One in five Americans will visit the Emergency Room (ER) at least once a year — and many of these visits are unnecessary. According to the National Hospital Ambulatory Medical Care Survey, between one-third and one-half of all ER visits are for non-urgent matters.(1) Many of the conditions— ranging from upper respiratory infections to allergies or sprains — can be treated at urgent care centers. A recent review of the top 100 diagnosis codes from a self-insured employer revealed that 83 percent of them were in the top 100 diagnoses seen at a nearby urgent care center.
Unnecessary and inappropriate use of the ER causes multiple systemic issues and wastes scarce resources. The average cost for an ER visit is $1,233 — compared to $125 for an urgent care visit. Further, individuals that do not need to be in the ER, take time and attention away from those who are suffering from life threatening conditions. In the state of Hawai’i, ambulances must take a person to the ER. Even if, after being assessed, the person could be seen in an urgent care center.
Chronic conditions — which affect 45 percent of Americans — account for 75 percent of health care expenditures in the US. Diabetes, heart disease, asthma, and other chronic illnesses are also responsible for a large portion of ER visits. Asthma alone precipitated 1.8 million ER visits in 2004.(2) The ER visits resulting from unmanaged chronic conditions are avoidable. Proactive disease management, effective patient and caregiver education and simple lifestyle changes, can reduce ER usage for this group by up to 69%.(3)
Appropriate use of the ER could save the U.S. healthcare system more than $18 billion a year.(1) Patients with avoidable or non-urgent conditions who use urgent care centers, primary care physicians, or preventative care contribute significantly to creating a sustainable healthcare system.
Effective Execution of an ER Diversion Program
An effective ER diversion program begins and ends with consumer education. Effective education happens in relationships, requires engagement and consistency, and must be relevant to the consumer. Effective ER diversion programs are tailor made to the employee group and relevant to their life style. Three strategies to change the pattern of inappropriate use of the emergency room follow.
Education Campaigns: Tailor made strategies to reach the employee group and their families are designed and launched. Educational messaging creates an awareness of cost consciousness, reinforcing how to use urgent care, emergency room care and primary care. Those individuals with chronic illnesses are targeted for intervention before they use the emergency room. Educational campaigns are embedded in events relevant to the employees’ lives. Most importantly, campaigns leverage long standing trusted relationships in order to have the greatest impact in changing the behavior of inappropriate ER use.
Member Engagement through Incentives: It takes incentives to encourage members to participate in the solution of excess waste with the proper use of the ER services. In order to reinforce behavior change, a great way to keep people engaged is to provide incentives to employees who seek appropriate care, including gift cards, coupons, and vouchers for dining, entertainment, and other goods and services.
Data to Define the Initiatives: The final strategy involves using data analytics to establish a baseline reading of ER and urgent care use. This information guides initiatives revealing the hotspots for intervention. Data analytics measure the impact of initiatives and allow for adjustments as needed.
What’s In It for Members?
Members who participate in ER Diversion Programs by managing their health and seeking urgent care treatment instead of ER services (when appropriate) can expect to enjoy a number of benefits:
- Save Time: The average wait time in an emergency room in Hawaii is 125 minutes.(3) Whereas the national standard of urgent care centers is a door through door time of 45 minutes. Walk in patients receive high-quality treatment quickly and efficiently.
- Save Money: Compare the $125 price tag of an urgent care visit to the $1,233 price tag of the average ER visit. Even if a member’s insurance covers these costs completely, members learn that inappropriate use of the ER drives up the cost of healthcare and inevitably the consumer will pay for it.
- Avoid Stresses: Using an urgent care center when an illness or injury strike relieves the stress of handling an unscheduled crisis. When families have easy access to affordable, high-quality and convenient care when they need it, they go home happier and satisfied.
US Med’s goal is to decrease inappropriate use of the ER by 10% in 6 months. The long-term goal is to flatten the trend of rising ER costs. It is vital to measure the success in order to identify the strategies that have the biggest impact. Baseline data and trends are captured as the starting point. Using claims data, US Med analyzes usage by diagnosis code, procedure codes, zip code, primary care physicians or lack thereof, and other data points that indicate hotspots in usage.
Through member education, patient engagement, and data analysis, US Med’s ER Diversion Program reduces health care expenditures and promotes smarter health care use.
- America’s Debt Help Organization. Emergency Rooms vs. Urgent Care: Differences in Services and Costs http://www.debt.org/medical/emergency-room-urgent-care-costs/ Accessed December 11, 2014
- The Center for Managing Chronic Disease. Chronic Disease Statistics http://cmcd.sph.umich.edu/statistics.html Accessed December 11, 2014
- Health Management Associates. Chronic Disease Management:Evidence of Predictable Savings https://www.idph.state.ia.us/hcr_committees/common/pdf/clinicians/savings_report.pdf Accessed December 11, 2014