(Courtesy Dr. J. Slutzman, presented to the American College of Emergency Physicians)
If you’re feeling chest pain that you think might be a heart attack, there’s only one thing to do, medical experts say: Seek emergency care. Do not pass go, do not collect $200. Or rather, do not think about the roughly $1,000 your care will cost the hospital. Your life may be at stake.
But at a calmer moment less fraught with risk, you might want to contemplate the bigger picture of chest pain and emergency care, as sketched out by Dr. Jonathan Slutzman of UMass Medical School and colleagues at a recent national conference on emergency medicine. To wit: Your costs are part of a national Emergency Department care bill that totals nearly $80 billion, including nearly $5 billion for chest pain alone.
Every year, Americans log a total of about 130 million visits to emergency rooms, Dr. Slutzman said. Among those visits, according to his team’s analysis of millions of records, patients who come in for chest pain are the single biggest line item on the bill.
“Chest pain is one of the two most common reasons somebody comes into the Emergency Department,” he said. “It’s somewhere on the order of 5 percent of all visits,” which may not seem like very much until you realize it’s 5 percent of 130 million, and each chest-pain visit costs about $1,000.
The grand total: $4.7 billion. It’s so high because chest pain is both a high-volume diagnosis and the treatment is high-intensity, Slutzman said, usually including blood tests, X-rays, sometimes CT scans and sometimes stress tests. They add up.
So now that we see that prodigious price tag, what is to be done?
Emergency medical specialists are working on that problem, he said, in part by figuring out what the “best practices” are for evaluating chest pain. “This is on people’s radar screens,” he said, “to try and ‘rightsize’ our care,” meaning that “we can safely treat many patients while doing less.”
To which I naturally responded: “Yikes. I don’t really want the system to be trying to save money when I might be having a heart attack.”
Slutzman calmed me down. His No. 1 takeaway from the findings, he said, is that more patients should probably be evaluated as to whether they’re having a heart attack without having to stay overnight in a hospital. Chest pain patients tend to be almost reflexively kept in the hospital for at least one night of testing, he said, “and a big subset of those people don’t really need it. One big key is more rapid access to outpatient providers. If someone can see their doctor in one to two days and maybe get some additional testing then, they can be safely discharged.”
That calmed me down a bit. I do believe in staying out of the hospital whenever possible.
He calmed me still further with a story:
Historically, back in the late ’80s and early ’90s, if you walked into an Emergency Department with chest pain, you got admitted to a cardiac Intensive Care Unit, pretty much no matter what, because there was so much concern that they could be missing heart attack. There was a lot of fear of that.
And then, over time, we learned more and more. We could read our electrocardiograms — our EKGs — a little better, we could learn a little bit more about what the squiggles meant, and which ones were dangerous and which ones weren’t.
And then we got more blood tests that were a little bit more sensitive and a little bit more specific, and a little bit better at figuring out who was having a heart attack and who wasn’t. Continue reading