Utilization of US emergency rooms has been rising for years; however, a good portion of the care received in ERs is non-emergent. In fact, the US spends around $60 billion a year on ER care, about 2% of the total $2.6 trillion spent on healthcare nationally, according to the Health Care Service Corporation (HCSC). HCSC 2013 claims data shows that roughly 50% of ER claims and 23% of ER claims payments for non-HMO members were for non-emergent care—equating to about 36,000 claims and more than $30 million in claims payments.
HCSC senior director Brian Swierczek says many people opt for the ER because they believe they have nowhere else to go or their medical problems are too serious for other care settings. "Moreover, patients know that ERs are designed to handle almost any issue, they are open at all hours and they are required by law to treat anyone who arrives at their doors, regardless of ability to pay," he says. "This inefficient use of the healthcare system drives up the cost of medical care, which ultimately impacts health insurance premiums, affecting the price we all pay for access to quality healthcare."
What providers can do
"Hospital administrators and other providers can aid in reducing the rate of non-emergent ER visits by continuing to play an active role in educating consumers on their healthcare options and the importance of having a primary care physician," says Swierczek.
Some of the things hospitals can do include offering educational brochures about alternative care settings during ER visits and partnering with local urgent care facilities, retail clinics and physician offices to offer educational materials and a spectrum of services. A new study from Accenture revealed that non-clinical "patient navigators" can help significantly reduce the overuse of emergency departments and even play a role in slowing readmissions.
At a University of Florida Health hospital in Gainesville, a clinic-based multidisciplinary team help cut frequent emergency department user visits dramatically. The resources included a social worker offering transportation assistance and access to resources like meetings with doctors and a clinical pharmacist for medication assessment. After intervention from the Care One Clinic, patients who were admitted more than eight times the previous year saw relative risk reductions of 22% for ED use, 30% for hospitalizations and 24% for days spent in the hospital.
"The more we have the entire healthcare system working together to educate the communities we serve, the better we all are in the long run," Swierczek says. "If patients can receive the same level of care in a primary care setting or a retail or urgent care clinic as they can in the ER at a lower cost with less time spent waiting, the patient and the entire health community will benefit."
A campaign to reduce unnecessary ER visits
HCSC recently launched a "Where You Go For Care Matters" campaign aimed at opening a dialogue with members on appropriate ER usage. "We recognized an opportunity to educate members on the options available when they require treatment and to provide tools to help with decision making," Swierczek says. "We offer information and advice about where to get appropriate care for dozens of common health conditions, ranging from minor cuts and scrapes to heart attacks and broken bones. We also give consumers information about the costs of visits and wait times, depending on the care setting."
The campaign began in January with pilot programs in Chicago and Houston. Members received materials by direct mail, to be followed by email communications and educational videos in the coming months. The program will be expanded in April to members in individual plans across five states.
Want to read more? You may enjoy this story about a simple method for reducing ED visits.