The world of healthcare is a constantly evolving one, and several unsettling trends have emerged so far in 2016. Healthcare costs are increasing and customers are struggling to figure out why as their wallets are consistently empty. More and more large medical and pharmaceutical brands are linking together to bump out smaller competitors. These smaller medical facilities then have to pay more than the big fish to offer the same healthcare for customers. Patients are also flooding hospital emergency rooms. ER usage is much higher than usual. According to a poll completed by 2,098 medical professionals for the American College of Emergency Physicians, 47 percent of doctors believe that ER overuse rates have become only slightly worse while 28 percent believe that they’ve become much worse. Many believe that those numbers will only increase unless this problem is stopped.

One interesting reason behind Overuse of ER

Mostly young adults who are busy in their daily lives are visiting the ER to save time. They are visiting the ER for simple checkups because it is convenient and easy to skip waiting periods with minimal co-pay. As a result, they take up valuable space in the ER.

This behavior costs a hospital in many ways. Doctors and nurses have to provide space and service to these patients even though their conditions are often not serious. These patients end up hogging precious time and resources. Some hospital employees and employers may not even be aware how much ER overuse is costing them.

More important than even money is how ER overuse affects overall health and wellbeing. Those who are sent to the emergency room often have a serious or life-threatening injury or illness. If a patient checks in with a case of the sniffles because they can’t find a doctor that accepts their health insurance, they’re preventing those who really need care from getting it. This can lead to more health maladies and even more deaths.

How It Got to This Point?

Minimal co-pay does not incent patients to pay close attention on the cost of  ER and the benefit. Also, a surprising decline in primary care physicians. According to government statistics, by 2020, there will be an estimated 20,000 physicians. That’s a very low number, especially when you compare Health Affairs data that reports that there were nearly 460,000 physicians in 1980 and 780,000 in 2000. When you consider the amount of doctors who accept health insurance plans like Medicaid, the number drops even lower, giving these patients seemingly no options.

Case in Point

Let’s take an example of one of our clients, 39% of those who visited the ER more than 2 times this past year did not have their recommended preventive medical exams. Educating the employees and having an effective outreach program can substantially reduce these “non-well” visits to the ER.

Through our data, we have seen that the top conditions that are presented for an otherwise avoidable ER visit can easily be treated in an outpatient clinic. When you are able to categorize the members that have overused ER services, you will be able to formulate solutions to correct the problem.

Times When ER Visits Can Be Avoided

There are plenty of times when it’s best to see a doctor instead of going to the ER. For example, a patient with certain medical conditions like diabetes, asthma, heart disease, arthritis, osteoporosis, cystic fibrosis, and other chronic conditions will have to take special care to keep their symptoms under control. Even if these symptoms aren’t managed and a patient’s health declines, this is still considered a non-emergency situation in most cases and one that can be handled by a primary care physician instead of hospital staff.

A stay at the hospital is more expensive than a doctor’s visit. The Robert Wood Johnson Foundation found it costs approximately $580 more in a 2013 study. Unless it’s an emergency situation, there’s no need to go to the ER. Emergency situations include:

  • Nonstop bleeding
  • Serious injuries
  • Lengthy seizures
  • Overdoses
  • Poisoning
The Solution

Many hospitals can barely handle the increase of patient volume now and may be overwhelmed and understaffed if this ER overuse continues. Luckily, corrective measures are relatively simple to put into place:

  • Implement preventative and condition management programs and ensure engagement in these programs. This will ensure better on-going care and avoid unnecessary ER visits.
  • Increase the ER usage copay to an optimal level to deter people from using it for non-emergency usage.
  • Provide other convenient alternatives such as on-site clinics, urgent care, after-hour PCP access or an alternate contract with PCPs to get better access and care.
  • Provide easier means for members on the plan to schedule time with their PCPs easily using technology or contract arrangements

Overall, by enacting the above measures, hospital staff can expect to save money, reducing the $18 billion annually that’s spent on patients misusing the ER.

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