The emergency room is the only place to go for a sudden and life-threatening medical event, such as heart attack, stroke or serious injury. But the ER waiting area can often be filled with patients seeking treatment for more common medical needs such as low-grade fevers, earaches, minor sprains, cuts or broken toes – particularly during off-hours or on weekends when primary care physicians may be off-duty.
ER visits have been on the rise for some time, but with the average bill for a visit to the ER in the U.S. currently at $2,168 (as reported by a National Institutes of Health-funded study) – and with charges for the most typical diagnoses ranging from just over $1,000 for a respiratory infection to more than $4,000 for kidney stones – the ER may not be the most affordable option. So in some cases, it might make sense to think twice before rushing to the hospital.
A study by the Network for Excellence in Health Innovation found that 56 percent of ER visits across the U.S. are classified as “non-urgent,” and a study conducted in Massachusetts found a similar avoidable rate of 50 percent.
What is considered a non-urgent visit? Examples, according to the NEHI report, are when patients go to the ER seeking treatment for minor illnesses, for acute events associated with an underlying chronic condition (such as an asthma attack), or for mental health or substance abuse-related issues.
Impact of overuse
The economic impact of unnecessary emergency department use is significant. The cost of an ER visit is, on average, $580 more than the cost of a regular doctor’s office visit, according to the NEHI, and emergency department overuse is responsible for $38 billion in wasteful spending each year.
ER overuse can also affect the quality of health care delivery. Waiting rooms can become overcrowded, and when patients repeatedly visit the ER rather than a primary care physician, they may see different providers each time, which can affect continuity of care.
“Crowding, long waits, and added stress on staff take away from patients in need of true emergency care,” the NEHI study states.
The National Quality Forum, which argues that increasing access to primary care can reduce ER overuse, recommends a variety of improvement measures such as expanded weekend hours, telephone consultation and triage lines, and access to alternatives such as urgent care facilities and retail clinics.
Blue Cross Blue Shield of Massachusetts, which provides health insurance plans to many MIIA members, offers a free, 24-hour nurse line that patients may call to describe their symptoms and receive professional recommendations on whether to see a doctor, go to the ER, or implement self-care at home. BCBSMA also offers co-payment programs for visits to retail and urgent care clinics when appropriate.
Educating employees about when and how to seek care responsibly can potentially help control municipal costs related to ER overuse.
The Medline Plus web portal (www.nlm.nih.gov/medlineplus), operated by the U.S. National Library of Medicine, offers patient guidelines for when to use an emergency room or call 911 – for both adults and children. For example, the guidelines advise calling 911 for choking or severe burns, and going to the ER for severe chest pain and pressure.
For its health plan members, Blue Cross Blue Shield of Massachusetts provides a simple chart outlining how to decide the right place to seek care for a variety of conditions. For example, call the nurse line in case of fever or cuts; visit a retail clinic for flu-like symptoms; or go immediately to the ER when a heart attack is suspected.
MIIA can work with member municipalities to conduct “consumerism” sessions that help train managers and employees regarding ER alternatives. MIIA can also provide tailored wellness programs designed to have a positive impact on the health of employees while reducing overall health care costs.
A recent, MIIA-run “Well Power” initiative conducted in Amesbury over a two-year period (which included free programs for employees focusing on cardiovascular health, weight loss, tobacco cessation, nutrition, and exercise) resulted in a 23 percent decrease in ER admissions and a 38 percent decrease in ER expenditures.