By Beth Kutscher

Originally Posted: May 20, 2013 - 2:00 pm ET by Modern Healthcare

Efforts to shift patients to lower-cost healthcare settings appear to flounder as the emergency department continues to play a larger role in where and how care is delivered.

A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009.

During that time, hospital admissions grew only 4%—not even keeping pace with population growth. But ER-related admissions jumped 17%.

Yet despite pushback to move patients away from ERs, the study's authors suggested that emergency departments also have helped prevent avoidable admissions: They found that even though patients show up to the ER with chronic conditions such as asthma and heart failure, admissions for these conditions remained flat.

Also, the study found that even primary-care doctors are directing more people to the ER—where they can be seen at all hours and where sophisticated diagnostic equipment can help form quick diagnoses—rather than admitting these patients themselves.

The growth in ER-related admissions occurred alongside a 10% drop in admissions from other outpatient settings, including doctors' offices.

RAND developed the study for the Emergency Medicine Action Fund, a consortium of groups that represent emergency medicine physicians.

“This report tells policymakers and hospital administrators that they should pay closer attention to the role that emergency physicians play in evaluating, managing and preventing hospital admissions,” Dr. Andy Sama, president of the American College of Emergency Physicians, said in a news release.

The group highlighted that emergency medicine physicians now handle 11% of all outpatient visits and 28% of acute-care visits, including half of the acute-care visits for Medicaid beneficiaries and two-thirds for the uninsured.