Cutting ER Costs through Scope-of-Practice Reform

Cutting ER Costs through Scope-of-Practice Reform

One of the main troubles with our current healthcare system is the overuse of emergency rooms to address non-emergency health problems. The CDC found that in 2015, of the nearly 140 million emergency department visits, only 12.3 million were hospitalized and 1.5 million were admitted to critical care units.

It’s a waste of doctors’ time and resources to deal with non-critical cases, which necessitates a certain degree of “triage”–prioritizing those with potentially life-or-death conditions over those whose issues could be addressed by a more traditional visit to the doctor’s office.

There is, of course, another option: expanding the scope-of-practice for pharmacists. While your pharmacist won’t perform your appendectomy or remove the bullets Snake from The Simpsons “fell on,” a study on the effects of such a policy in our neighbor to the north, Canda, shows the potential benefits of this liberalization:

Pharmacists have been shown to be beneficial for inclusion in emergency department (ED) services; however, little has been done to assess these benefits with pharmacists having even wider scopes of practice, including limited prescribing authority. The aims of this study were to determine the proportion of ED visits that can potentially be managed by pharmacists, the most prevalent conditions within these cases, and the factors associated with patients presenting with such cases to the ED…Among all unscheduled ED visits in Ontario, all visits with a Family Practice Sensitive Condition and Canadian Triage and Acuity Scale score of IV or V [less- or non-urgent cases] were identified, in addition to conditions that can be managed by pharmacists with expanded scope…Of 34,550,020 ED visits identified, 12.4%…were considered FPSC with CTAS IV or V. Of these, [35%] were for conditions considered to be potentially manageable by pharmacists, representing 4.3% of all ED visits. The most frequent diagnoses observed were: acute pharyngitis, conjunctivitis, rash and other nonspecific skin eruption, otitis externa, cough, acute sinusitis, and dermatitis…Under an expanded scope, pharmacists could potentially have managed nearly 1.5 million [about 4.4%] cases presenting to the ED over the study period. The introduction of ED-based or community pharmacists practicing under an expanded scope may have a positive impact on overcrowding in EDs.

At the risk of sounding cold-hearted, not every medical problem is an “emergency,” and the cost of such overutilization is in the billions. In Overcharged, Charles Silver and David A. Hyman find the costs of an ER visit are 13 times the average charge for an urgent care center visit.

Though this is is a separate question from the costs of care in an emergency room, the research shows how liberalizing the ability of other high-skilled professionals (i.e. pharmacists) can reduce the workload of doctors and trim the costs of providing healthcare overall.

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By |2019-01-15T10:54:35-08:00January 15th, 2019|Blog, Occupational Licensing|