Many ER Visits Unnecessary

Trips to the hospital driving up the cost of health care and premiums.

Eric Spangler

It’s a growing problem that is costing employers and employees money.

That problem is patients are going to a hospital’s emergency room when they could be receiving care for noncritical ailments at more appropriate—and less expensive—settings, says Jeff Blunt, director of public relations for Anthem Blue Cross and Blue Shield.

Those settings for noncritical ailments include a primary care physician’s office, an urgent care facility, a health-care clinic in a retail location or even communicating with a physician from home via a computer or tablet, he says.

Dr. Barry Malinowski, Anthem Blue Cross and Blue Shield’s medical director, says, “Two-thirds of emergency room visits could have been handled, very easily, by a primary care doctor.” And patients can generally get better quality care by visiting a primary care physician, he says.

That’s because a primary care physician already knows which medicines a patient is taking—and should not be taking—and what tests have been run on a patient, says Malinowski. “So you go to an emergency room and often you get … tests that are, frankly, inappropriately repeated,” he says.

So how much more is it to visit a hospital’s emergency room than other health-care settings? Blunt says the average emergency room visit is a little over $1,200. “An urgent care visit, by contrast, is a little under $200,” he says. “There’s a six-fold differential there.”

A visit to a primary care physician costs an average of $120, a visit to a health-care clinic in a retail location, like The Little Clinic, costs an average of $85 and getting a diagnosis from a physician over a computer or tablet connection costs about $49, says Blunt.

And more employers are realizing that inappropriate visits to the emergency room are one of the reasons health care and premiums are rising, says Malinowski. Anthem is encouraging employers to be more proactive in training employees on when it is appropriate, and not appropriate, to visit an emergency room vs. another health-care setting, he says.

“People are going to emergency rooms for things like earaches when they could get instant care from their home without having to leave the comfort of their home for $49 vs. driving to an emergency room, waiting six hours and then getting in to see a doctor and paying $1,200,” Blunt says.

The use of telemedicine— getting a diagnosis from a physician over a computer or tablet connection—is becoming more popular, especially with the younger generations, says Malinowski. “Once people start using it it’s like they really like it,” he says. “It’s a much more … convenient way and cost effective way of handling your problem.”

The key is knowing where to go for health care before the need arrives, says Blunt. “It truly is an education around the spectrum of care and encouraging employees to learn those care options and be aware of them before they get into an urgent care emergency sort of situation,” he says.

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