ACADEMIC DEPARTMENTS OF EMERGENCY-MEDICINE - THE EFFECTS OF MANAGED CARE

Objective: To survey academic departments of emergency medicine (ADEMs ) concerning the effects of managed care on their operation and practi ce. Methods: A 38-question survey was mailed to the chairs of all 52 A DEMs in the United States requesting information concerning managed ca re activity and its effects on ADEMs in academic years 1994-1995 and 1 995-1996. Results: Forty-seven ADEMs (90.3%) responded. When comparing the 1995-1996 and 1994-1995 academic years, the following changes wer e noted: decreased overall growth in ED patient volume (38.3% vs 51.1% ), larger percentage of respondents reporting an actual decrease in ED patient volume (38% vs 27.6%), less growth in ED gross revenue (43.7% vs 52.1%), larger percentage of ADEMs reporting actual decreased gros s revenues (25% vs 12.5%), increase in ED patient acuity (76.6% vs 59. 6%), and relative stability in the number of EM faculty (40.4% vs 44.7 % reporting no change in faculty number). Two-thirds of ADEMs used mid -level providers (i.e., physician assistants, nurse practitioners), mo st commonly in a fast-track setting (41%). Thirty percent of ADEMs rep orted that other academic departments actively directed patients away from the ED, with pediatrics, family medicine, and internal medicine t he most active. Ninety-eight percent of ADEMs reported ongoing negotia tions between their institution or hospital and managed care organizat ions (MCOs); only 54.3% of ADEMs were involved in these negotiations. Twenty-eight percent of ADEMs reported MCOs have had an effect on thei r emergency medical services system, with 37% indicating HMOs routinel y discouraged their enrollees from using 9-1-1 services and 16% report ing HMOs provided 9-1-1 services to take patients only to participatin g hospital EDs. Conclusion: ADEMs have experienced significant changes in nearly every aspect of their practice over the two academic years under study, much of which is due to managed care. ADEMs must take a l eadership role in dealing with MCOs.