How to Solve the E.R. Problem

I have a lot of respect for Dr. Ezekiel J. Emanuel even though I never met the man. He helped design Obamacare, but his views on health care issues are practical, honest and display common sense not typical of naive policy makers. Here is another example with regard to use of emergency rooms. 

Obamacare promised lower ER use as a result of expanded coverage and expanded Medicaid. So far anecdotal info from ER physicians indicate the opposite result. Inappropriate use of the ER has always been a problem even among those with health insurance. The typical employer plan has long applied special co-pays on ER visits unless the visit resulted in hospital admission. 

Patients without health insurance are used to using the ER and its a hard habit to break. Today with the expansion of urgent care centers, there are viable alternatives. 

Dr Emanuel has an article in the NYT explaining all that is necessary to reduce unnecessary ER visits beyond simply providing health insurance coverage. I urge you to read the full article.

Here is the essence of his strategy as related to the experience of one plan. As usual, the right incentives accompanied by communications are the keys to success. 

First, it offers a $100 cash incentive if workers complete four steps. The steps evolve each year but have included signing up for MyGroupHealth, an online platform where workers can email doctors, order prescriptions, and access health information and self-help resources; completing a “health risk assessment,” a tool commonly used in corporate wellness programs; and completing preventive primary care and dental appointments.

Second, it increased the co-pay for an emergency room visit to $200, while the out-of-pocket charge for an urgent care visit remained at just $15.

Third, it introduced a “Care Begins With You” social media campaign to educate workers about the proper use of the emergency room. The campaign includes a short video that workers view as part of their re-certification process. It reinforces the co-pay information and explains the differences between urgent care and emergency room care. Urgent care is the place to go for coughs, headaches and back pain, while the emergency room should be reserved for life-threatening conditions, like crushing chest pain.

Finally, the partnership took steps to remind workers of the locations and hours of urgent care centers, how to schedule appointments there and with primary care doctors, as well as about Group Health’s 24-hour consulting nurse advice line. Group Health also started a case management program to provide individual support to people who still used the emergency room more than five times in a 12-month period.

via How to Solve the E.R. Problem – NYTimes.com

Ezekiel J. Emanuel, an oncologist and former White House adviser, is a vice provost and professor at the University of Pennsylvania. He is a contributing opinion writer for The New York Times on a range of topics including health and health policy.