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ACEP Chief: ER Docs Must Look Beyond Acute Care

Cheryl Clark, for HealthLeaders Media, October 17, 2011

One keynote speaker, Richard Wolfe MD, chief of emergency medicine at Beth Israel Deaconess Medical Center in Boston, said emergency room physicians can do more to be effective gatekeepers to keep patients out of the hospital if they don't need to be there.

"What is the most expensive thing we do?" He asked "It's that we admit patients to the hospital."

"If we can be effective gatekeepers, we can play an absolutely critical role (in reducing costs), but we need to start thinking about how we find other safe places to deliver care," he said. "And I would argue that if we build home care networks... (and make sure there are) checks with primary care physicians the next day, a much better social infrastructure, and use of nursing facilities for those patients we admit a little bit for medical problems but a lot because we don't think they're safe at home, we can have a very huge impact at that point."

ACEP's leaders are worried about cost cutting efforts taking place in many state Medicaid programs, such as a recent action in the state of Washington. There Medicaid officials ? in an effort to save $72 million a year ? have classified 700 patient symptom presentations as non-emergent, for which they will not pay even though many could indicate life-threatening conditions, such as vaginal bleeding during the third trimester, ACEP leaders said.

Other parts of the new state rule include a cap of three visits per month. The new rules were adopted without a comment period and without collaborating with the medical community, the Washington state emergency doctors say.

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