by
Brendon Nafziger, DOTmed News Associate Editor | September 27, 2010
"Billing codes for providing ED preventive services that we studied generally do not exist," Delgado told DOTmed News by e-mail. "For example, a primary care provider can bill for smoking cessation counseling, but this cannot be done in the ED setting. Thus is there is little incentive for ED providers to do this or prescribe quit aids (such as nicotine patches), even though a patient may be there for a related problem such as asthma."
Despite the variations, less than a third of directors, 27 percent, thought the services shouldn't be offered at all.
"Our findings imply that more widespread dissemination of ED preventive services will likely be contingent on improved reimbursement," the authors concluded.
Still, the study had some limitations. The authors cautioned the results might not apply to high-volume city hospitals, which have the most at-risk patients. Also, terminology used in the survey hasn't been validated in previous research, so there's a chance each respondent could have a different interpretation of the wording.
While cost was an objection for many directors, Dr. Robert Norris, chief of emergency medicine at Stanford, said preventive-care services can save costs in the long-term along the "ounce of prevention is worth a pound of cure" principle.
"[F]or example, people who come in with an alcohol-related injury - we can discuss with them why this happened and how much worse the consequences could have been and then help to get them set up in a treatment program," he said in a statement.
But the authors believe more research is needed, as they say little work has been done to determine the cost-effectiveness of offering preventive-care services in the ED.
"ED resources are finite, and in some places EDs are so over capacity, they can barely handle getting to potential heart attack patients in the waiting room in a timely fashion," Delgado said. "Thus if we are going to invest in more preventive services, we have to make sure that they are effective in the long term, worth the cost, and that they don't hamper the EDs primary mission to provide acute care."
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