Geriatric Emergency Rooms — Marketing Ploy or Better Outcomes?

Recent newspaper articles have reported on the development of emergency rooms dedicated to seniors.  The Denver Post describes how Exempla Lutheran opened a senior emergency room two years ago, with two more area hospitals adding senior-focused emergency room space.

Denver is joining the rest of the country in opening geriatric emergency rooms.  According to The New York Times, Holy Cross Hospital in Silver Spring, Md., was one of the first emergency rooms dedicated to caring for seniors when it opened in 2008.  Since then, geriatric emergency rooms have opened in New York City, New Jersey, Missouri, Kansas, and Texas, among other locations.HC BLOG_emergency

Geriatric emergency rooms are specifically designed for an elderly patient with features such as softer lights, a nonskid floor, and handrails lining the walls. The noises found in usual emergency rooms are muted.  Many senior emergency rooms are staffed with health care providers who specialize in geriatrics.

While it may seem like geriatric emergency rooms are merely a marketing tool, Drs. Ula Hwang and R. Sean Morrison stated in a 2007 paper that a traditional emergency room is not aligned with the care needs of a geriatric patient.  The traditional emergency room’s focus on rapid triage and diagnosis may be impossible in a geriatric patient with multiple and complex medical conditions, who takes many medications, and may have dementia.  Hwang believes that the use of geriatric emergency rooms may address an elderly patient’s special care needs better than traditional emergency rooms.  Dr. Mark Rosenberg, chair of emergency medicine at St. Joseph’s Regional Medical Center in Paterson, N.J., reported last December that since his hospital opened a geriatric emergency room, the rate of unscheduled geriatric readmissions for the same illness or injury within 30 days dropped from 20 percent to less than 1 percent.

Decreased readmissions help geriatric patients who visit the emergency room as well as help a hospital’s Medicare reimbursement.  One provision of the Affordable Care Act provides a financial incentive for hospitals to reduce preventable readmissions.  Hospitals with excess Medicare readmissions receive a financial penalty.  A readmission is defined as a Medicare patient who is readmitted to the same or another acute care hospital within 30 days of discharge.  Certain readmissions, such as transfers to another hospital and planned readmissions, are excluded.  For now, the program applies only to readmissions of Medicare patients 65 and older with diagnoses of acute myocardial infarction, heart failure, or pneumonia.  42 U.S.C. § 1395ww(q).

In fiscal year 2015, the program will also include readmissions after elective total hip and knee arthoplasty and chronic obstructive pulmonary disease, according to the final rule.  78 Fed. Reg. 50494-51040 (Aug. 19, 2013).  It would not be surprising to see the program expanded to additional diagnoses, so improving a hospital’s readmission rate through the use of geriatric emergency rooms can make financial sense.

Image courtesy of Flickr by Taber Andrew Bain