The following blog by Wesley Curry, MD is a ten year forecast, and it has also been our most popular blog for 2012, with over 2,000 clicks. Perspectives on the Acute Care Continuum congratulates Dr. Curry, and we look forward to a new year with your thoughts, comments, and solutions for the challenges of the next decade.
As the CEO of a physician group that provides medical care to over 4 million patients per year, I have the opportunity to study in great detail the trends in patient acuity, demographics and yearly visits in more than 80 emergency departments and watch the monthly variations. I recently asked staff, with the assistance of our in-house biostatistician, to project the ED patient volume in the future based solely on the incremental increase in the past patient volume in the past decade, while making no other assumptions.
The results were startling. If nothing changes, the “people curve” of patient visits to the emergency departments we serve will rise dramatically by 2020. These futures are merely a projection of actual growth rates from the past decade and they showed a doubling in ED patient volume between 2000 and 2020. At a hospital in California’s Central Valley, for example, we saw the volume of ED patients rise from 50,000 in 2000 to 70,000 in 2010 and they are expected to grow to 95,000 by end of this decade. Most noteworthy in the analysis were the number of hospitals with ED visits that are projected to exceed 100,000 patients per year.
These projections do not even include five major forces at play right now:
The U.S. Census Bureau projects that from 2010 to 2020, the population will grow to 336 million. The CDC reported national ED visits as 136 million in 2009, the latest data available, which was a 9.9% increase over 2008. Extrapolating total national ED visits for 2012 using our internal data for the period 2010-2012, I would project over 150 million ED visits across the nation.
The AAMC projects a shortage of 91,500 physicians by 2020. 45,000 of these physicians will be needed in the primary care setting. If nothing else changes, my experience leads me to believe that most of those people without dedicated primary care will access the ED for urgent, primary care, and specialty evaluation which is unavailable from other sources.
A study in the Journal of the American Medical Association indicated that from 1990-2009, the number of EDs in non-rural areas declined by 27% and some have predicted the closure of an additional 30% of EDs by the year 2020. The Governance Institute believes 5% of hospitals will close by 2020. As consolidation or closure of hospitals continues, the burden only grows on those hospitals that remain to adapt to rapid increases in patient volume that were not anticipated when their respective emergency departments were built.
Today’s healthcare system is incredibly complex. This article does a good job scratching the surface of some of the layers of administrative complexity, while a 2010 World Health Organization Report looks at the complexities that have arisen in the practice of medicine itself. At every level, from the entire country, to the hospital, to the department, and to the provider, we are experiencing increasingly complex budget, management and oversight which all add to the burden of providing care.
Healthcare consultant Nate Kauffman has summarized this concept best: “There’s no new money, only consequences.” As counties, states, and the feds struggle to balance their budgets, we have begun to see the inevitable pushback on reimbursements going to hospitals. Government and other payers will be expecting hospitals to continue with their standard of care but with far fewer resources.
Unless Congress focuses on the “people curve” and not just the “cost curve,” I believe the total ED visits by 2020 could easily top 200 million visits per year. The hospitals of 2020 will have to contend with the impact of these five trends and get ready for 100,000+ ED visits. There are already a few of them out there today, which I call “tomorrow’s hospitals today.” Their example should give us the means to address a rapid rise in ED volume.
I believe the ED will continue to be the nation’s safety net because there doesn’t appear to be any foreseeable alternative for the future.