Reducing Preventable ER Visits

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February 10th, 2014

Preventable ER VisitsEmergency room visits and treatment account for approximately 2% of all US Healthcare spending. In an age where cost means everything and subsidized healthcare has become the nation’s crutch, this becomes an alarming figure. While ER visits have risen between 1995 and present day by almost 30%, more concern should be shifted towards the fact that a large amount of these visits are preventable. Preventable ER visits total approximately $14 billion USD a year.

What causes patients to choose the ER?

Many of today’s patients see the ER as its go-to source for emergency or rapid care services. As a result, use of the ER for non-urgent or preventable visits has become a common side effect. Patients seeking non-urgent care in the ER often end up there due to limited access to primary care. In fact, nearly 80% of adults aged 18-64 visited the ER in 2011 due to limited care from other providers, most notably Primary Care Physicians (PCPs).

From chronic illnesses to narcotic prescriptions, patients are abusing the ER now more than ever. To make matters worse, many PCPs are sending their patients to the ER due to the wide range of treatment options available and its convenience. This leads to costs driven up through unnecessary spending on treatments that may be preventable and creates a backlog of patients who truly need emergency care. To put it in perspective, the average cost of an ER visit is $580 more than the cost of an office visit to a PCP.

For the patient, this lack of continuity in their care plan can disturb treatment procedures while additional and unnecessary tests may disrupt and delay diagnosis. Unlike the patient’s PCP, ER physicians and staff do not have access to the patient’s treatment records and medical history. This can be the difference between treating the patient for a sore throat instead of picking up on a far more serious health condition.

How can we reduce preventable ER visits?

The solutions to reducing preventable ER visits remain vast. Many point towards coordinated care as the answer. A recent initiative was launched involving 15 organizations throughout the US, England, and Sweden working with the Institute of Healthcare Improvement. The initiative is geared towards developing models of care that hope to reduce preventable ER visits and unnecessary hospital admissions or readmissions.

Coupled with utilizing electronic medical records, offering patients individualized care plans and collaborating with primary care physicians, even during follow-up care, has seen almost a 31 percent reduction to preventable ER visits. The initiative hopes to see its model become the standard for primary care and ultimately rid the reliance patients have on costlier alternatives like the ER.

Further solutions that have been effective involve educating patients on the role of the ER and offering a number of cheaper and easily accessible alternatives to visiting their PCP.

For example, 24-hour access to nurse of physician operated phone lines have seen reductions in preventable ER visits and net savings of nearly $400,000 in the areas they serve.

Other alternatives and programs that have proven successful include case management programs, payment regulations such as higher copays for ER visits and group treatments for patients with the same chronic illness.

The fact remains that too many patients are visiting the ER for unnecessary treatment and it will continue to drive healthcare spending through the roof – especially with federal subsidies taking on a larger financial role in the industry.

Only time will tell if the programs and initiatives already in place to reduce preventable ER visits will have a long term effect. In the mean time patients, providers and payers must make the extra effort to be conscious of the ER’s role in the healthcare landscape and seek alternative and cheaper options for treatment.

To find out more on the roles of patients, providers and payers in reducing preventable ER visits, subscribe to our monthly Health Insights newsletter here.


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