This is part of a continuing series exploring the Confusing array of changes to healthcare and identify the Opportunities for our specialty. The goal is to give you three things:
- The What
- The Why
- The Opportunity (for our emergency medicine)
There is a tidal wave that is coming. The baby boomer generation (those born 1946-1964) are now entering retirement age. Combined with increases in life expectancy it is causing an unprecedented “graying” of the United States and most other industrialized countries. Just look at the last census. While the total population only increased by 9.7% those over 62 increased by 21%!
In the State of New Jersey those over 65 with increase from 1.2 Million now to almost 2 Million by 2030.
So how will this impact the ED? Based on CMS data geriatric patients utilize emergency department services at a rate 7 times that of the rest of the population and generally make up 15-20% of ED volume. They account for over 40% of all admissions and nearly half of ICU admissions. While in the hospital their LOS tends to be 1-2 days longer on average. Furthermore these patients are living longer and staying independent despite increasingly complex web of chronic conditions.
As this Tsunami is crashing onto our healthcare shores other trends will be eroding the traditional care pillars. First the pool of primary care providers is graying as well and replacements are not anticipated to keep up with demand. Second despite rising demand EDs are closing along with the hospitals they are based in. Third more healthcare is expected to be provided outside the hospital setting.
So now we know we have a rapidly growing population of very complex patients to look forward to. So what should emergency medicine do? Where is our opportunity to improve care?
We in emergency medicine are in the right place and have many of the tools that this population needs. We are already experts in evaluation of acute conditions (which many of these patients will have); we have spent decades honing our system responses to critical patients (which many of these patients will be); and we are the masters of collaboration (which these patients will really need).
It is in that last category that we can show the value of our care. Elderly patients and the desire to keep those with chronic, complex conditions at home will need considerable coordination of care at times of acute illness or decompensation. We are positioned to be the hub of that care by providing:
- Coordination of hospital resources
- Coordination of community resources
- Services such as extended observation (in and out of the hospital)
- Palliative care
Because of our unique position and availability emergency medicine has always excelled at related tasks (observation medicine, hyperbarics, travel medicine, urgent care). While more service intensive we have the same opportunity for geriatrics. Some of these could include:
- Comprehensive Geriatric Screening
- Emergent/Urgent at-home evaluations through community paramedicine
- Telemedicine for urgent evaluations of nursing home patients
- Palliative medicine
To finish up the Silver Tsunami analogy. We are the life guards on the health care beach. Our tasks will continue to be the care of the acute conditions and when possible the prevention of illness decompensation.
Mark Rosenberg DO, MBA, FACEP, FACOEP-D
Dr. Rosenberg is the Chairman of Emergency Medicine, Chief Geriatric Emergency Medicine, and Palliative Medicine at St. Joseph’s Regional Medical Center in Paterson, NJ. He is the Secretary/Treasurer of NJ-ACEP, and a member of the Presidents Council for ACEP as well as the Council Steering Committee. He can be reached at 973-754-2240 or firstname.lastname@example.org.