Executive Summary. Problem Statement. What Actions Can

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

Despite the countless advanced in technology and the abundance of health care organization popping up all over the place, whether they are free standing clinics, hospitals, urgent cares or etc, many people still lack the ability to receive quality health care. This has become a concern throughout the world, but especially a more vocal concern for residents of the United States in the past few years. In this paper we will discuss the reasons preventing access to quality health care and how we can overcome the many obstacles that stand in our way to provide quality health care to many who lack it today.

(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on individuals who frequently utilize the emergency department (super-utilizers); and targeting the needs of individuals with behavioral health problems. (Mann, 2014, pp 2-4) Many resources and processes have been implemented in order to help decrease inappropriate emergency department visits. This paper is going to demonstrate some resources and processes that are in place to help individuals obtain health care at the appropriate health care setting.

When the info-graphics site Visually was hired to put together information related to drug abuse in the state, one could only imagine the startling information that was discovered. To begin with, drug is considered the #1 cause of accidental deaths with 11 people dying everyday from a drug overdose. Each year, an estimated 40,000 emergency room visits are drug related, and 3 of every 10 auto accident fatalities are as a result of drug use. Sadly, only 15% of the state's addicts are said to ever receive treatment. These numbers point out the need for educating residents about the availability of outpatient and inpatient addiction treatment services (drug and alcohol rehab) throughout the state and other parts of the country.

The problem is defined in America’s healthcare ranking as the most expensive, least available, and poorest quality health care in the world.

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

I am currently employed in the Veteran’s Affairs Loma Linda HCS in the Emergency Department. Our target population are adults, mainly male, with multiple on-going health conditions. In our ED, we see a huge volume of veterans who have chronic illnesses and conditions. I noticed that many re-peat ED visits that could have been easily avoided and prevented. Some are legitimate emergencies and urgencies, but unfortunately the great majority are the result of non-compliance, lack of adequate knowledge in managing illness and failure to partner with their care provider to promote better overall health.

Yet, our healthcare remain broken and threatens the financial well-being of America in the near future. At the conception of America’s healthcare system, the biggest issues concerning the management of American’s health were the methods of treatment, knowledge sharing among physicians and therapist, the lack of resources at the state and local level, and the true role of the Federal government. (Greg, 2010) The same issues haunt America’s healthcare system unto today. With healthcare cost growing more out of control, the question concerning how to best management America’s health has become increasingly relevant.

In some areas of population health, technology in enhanced patient information is utilized to perform risk stratification to identify the high risk patients. These patient’s often have uncontrolled BP, diabetes with an HgbA1c over 9, COPD, etc. Once identified as high risk or potential high risk, these patients receive additional care or patient outreach to help manage their condition. Some organizations employee RN Health Coaches and Care Coordination teams to help these patients and identify gaps in care. The primary care physician assumes care of the patient along with striving for the patient to become active in their overall health thereby keeping them out of the hospital (Sanford, 2013). One enhanced area of population management is the PCMH model. PCMH practices increase patient’s engagement in shared decision making while providing compensation for care coordination, care management and medical consultation outside of traditional face-to-face visits (Berryman, Palmer, Kohl &Parham, 2013). A patient centered approach pushes for changes not only in the delivery of medicine but in traditional encounters. In addition, PCMH encourages increased access to the patient’s primary care physicians and improved patient satisfaction scores. PCMH and population health encourages providers to increase after hours care to decrease emergency department visits and/or hospitalizations. Thereby reducing cost and improving the patient’s

They argue that nearly 70 percent of Texas physicians are reluctant to see Medicaid patients due to low reimbursement rates (7). They claim this to be the prime reason why patients seek primary care services at the emergency department (7). In contrast, supporters of Medicaid expansion argue that uncompensated care is the fundamental basis for Medicaid expansion, as increasing the number of people with Medicaid coverage will lower the unreimbursed costs to the hospitals (7).

The decline in hospital capacity was accompanied by a rise in staffing. Full-time equivalent personnel rose (Malagi & Kamath, 2016). Most of the additional personnel in hospitals are not focused on patient care but management or administration purposes. The American Hospital Association data shows that outpatient department visits have risen per 1,000 persons indicating that capacity for ambulatory services has risen overtime. Emergency departments have reduced with a larger percentage of closures being in rural areas. Compared to hospitals, physicians have continued to increase. Specialists have increased except for radiologists and general surgeons. There is, however, an uneven distribution of physicians between rural and urban areas. There is an estimated shortage of 3,000 physicians in nonmetropolitan areas. In addition to an increase in physicians, there are new forms of acute-care facilities. There are relatively new facilities that have been accredited. Ambulatory surgery centers have, for instance, risen (Best et al.,

Hospitals in the United States offer top quality care to its citizens but regrettably not everyone receives equal access to this care. There is an alarming difference between qualities of care received by some population groups relative to other population groups.

The concept of hot spotting came about through a keen observation of Dr. Jeffrey Benner. Realizing that health care costs were mostly spent on patients with repeated hospitalizations, Dr. Benner proposed the idea of identifying these patient population to focus on their care. Kudyba (2016) also cited Dr. Benner’s conclusion that these “hot spots” patients were the ones that did not receive the best care. Since its introduction, Kudyba (2016) mentioned several Medicaid agencies recommended the practice of hot spotting to lower the health care costs and improve the quality of care. Therefore, as clinicians, targeting these patients would mean understanding beyond their illness, but other conditions contributing to

There are many issues that are causing changings in the healthcare system. Population aging, rapidly increasing costs of healthcare and the growing burden of chronic disease are challenges to health systems worldwide. To meet these challenges will require new approaches to healthcare delivery and comprehensive population health management. Many states are not prepared to tackle this issue yet. The US has the most expensive healthcare system in the world with health status indicators that are only average in comparison

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).