The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
Some findings in the retrospective analysis of emergency department (ED) utilization and hospital admission trends in the last decade reported by the RAND Corporation in May, 2013 were not surprising. Some patients refer themselves to EDs because they have no other way to access first-contact care. Others use the ED because their primary source of care is not available after hours, weekends, or holidays. But other findings by the RAND research group were more surprising. Four out of five patients who succeed in contacting their doctor about an urgent illness or injury are referred to the ED. Primary care providers (PCPs) today are increasingly likely to refer patients to the ED to determine whether they need to be hospitalized.
In fact, scheduled admissions for elective procedures and treatment remained flat across all major payer classes in the post-millennial decade studied by RAND. The only growth in hospitalizations occurred from the ED, which is now responsible for more than half of all hospitalizations. So what is the role of the ED in this context?
The Acute Care Continuum was featured in the most recent issue of Becker’s Hospital Review. Lindsey Dunn, Editor in Chief of Becker’s Hospital Review, interviewed Wesley Curry, MD, Denise Brown, MD, and Nate Kaufman for an article entitled “The Acute-Care Continuum: The Future of Hopsital-Based Care.”
Dunn provides context to begin the article:
Since the passing of the Patient Protection and Affordable Care Act in 2010, there has been a swelling of efforts by healthcare providers to manage what is often referred to as the "continuum of care" for patients. Physicians and health systems are engaged in a number of different structures and agreements that aim to essentially achieve the same thing: manage care for patients across all care settings and — perhaps more boldly — from birth to death.
Most everyone assumes that the Patient Protection and Affordable Care Act (PPACA) facilitated Exchange Plans, by increasing the number of insured patients and reducing the rolls of the uninsured, will generate additional revenues for hospital Emergency Departments and emergency physicians. However, the net effect of these Exchanges and other aspects of the ACA could spell disaster for many emergency care safety net providers.
On the surface, it appears the PPACA should have a positive impact on payer mix for most ERs. In 2012, the Abaris Group ran some projections for the Santa Clara County EMS Agency in California that suggested that as a result of full implementation of the ACA, including expansion of Medicaid and fully operational Exchange Plans, by 2022 the percentage of uninsured in the county’s EDs would decrease from 12.9% to 3.3%, and the percentage of commercially insured would increase from 37.4% to 43.7%.
Scribing, particularly in Emergency Medicine (EM), has been something of a phenomenon during the past decade. Scribes are typically employed by third party vendors such as Scribe America as well as directly by provider groups. Scribe America has experienced phenomenal growth and now employs over 2500 scribes; physician group CEP America employs over 600 scribes for their ED and Hospitalist Practices. What accounts for the scribe boom, and how do we measure the impact of scribes on the Acute Care Continuum?
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