Results of a survey published in the Journal of the American Osteopathic Association found on average only 38 percent of emergency medicine healthcare professionals—including physicians, physician assistants, and nurse practitioners—could accurately estimate the costs for common emergency department treatments.
Kevin Hoffman, DO, an emergency medicine resident at Lakeland Health in Saint Joseph, Michigan, led the research.
“Early in my residency, I realized I had no idea how much money I was spending with all the tests and medications I ordered—mostly because it’s just not discussed,” Dr. Hoffman says. “I began to wonder if any of my colleagues knew.”
The survey presented three cases with details about patient symptoms, diagnosis and treatment. The conditions chosen were common to emergency department patients: abdominal pain, labored breathing and sore throat. Respondents were then given a multiple choice for ranges in costs of standard treatment for each patient.
The correct cost range was chosen by 43 percent of respondents for the first scenario, followed by 32 percent on the second and 40 percent on the third.
Demographic data was collected for each respondent, showing that geography had no bearing on correct answers. However, those working in larger institutions did lean toward higher cost estimates. Worth noting, respondents with higher levels of training believed they had a greater understanding of costs, yet performed no better in accurately selecting the correct range.
Prior research has shown that, when doctors understand the cost of care, healthcare spending goes down, while maintaining positive patient outcomes. Dr. Hoffman hopes his research can nudge emergency medicine physicians toward becoming more conscious of spending.
A balancing act: Economy and efficacy
“ER docs want to save lives, they’re not usually worried about the associated costs,” Dr. Hoffman says. “But the truth is some of our patients are not here for medical emergencies. They simply don’t have insurance or access to primary care.”
He says this highlights the importance of being economical in treatment. “The bills generated by emergency department care can potentially financially cripple these patients or add to the mounting burden on taxpayers.”
Dr. Hoffman adds that physicians must reassess their treatment protocols and find ways to deliver the same quality of care, while being cost conscious. He gives an example: “If I order a drug to be given via IV, it’s going to be a lot more expensive than if I give it orally, as a pill.”
He explains that IV-delivered medications come with multiple charges. Patients are charged for the IV itself, for a nurse to establish the line, and then for a nurse to administer the drug.
“That’s three separate charges on top of the cost of the drug itself—which is also more expensive in IV form. But much of the time the pill is equally effective.”
Unlike other departments, the emergency room cannot turn patients away, and Dr. Hoffman says many of his patients without insurance or access to primary care often come in for one specific complaint but then get several issues addressed.
He suggests that emergency department staff can address the most acute symptoms of the patient but then give a referral to schedule future diagnostic tests and follow-up care at an outpatient clinic.
Test your understanding of the costs of care
Case 1: Abdominal Pain
Presentation: 35-year-old obese woman with no medical history presents to the ED with a chief complaint of right-sided progressive cramping abdominal pain for the past 2-3 d. She reports nausea and vomiting (3 times) without fever/chills. Her pain worsens with eating, but she is still drinking liquids normally. No changes to urinary or bowel habits; no vaginal bleeding or discharge.
Physical Examination: Vital signs are normal. Heart and lungs are without notable abnormality. Abdomen is soft; tender in the RUQ and RLQ without rebound. Pelvic examination is normal. Diagnostics: CBC, CMP, urinalysis, urine pregnancy test, abdominal RUQ ultrasonography, CT of the abdomen/pelvis with IV/oral contrast. No significant pathologic cause is identified.
Diagnostics: CBC, CMP, urinalysis, urine pregnancy test, abdominal RUQ ultrasonography, CT of the abdomen/pelvis with IV/oral contrast. No significant pathologic cause is identified.
Intervention: Morphine, 4 mg IV, and ondansetron, 4 mg IV. Symptoms resolve and patient is discharged home.
Case 2: Dyspnea
Presentation: 57-year-old man with medical history of CHF presents to the ED with chief complaint of 3 d of progressive dyspnea, lower extremity edema, and 2-3 pillow orthopnea. No chest or abdominal pain or changes in urinary or bowel habits.
Physical Examination: Mildly distressed. Vital signs are stable but notable for tachypnea at 24/min and a room air pulse oximetry of 84% at triage and 96% on BiPAP. S3 heart sound present with bilateral rales above the midlung field. Bilateral and symmetric 2+ pitting edema in the lower extremities to above the knee.
Diagnostics: EKG, CBC, CMP, BNP, chest radiography, troponin, D-dimer. EKG shows LVH without signs of ischemia or infarction. Radiograph shows bilateral pleural effusions and moderate diffuse pulmonary edema. BNP is elevated at 20,000 pg/mL. No other notable abnormalities.
Intervention: Furosemide, 60 mg IV. Patient is admitted to the hospital for stabilization.
Case 3: Sore Throat
Presentation: 7-year-old boy with no medical history presents to the ED with chief complaint of sore throat for 24 h. He is reported to have had a fever of 102.4°F without a cough. He is eating and drinking normally. No other symptoms.
Physical Examination: Mildly distressed. Vital signs are stable. Heart, lung, and abdomen are unremarkable. Throat examination shows diffuse pharyngeal erythema with 2+ tonsils with exudate without signs of abscess. Airway is patent. Neck examination shows anterior cervical lymphadenopathy.
Diagnostics: Rapid strep test is positive.
Intervention: The patient is discharged home with a prescription for amoxicillin liquid and follow-up with his PCP in 24-48 h.
Case 1: The correct answer is $4,713.
Case 2: The correct answer is $2,423.
Case 3: The correct answer is $596.
You answered them all right!