Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

The Impact of Increased Transparency on Emergency Care

10/10/2013 4:07:10 PM | 1 comments

In the previous installment of our four-part series, Dr. Li and Dr. Weeker discussed the trend toward increasing transparency in healthcare. This week, they examine the impact of transparency on the acute care setting and the appropriateness of financial discussions in the emergency room.

When it comes to price transparency in medicine, it appears our industry has started down the road of no return, and this is generally a good thing. Access to pricing and quality data can help patients make informed healthcare choices and avoid financial hardship. This is especially true when they're researching "shop-able" services like preventative care and elective procedures.

However, it's important to note that too much transparency also has its pitfalls. This is especially true in the realm of acute care. No one can plan ahead for a car accident, appendicitis or a heart attack. And when a patient walks into the emergency room with a condition like chest pain, an infinite number of scenarios (and associated costs) could result.

As emergency physicians, we see a great need for a measured, incremental approach on the part of regulatory bodies. This is particularly true when it comes to publishing hospital prices and formulating requirements around cost disclosure. What makes perfect sense in the outpatient setting may cause chaos — and even harm patients — if applied inflexibly in the emergency room.

For example, if a patient arrives with stroke symptoms, every second counts. Does it make any sense to present them with the cost of the CT scan, then stand back while they weigh the pros and cons? And what if a patient refuses life-saving treatment because of concerns about cost?

Heavy-handed regulation could be a real threat to the quality of emergency care. It's therefore important that policymakers take a nuanced approach. In other words, let's not use a sledgehammer to drive in a thumbtack.

That being said, price transparency certainly has an appropriate place in emergency care. A recent study at the University of California, San Francisco examined hospital bills for the ten most common outpatient conditions treated in U.S. emergency rooms. Researchers found wildly differing charges for the same diagnosis. (Treatment for a sprain, for example, ranged from $4 to $24,110.)

The team concluded that:

"While most patients with time-sensitive conditions such as acute myocardial infarction, stroke, or sepsis may not be in a position to make decisions about their care based on costs or charges, there are many situations in which patients could reasonably inquire about the potential financial implications of their medical care before making treatment decisions.''

We've certainly seen such situations in our own practice. For example, sometimes patients will insist that a plastic surgeon perform a laceration repair that the emergency doc could have done just as well and for less. Discussing costs up front could save the patient money, and would probably get them out of the ED faster.

Price transparency in the emergency room could also help physicians better advise patients. Few providers actually have a handle on the costs of the care they provide. (To get an idea how this can play out, check out the essay "Saving My Appendix" by Andrew T. Gray, a physician assistant who came down with appendicitis while uninsured between jobs.)

Finally, greater transparency might influence patients to choose more appropriate levels of care. Those with non-emergent conditions might be more likely to utilize ambulatory or urgent care services if they knew how much more an ED visit would cost them.

In summary, while price transparency is generally a good thing for patients, its application to acute care is complex. It's crucial that public policy take into account the unique circumstances in the emergency room and allow physicians flexibility to provide expedient care.

However, in less emergent cases, financial discussions are often appropriate and can be an important factor in providing high-quality, patient-centered care.

In this series:
Physicians Discuss Price Transparency in Medicine (Part I)

Perspectives on Hospital Pricing: Where Did This System Come From? (Part II)

Transparency in Medicine: Where Will Be in 10 Years? (Part III)
The Impact of Increased Transparency on the Acute Care Continuum (Part IV)



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