March 22--Central Ohio hospitals say emergency-department visits have risen 18 percent in four years.
The area's four largest hospital systems -- Mount Carmel Health System, Nationwide Children's Hospital, Ohio State University's Wexner Medical Center and OhioHealth -- reported 771,829 such visits in fiscal- or calendar-year 2012, up from 651,387 in 2008.
The rising visits appear to span the spectrum of severity and are not driven just by people in search of care that could be provided in nonemergency settings at less cost.
In Ohio, there were 564 visits per 1,000 people to hospital emergency departments in 2011, the most-recent year for which the American Hospital Association has data. That's the fifth-highest rate among states and 36 percent higher than the U.S. average.
Ohio had 5.59 million emergency-department visits in 2011, up from 5.29 million in 2010, according to the Ohio Hospital Association, which plans to release 2012 data next week.
Central Ohio's aging and growing population both contribute to the trend, but that might not fully explain it, officials say.
High numbers of emergency-department visits often are seen as a visible symptom of the fragmented nature of the nation's health-care system. Many patients have problems that would be more appropriately -- and less expensively -- treated in other settings.
Others, especially older patients, might have bona-fide emergencies when they arrive at an emergency department. But many of those conditions could have been headed off by a family doctor before they became severe, said Dr. Howard Mell, a spokesman for the American College of Emergency Physicians and site director of the emergency department at Lake Health's West Medical Center in the Cleveland suburb of Willoughby.
For example, some chronic conditions, such as congestive heart failure or asthma, can be managed proactively before a trip to the emergency room becomes necessary, Mell said.
"I think that conundrum is really hurting us," Mell said.
The American College of Emergency Physicians said emergency-department care consumes 2 percent of U.S. health-care spending, far less than technology, prescription drugs and chronic disease. Still, nonprofit hospitals -- which by law can't turn people away -- typically shift the cost of any uninsured care to patients who have health insurance. And insured people who use emergency departments inappropriately also drive up the cost of care for others.
A greater emphasis by the state and federal government on patient-centered care eventually could reduce unnecessary emergency-department use, experts say.
The growth in emergency-department visits has been especially significant at Grant Medical Center and Doctors Hospital, which during the past two years saw visits increase 29 percent and 23 percent, respectively.Grant is adding eight beds to help keep up with the demand.
The growth shows that "patients in our community really don't have that access when they need it," said Duane Perry, the nursing director of Grant's emergency department.
OhioHealth officials predict that visits to its more-established emergency departments will decline slightly in its current fiscal year, which ends on June 30. The exception is its new emergency-care center in Westerville, which opened in June and is on track to see 15,531 patients in its first full year. That would push the health system's overall emergency-department use to a record high.
Perry said emergency-department visits might decline slightly with the growth of urgent-care and health clinics in retail settings. Ohio State credited the opening of its AfterHours Care in October with a recent slight decline in its emergency-department visits.
bsutherly@dispatch.com
@BenSutherly
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