| Statement of the Problem. In 1993 there were 357 emergency room visits per 1000 population. However, in California, a highly penetrated managed care state, emergency room visits were as low as 75 per 1000 population. Also in that same year, the General Accounting Office reported that as many as 45 percent of all patients seen in emergency departments were non-urgent cases and could be treated in primary care settings, saving patients and payers approximately $7 billion annually. Also, one additional ED admission per day could total $1.75 million in annual hospital revenue. Prior to 1996, ED patient visits have increased about 5 percent annually over the past ten years. Yet, in states with a high penetration of managed care, ED visits have gone down as much as 10 percent.;Methods. A cross-sectional survey research design was utilized. Nonparametric Chi-Square statistical analysis was performed. The participants were the emergency department medical director from each of the twenty purposefully chosen hospitals located in north and central California. Three researcher designed instruments were used: two interview protocols consisting of free-response and Likert Scale response questions; and a demographic questionnaire consisting of a mix of short response, checklist, dichotomous and free-response questions.;The researcher investigated managed care's impact on emergency department census, medicine and management, and its resultant impact on acuity, staffing, the use of physician extenders, operations, length of stay, physician attitude, regulatory constraints and future concerns.;Results. Since managed care the ED director has changed the way he practices emergency medicine and manages the emergency department. He feels under greater stress as he has to get authorization for much of what he does in managing his patients. It therefore takes him longer to treat and discharge his patients. His stress is also a result of facing ethical dilemmas and challenges dispositioning his patients under the looming fear of a COBRA violation. As a result of managed care, the median emergency department director spends more time managing the department and competing for patients, taking greater financial risk and receiving less remuneration for services rendered. His relationship with primary care physicians is strained because of conflicting, patient-care objectives.;Conclusions. As a result of managed care, emergency department managers can anticipate: a change in census; an increase in the acuity of their patient population; operational changes and services in the ED will transform; physicians will need to practice quality, cost-effective medicine; non-urgent patients will be diverted away from the ED to the PCP and market driven centers; more observation care will take place in and adjacent to the ED; physician extenders' role in the ED will depend on workforce decisions among medical school and residency administrators. |
