The Emergency Room — high cost of care

ER signPeople go the the ER but often do not get admitted to the hospital.  Why does this happen?  Do they think the problem is an emergency or do they just not have access to other health care?  The CDC presented the following data from 2011:
ER_1 ER_2 ER_3

(note respondents could answer yes to multiple items)

The bottom line:  people who go to the ER but do not get admitted do so because they think the problem is serious, but 80% also say they lack access to other providers.

Social factors often force the ER visit:

  • No primary care provider has been established
  • Primary care does not have enough walk-in capacity
  • In rural communities once the few primary care offices close there is no other alternative
  • Work hours force evening or night care for family members
  • ER is closer than other options
  • ER is more willing to see someone without insurance
  • Patients seek continuity of care once they have been seen at the ER — they return.

A not uncommon scenario is when a single parent picks up a child from day care only to find they are sick but doctor’s offices are closed.  And, the parent is expected back at work early in the morning.

Possible solutions:

  • Encourage urgent care or “community ER” clinics.  In many larger cities doctors or hospitals have opened urgent care clinics — they are not intended to provide continuity of care but just service when needed.  In the UK such clinics are often staffed by nurse practitioners.
  • Assign one provider in a primary care office to walk-in duty — thus increasing the capacity for unscheduled visits and allowing the other providers uninterrupted time to see scheduled patients.
  • Locate some primary care clinics with extended hours next to the ER.  The patients can see a primary care provider at a lower cost — but if the problem really is critical the ER is next door.
  • Use the phone more.  Also, use Skype since it is encrypted and should meet HIPPA guidelines.  Cost would be lower for everyone if health care providers made better use of technology.  Accountable care organizations (with less fee for service incentive) should find the lower cost aspect very attractive.
  • Provide more mobile care.  Some enterprising ambulance services provide service on location and don’t actually transport the patient to the ER.  Unfortunately, the overhead cost is rather high — but the same can be said for the ER in general.  It’s like the guy who comes to your driveway to replace a car windshield.  Instead, you might get a laceration sutured in your kitchen!  Or your child with a sore throat could be checked with a strep-screen.

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