Bending the Cost Curve: ER Overuse

NEHI (New England health Institute) recently published a paper outlining the results of their research that not only points out $700 Billion in needless health care spending annually, but offer solutions to health care providers and the consuming public on how to reverse this trend.

$38 billion is attributed to overuse of ER departments.   This translates to 56 percent of all emergency room visits. This particular assertion hit home for me as a long time insurance agent because it has always been our number one customer service call.  Insureds looking for payment on $1,500 to $5,000 non emergency services rendered by the emergency room. Of course the study isn’t concerned with the bill getting paid but about eliminating the charge completely from the annual national health care expenditure.

The problem is that patients don’t understand the cost.  Even if you are simply using the ER for an ear infection, you are incurring an average charge that is $580 over the cost of the a normal office visit.   The study found that use of the ER for non emergency purposes spreads across all age groups regardless of the level or type of insurance. 

Patients admit they use the emergency room because it is a place to receive immediate care, instant access to all diagnostic tests and feedback before you leave the building.  This instant reassurance isn’t something you can get in one office visit.  The solution hovers around addressed those points.  That is why we see Urgent Care offices popping up in close vicinity to ERs.   Even markets and pharmacies are opening walk in clinics.  Insurance companies offering 24 hour nurse lines are standard but perhaps not used enough.   Even Doctors On Call, allowing phone access to a doctor 24 hours a day has become a popular part of our product line.  The alternatives are there, educatingthe public on the problem, it’s costs, and the solutions are the task everyone can work on now.

Emergency rooms are expensive to setup and and maintain.  They are full of expensive equipment and personel and done so based on expanding demand for services.  Once you hit the emergency room, defensive medicine is going to push those expensive assets into use.  Until the public gets involved and recognizes how society as a whole is pushing up the health care bill, prices aren’t going down anytime soon.

About Paula L Wilson, RHU, REBC

Insurance and Employee Benefits, business owner, wife, mother, grandmother. Specializing in Employee Benefits, Personal Life, Disability and Long Term Care Insurance. Registered Health Underwriter, Registered Employee Benefit Consultant, Past President Orange County Association of Health Underwriters 1991, Past Vice President California Association of Health Underwriters, Past Legislative Chair of the National Association of Health Underwriters. Recipient of the Provencio Award for Excellence and Leading Producer Roundtable Award Recipient View all posts by Paula L Wilson, RHU, REBC

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