for senior citizens, psychiatric patients, pregnant women, or children, according to an article in Modern Healthcare magazine.
"The specialty ED can relieve pressure from the general emergency department by treating patients with less acute needs," the article said. "It can also help hospitals tap into a lucrative patient demographic or offer better workflow for office-based physicians."
Mini-ERs. Similar to the specialty ED idea is the use of “mini-emergency” rooms.
"Putting the lower acuity patients — those with less severe issues — in a separate area from the patients with more severe illnesses has been one of the industry’s major trends," said Randy Pilgrim, MD, MD, FACEP, SCP enterprise chief medical officer in an interview with The Advocate, a Baton Rouge, La., newspaper. "The separate area almost functions as a mini-emergency room or urgent care clinic within the emergency department."
Medical scribes. Another method in play is the use of medical scribes who follow the physician during rounds gathering, documenting, and entering information into the EMR at the doctor’s direction.
SCP is currently piloting the use of virtual scribes — V-scribes as we call them — who are off-site and communicate with the provider via a headset.
The approach “improves documentation, expedites patient throughput, and enhances the patient experience,” said David Schillinger, MD, division chief medical officer for SCP. “It eases the task of EMR documentation, allowing the physician to spend more time with more patients.”
Online scheduling. An increasing number of hospitals are allowing patients to make online appointments to visit the emergency room. Appointments are not for life-threatening conditions, of course, but for patients with less acute conditions, such as a fever or sprained ankle.
SOrT. SCP physicians practice SOrT (See-Order-Treat), a program that utilizes providers to examine the patient in triage shortly after arrival to the emergency department, to speed up the encounter and reduce throughput times and LWBS (Leave Without Being Seen) rates. The goal is to reduce wait times to 30 minutes or less.
Despite ACA provisions intended to reduce the volume of patients seeking treatment in Emergency Rooms, the trend toward rising ED visits is not expected to abate anytime soon — a fact that makes reducing wait times a very real challenge.
Nonetheless, hospitals and practice management groups like SCP have taken up the gauntlet, with innovations designed to make such reductions a reality and improve patient satisfaction in the process.