For more than a year, the NAPH Safety Network (NSN) has been working with 22 safety net hospitals to reduce preventable readmissions. The Partnership for Patients set our goal at a 20 percent reduction by the end of 2013 from a 2010 baseline. While we are still working to achieve this goal, many hospitals have made impressive strides. This summer at the NAPH Annual Conference in Hollywood, Fla., we look forward to sharing our hospitals’ work and hearing what others have been doing.

The truth of the matter is that most hospitals are working to reduce readmissions, in large part due to new financial penalties that are now associated with them. Nearly two-thirds of hospitals receiving traditional Medicare payments are expected to pay penalties totaling about $300 million in 2013 due to their high 30-day readmissions rates.

I often have heard the key to reducing readmissions is getting people to stop using the hospital, and in particular the emergency department (ED), as their primary care provider. But what if patients prefer to use the ED as their primary care provider?

A recent qualitative study by Lapedis et al. highlighted reasons patients might seek primary care in the ED instead of a federally qualified health center (FQHC), which are federally funded organizations that offer primary care and preventive services to vulnerable populations regardless of their ability to pay.

The reasons found for preferring the ED included no payment up front, multiple tests and providers seen in one visit, easy access via public transportation, and a perception of equal treatment because everyone must wait. The study notes that most of these reasons stem from system issues and should not be taken as a slight on FQHCs. The authors suggest that improving the communication between EDs and FQHCs can help make it easier for patients to use FQHCs for primary care.

In the meantime, as care coordination between EDs and FQHCs gradually improves, it would not be surprising if hospitals are seen as primary care providers of choice as the Affordable Care Act’s Medicaid expansion and insurance exchanges roll out. To accommodate the demand and survive financially, hospitals will have to become efficient and effective in treating patients. Currently, hospitals can ill afford to let ED visits turn into readmissions. As scrutiny of ED visits soon after discharge rises, the role of the ED will continue to evolve.