The practice of primary care physicians (PCPs) referring stable, non-emergent patients to the emergency room (ER) for new workups or post-diagnostic testing coordinated referral is becoming a new (alarming) trend seen by emergency medicine providers in recent years. Many nationwide EDs, due to unprecedented patient volume capacity constraints in their facilities, are indeed becoming very resentful of this concerning trend/practice straining an already fragmented system even further. This practice raises questions about its potential impact on patient care, healthcare costs, and the role of the ER systems throughout the country.
Some ED physicians question the surge in this practice from their primary care counterparts. The question should be what underlying contributing factors fuel this practice since some have theorized it is a by-product of defensive medicine.
While it's difficult to label this as a "defensive medicine move definitively," it's certainly a strategic response to the pressures faced by PCPs in today's constrained healthcare environment. Perhaps, and most likely this is multifactorial; here are some potential factors propelling & contributing to this new trend:
- Overburdened Primary Care Medicine: PCPs are often overwhelmed with patient volume, administrative tasks, and increasing regulatory burdens. This can lead to long wait times for appointments and limited availability for timely follow-up care in their offices.
- Complex Patient Cases: The growing complexity of patient conditions and the need for specialized care can strain PCP resources. Referring patients to the ER for testing and follow-up may be seen as a way to ensure timely and comprehensive care.
- Financial Considerations: While not the primary motivator, ethically speaking, the potential for increased reimbursement from ER visits compared to office visits might be a secondary factor influencing some PCPs' decisions for this activity.
- Patient Expectations: Patients may demand quicker access to care, especially for test results and follow-up appointments, etc. So referring them to the ER can fulfill this expectation, even if it's not the most efficient or cost-effective solution, but it appeases the patient's need to "I need to know ASAP." Sadly, that has become the American healthcare consumer, and why not? The consequences of this trend are multifaceted since we have the technology and expertise:
- Increased ER Crowding: ERs are already overwhelmed with true emergencies. Adding non-urgent patients can exacerbate overcrowding and delay care for those in critical need.
- Higher Healthcare Costs: We know ER visits are significantly more expensive than office visits. So obviously this practice can lead to higher healthcare costs for both patients and the overall healthcare system—no secret there.
- Suboptimal Patient Care: Ironically, ERs are not designed for ongoing, coordinated care. Yet, patients may believe they will receive less fragmented care and will experience less delayed care if receiving the necessary treatment through their local ED.
- Erosion of PCP Role: The erosion of the PCP's role as the primary point of contact for patients in our country over the last decade or so can lead further to a fragmented and less coordinated healthcare system.
To address this issue, a multi-faceted approach is needed:
- Increased Primary Care Capacity: Investing in primary care infrastructure, expanding access to PCPs and postgraduate medical training, and reducing administrative burdens can help alleviate the capacity constraints given the decreased provider workforce post-the Covid pandemic.
- Improved Coordination Between PCPs and ERs: Better communication and collaboration between PCPs and ER physicians can help streamline patient referrals and ensure appropriate care. However, this is nearly impossible given the already existing workload demands currently faced by PCPS and EM physicians.
- Alternative Care Models: Exploring alternative care models, such as telehealth and urgent care centers, can provide additional options for patients seeking timely care. However, this can be costly too.
- Addressing Root Causes: Addressing the underlying issues contributing to this trend, such as healthcare disparities, inadequate insurance coverage, and lack of mental health support, is crucial for long-term solutions.
While the referral of stable, non-emergent patients to the ER is a concerning trend, it's important to understand the complex factors driving this behavior. By addressing the root causes and implementing comprehensive solutions, we should come together and work towards a more sustainable and patient-centered healthcare system, which is drifting further away every day. This issue is spiraling to new heights, thus remaining unresolved and escalating almost to the point of creating the proverbial?"Perfect Storm."
