Unfortunately, many people have not planned ahead for what to do when an urgent medical situation arises. Awareness of options like telehealth, retail and urgent care clinics, and understanding the types of conditions that are appropriately evaluated and treated in each of these settings can lead to better choices of where to seek care in an emergency.
Use of the emergency room (ER) for services that could be provided in a lower-cost setting is often portrayed as an issue related to being uninsured or under-insured. But, a 2018 study estimated that there are 18 million avoidable emergency room visits annually that result in $32 billion in additional costs to the healthcare system among commercially insured individuals.1 Our Employee Health Trends 2021 report showed a decrease in the rate of ER visits for common conditions that can generally be treated in a less costly setting during the first nine months of 2020 compared with 2019.
Following an initial 67% decrease in the rate of these visits at the start of the pandemic (April 2020), year-over-year rates continued to be over 30% lower in the fall. While this is great news, we need to ensure that these rates continue to decrease as the pandemic resolves.
A recent report in the New York Times documented how an ER in Greenwich Village charged patients over $3,000 for COVID-19 testing – about 30 times greater than what is typically charged. While this example is more extreme than most, we found that the cost of an ER visit is substantially higher than an office or urgent care visit for the same condition.
Springbuk 2020 data in the table below shows differences in median cost using net payment by site of service for several common conditions that can generally be treated in an office or urgent care setting.
But cost is not the only issue. Patients are likely to benefit from receiving care from their primary care physician (PCP) when feasible. PCPs are more aware of a patient’s complete medical history, including allergies and medications. Because of this, they can assess the patient’s current symptoms in the context of known issues and may be less likely to prescribe medications that may adversely interact with current medications.
Over 90% of ERs report issues with overcrowding. While much of the problem is due to boarding individuals in the ER while waiting for open hospital beds, avoidable ER visits also contribute to the issue.2 Because this overcrowding is associated with poorer outcomes for the most emergent patients and more medical errors, it’s in everyone’s best interest to reduce unnecessary ER use.
Studies performed to understand why individuals choose to receive care in the emergency room for issues that could be treated in less costly settings have uncovered several factors that influence these decisions.3-6 Among those with commercial insurance, common reasons include:
Understanding why employees and their family members seek care in the emergency room informs strategies to reduce unnecessary use of the ER.
Springbuk’s health data analytics platform enables you to determine conditions driving emergency room use. We also help identify individuals and conditions responsible for avoidable or preventable emergency room use, individuals with frequent ER visits, and track the impact of programs you implement with a few clicks.
Understand recent use - Springbuk Answers allows you to track emergency use rates compared with a benchmark and to quickly identify diagnoses responsible for the most ER visits or spending.
Create strategies based on drivers of preventable ER visits – Assessing different categories of potentially avoidable ER visits, including visits for flare-ups of chronic conditions, non-emergent conditions, or acute conditions that could be treated in a primary care setting will inform best strategies to reduce these visits. Frequent ER users can be targeted for personalized education.
Understand the impact of strategies you employ - Springbuk Timeline is a unique feature that allows you to keep track of implemented strategies and visualize impact.
Most unnecessary use of the ER by commercially insured individuals is due to an inability to assess the seriousness of their condition and lack of knowledge about the capabilities of less costly care settings. Educating employees and encouraging them to plan in advance for the potential of an emergency are strategies that will result in better choices for treatment. Springbuk can help you identify avoidable ER visits and monitor impact of strategies to reduce them.
Or, read the posts in this series on trends:
4Coster JE, Turner JK, Bradbury D, Cantrell A. Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis. Acad Emerg Med. 2017;24(9):1137-1149. doi:10.1111/acem.13220
5Vogel JA, Rising KL, Jones J, Bowden ML, Ginde AA, Havranek EP. Reasons Patients Choose the Emergency Department over Primary Care: a Qualitative Metasynthesis. J Gen Intern Med. 2019;34(11):2610-2619. doi:10.1007/s11606-019-05128-x