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Debate swirls over ER usage Anthem says a majority of its customers who use the ER don't belong there; others disagree Date published: 8/8/2010
BY JIM HALL More than 60 percent of people who go to an emergency room don't belong there, according to a new study by Anthem Blue Cross and Blue Shield. Virginia's largest health insurance company says many of its customers could go instead to an urgent care center, retail clinic or walk-in doctor's office, where comparable care is cheaper and usually quicker. The insurance giant is starting a campaign in Virginia to educate its customers about "avoidable" ER visits. The company has placed a mapping program on its website that shows where these centers are located. If successful, the pilot project will be used nationwide, the company says. But local hospital officials dispute Anthem's findings and say that the insurance company has the luxury of hindsight when deciding whether an ER visit is appropriate. "It's easy to look back on a visit and say that was an avoidable [ER] visit. It's really difficult to proactively tell," said Dr. Jody Crane, an ER doctor and leader at the physician practice that staffs Mary Washington Healthcare's three emergency rooms. ER CARE IS EXPENSIVE Anthem's effort to direct its customers away from the ER comes at a time of rising health care costs and the start of a new national health care system that could bring even more people to the ER. Emergency rooms across the country are already swamped with patients, more than 300,000 a day, according to the American College of Emergency Physicians. Demand is up by almost a third over the past decade, according to the association. In the Fredericksburg region, Mary Washington Healthcare's three emergency rooms--Mary Washington Hospital, Stafford Hospital and the Freestanding Emergency Department at Massaponax--recorded more than 140,000 patient visits last year, Crane said. In addition, the emergency room at Spotsylvania Regional Medical Center has treated about 4,000 patients since it opened in June, said Tim Tobin, president and CEO. Anthem said last month that it has studied its claims data in Virginia and found that many of these ER visits were unnecessary. The company lists 16 diagnoses--cough, sore throat and stitches, for example--that show up frequently in the data and could have been treated at other types of walk-in centers. As a result, the company's costs are higher than they would be otherwise, and its customers are paying more in out-of-pocket expenses, it said.
Read more stories about Fredericksburg Date published: 8/8/2010
To show how many of the people that don't belong in the ER, also don't belong in the United States.
folks with insurance are guided to call their insurance company before going to the ER. In my experience, we've never been told not to go, because each experience included either severe headache, abdominal pain, or tingling arm sensations, all occurring in the night. Who (insured) would want to go to the ER during the day if he/she can go to the doc and/or go to an urgent care facility. WHO (insured) would want to go to ER if it really wasn't an EMERGENCY???
Let me help you out. Yes, Anthem has an agenda. They're a business, and as such they have 2 basic goals. 1. To provide a good or service to their customers based on the demand for them. 2. Make enough money to cover their costs, plus a margin of profit that is supported by the market's supply and demand environment. Show me a business that isn't making a profit, and I'll show you a failing business. Of course they're going to do cost analysis studies. If it was your business, wouldn't you want to know?
You can be sure they don;t have any agenda, right?
It is dead...they just don't know it yet. Just wait until the judges get done.
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