ACEP Slams 'Blame the Patient' Trend
Data From Massachusetts and South Carolina on Emergency Patients Do Not Add Up
Washington, DC — Aiming to stop a trend in which emergency patients are blamed for the nation’s high health care costs, Dr. Sandra Schneider, president of the American College of Emergency Physicians (ACEP), today issued the following statement:
“We are disturbed by reports coming from Massachusetts and South Carolina that suggest emergency patients are responsible for the high cost of health care. Emergency care amounts to only 3 percent of all the health care spending each year in the United States. Focusing on emergency care as a source of waste in the health care system is counterproductive, as are efforts to keep a small subset of emergency patients out of the ER.
“Most distressing is the rhetoric in South Carolina directed at Medicaid patients, who have been characterized as ‘abusers’ of the health care system. Medicaid patients are usually the most vulnerable members of society because of poverty, illness or both. These are patients who need the most help, not the least. A legislative effort in South Carolina to keep these patients out of the emergency department is built on incorrect and discredited data, as well as quotes by ACEP member Dr. William Gerard that were taken out of context and used without his permission. There is also no indication that it would actually save the state money, though it would accomplish the goal of discouraging sick people from seeking medical care they desperately need. It’s very bad medicine.
“Studies show that most emergency patients classified as frequent users – who make up only 8 percent of all emergency patients – have complex physical and mental health problems and a usual source of medical care outside the ER. The Robert Wood Johnson Foundation reported in 2009 that these patients use the emergency department as ‘a supplement rather than a substitute’ for other medical care.
“Another target, non-urgent emergency patients, actually comprise less than 8 percent of the nearly 124 million emergency patients who seek care every year, according to the Centers for Disease Control and Prevention. But the CDC points out that non-urgent does not mean unnecessary, as these patients require medical treatment in 2 to 24 hours. ACEP worked for 17 years for passage of a prudent layperson standard to require health insurance plans to base coverage of emergency care on a patient’s symptoms, not the final diagnosis. Last year’s health care reform legislation applies this standard to virtually all health plans. Patients should not be diagnosing themselves.
“Considering that two-thirds of all emergency visits occur after normal business hours, most of these patients have no place to turn for care other than the ER. The Robert Wood Johnson Foundation cast doubt on the idea that diverting non-urgent patients from the emergency department ‘to other settings would produce significant cost savings.’"
In addition, Dr. Schneider said the “Report on Frequent Users of Hospital Emergency Departments in South Carolina” is inaccurate when it says the proportion of non-urgent visits has increased nationwide. The percentage of nonurgent patients actually has declined for 3 years to less than 8 percent in 2007, according to the CDC.
ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.