Concierge Emergency Department

Is it possible for there to be a bed for every emergency department patient? Quiet individual rooms. Entertainment kiosks. Private bathrooms. Couches for family and guests. There is demand for this level of service.

The number of patients presenting to emergency departments outnumber the beds available. Nationally, ED visits went up 32% from 1996 to 2006. ED visits in my hospital have gone up 35% since 2001. We can't build 35% bigger EDs. We can't squeeze in 35% more ED beds. We don't have the funds.

We improve processes. We see more patients in less space, in less time, with less people, and they are often satisfied.

Many patients go to the ED and never see an ED bed. They see the physician and nurse in an intake area. Blood is drawn, x-rays are ordered, and medications are given. They sit in results waiting areas for their tests and treatment to be complete. They are discharged home. Only the sickest patients get a bed.

Some patients want more service. Some would be willing to pay for that service. Others see that service as a waste of their money.

This might occur safely if we ensure that:

• The sickest patients get a bed.
• Care is not delayed for anyone.
• Although extra service may be purchased, care is equal.

For a fee, families or individuals could become members of the Concierge Emergency Department. They might want:

• A private room.
• Couches and chairs for family.
• Wireless or wired internet connections.
• Flat screen television with movies and video games.
• Food and drinks.
• The hospital's nursing and ancillary service stars.
• Member events and dinners where they get to meet the board, executives and physicians.
• Answers to outpatient questions and appointments with hospital-based preferred physicians.

Many of the tactics used by concierge primary care physicians, hotels, and frequent flier clubs may be adopted by hospitals and hospital based physicians. The fee could be paid annually or at a higher level at the time of service. A source of cash flow for hospitals.

Is it possible to separate service level from quality of care?

Comments

[shadowfax]

Already happening in Texas, if you believe Scalpel...

[shadowfax]

No HTML in comments? Geez. here's the full link, then. Choke on it:

http://scalpelorsword.blogspot.com/2008/03/wave-of-future.html

[Richard Winters]

Choke, Choke. What fool administers this site? Oh. It's me. HTML now turned on.

[Richard Winters]

I am aware of freestanding EMTALA-free Texas EDs that offer limited "concierge-like" services. Do you know of any hospital EDs that are providing similar services? EMTALA certainly applies to the care of patients in the ED. However, I do not know that EMTALA restricts payment for service.

[Sherry Reynolds]

1) I believe there is a hospital in Florida - Memorial Regional South that offers what they call a concierge clinic that is marketed to doctors who can't see patients the same day (whole other problem that is solvable.

http://www.memorialregionalsouth.com/Concierge.aspx

2) USC school of engineering did some great research on flow through the hospital and how to free up space in the ER.
http://viterbi.usc.edu/news/news/2006/management-engineering-could.htm

3) My feed-back is to also adopt the model used in Denmark where after hours the doctor comes to your house. NPR did a special on it last summer. http://www.npr.org/templates/story/story.php?storyId=92606938

4) Finally, keep the people out of the ER in the first place. Universal coverage and doctors who make house calls as highlighted on tonights news.
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[Suzanne Dewey]

Hmmmm, while concierge offerings have their appeal for some, the market is small and doesn't really address the issues you are describing in emergency care.

I think you nail the concept when you state the shrinking number of primary care physicians AND the growing number of uninsured. If we could address these two issues, EDs would not need the beds and hospitals would not need to glean an additional revenue stream from concierge EDs.

[Richard Winters]

Suzanne-

Please elaborate on how you determined that the market for various service offerings in medicine is small.

[Peter]

How will it be paid for? Primary care concierge clinics can have a yearly subscription rate because their services are expected to be demanded on a more frequent basis. Not so with emergency care. Concierge emergency practices will need to have a fee schedule accessible by patients before even considering a visit:

"$125 to visit the ER to see if I really hurt myself? I don't want to risk not being seen for a potentially serious injury, and $125 is worth it to know the truth."

An individual may need to visit the ER once every 5 years perhaps. Few would be willing to pay a yearly subscription for services unlikely to be needed every year.

Follow the Best Buy model: initial consultation fee is $125 in cash upfront, and any further medical care will be billed separately and will also require cash upfront perhaps. How would CT scans be paid for? Cash upfront? What about MRI? Will these be reimbursable by insurance? If you take insurance, won't the benefits of going cash-only be negated by the personnel required to manage the paperwork? Will you refer patients to radiology centers for their imaging studies so that you can avoid the insurance paperwork yourself?

The business model needs to be worked out, but it appears to be an interesting solution to the problems EM physicians are dealing with especially out in California.

[scalpel]

The practices I described in my post are still going strong. Patients love them. Nurses and techs love working there, so they end up stealing the best of the best nurses and techs from our "regular" ERs.

They have flat screen TVs in every room, CT, X ray, and lab in house, and they turn a good profit seeing only a dozen or so patients per day.

The concept won't work unless Medicare and Medicaid are excluded because you can't balance bill, but so far they are finding that they don't miss those patients or the frustrating loss of autonomy required to accept the government dime.