Ezekiel Emanuel: How to Solve the ER Problem

Ezekiel Emanuel: How to Solve the ER Problem

A Seattle Experiment Reduces ER Use Among Sickest by 27%

In a column in the New York Times, Ezekiel Emanuel details how a Seattle experiment with 13,500 of the sickest and most expensive set of patients reduced emergency room use by 27% over four years.

Emanuel, PhD, MD, MSc, is Penn's Vice Provost for Global Initiatives, Chair of the Department of Medical Ethics and Health Policy, and an LDI Senior Fellow.

His column and its example is a counterpoint to the new survey by the American College of Emergency Physicians that found 75% of ER doctors reported increases in patient volume since the Affordable Care Act went into effect. One of the early expectations of ACA proponents was that the law's sweeping insurance reforms would lower overall use of emergency departments.

Emanuel details Seattle's four-step program that included cash incentives, simultaneously raising ER visit fees and lowering urgent care visit co-pays, social media educational programs, and a case-management program providing individual support to people who used the ER more than five times annually.