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A new study--disputed by doctors--concludes that most ER visits aren't emergencies. Here, Peyton Wardlow,
Emergency rooms at Spotsylvania Regional Medical Center and other facilities are open if you need them.
Thelma Hayden is attended by (from left) Certified Nurse Assistant Charlotte Leach, Registered Nurse Karen Gardella and Nurse Practitioner Henri Perrotte (with Hayden's husband, Emmitt) at Spotsylvania Regional Medical Center's ER. |
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.
"Emergency room visits are some of the most expensive episodes in the healthcare industry," Anthem President C. Burke King said in a statement.
A patient with bronchitis, for example, paid an average of $646 to go to an ER, according to Anthem. The same visit cost $97 at an urgent care center and $54 at a retail clinic.
Average costs for all of the conditions studied were $441 for an ER visit, $98 for an urgent care center and $52 for a retail clinic, Anthem said.
"Hospitals see a lot of people who come into the ER that really don't need to be there," said Anthem spokesman Scott Golden. "It takes their time away from working with patients that really and truly do have emergencies."
NUMBERS EXAGGERATED
Critics, however, say that Anthem's numbers are exaggerated, and that its efforts to direct customers away from the ER are misdirected.
The American College of Emergency Physicians says the cost of emergency care represents only 3 percent of what the nation spends on health care.
And it says that most of the people who go to an ER need to be there.
Crane, the ER physician at Mary Washington, estimates that about 30 percent of its ER patients are there with minor illnesses or injuries, about half of what Anthem estimates.
"I think Anthem's number is way off," Crane said.
But even if a patient goes to the ER with what appears to be a minor problem, Crane said, the symptoms may mask something more serious. Vomiting could be an indication of a small-bowel obstruction, he said. Leg pain may be caused by blood clots.
"When patients present to the emergency department, once we run tests and do a complete work-up, the end diagnosis could be completely different," said Liz Smith, senior leader for emergency services at Spotsylvania Regional Medical Center.
And despite the wait and cost, going to an ER can make sense for some patients, officials said. Patients who do not have a doctor or who are unable to get in to see their doctor can see one in the ER at any hour.
"Patients are drawn to the ER to see a physician in a timely manner," Smith said.
In addition they can get needed lab and imaging tests while they're there.
"You leave here with all your results," Crane said. "In a way, you can't beat that level of convenience."
Jim Hall: 540/374-5433
Email: jhall@freelancestar.com
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