Timely & Efficient care
Posted By: Lisa Harmon 
Date Posted: March 25th, 2010 Category: Cost & Quality
Emergency rooms are filled with people who could & should be seen in urgent care centers or their Doctor’s offices, this makes the real emergencies wait much longer than is necessary. Maybe we should have “Urgent care” areas affixed to the hospitals since this is where most patients tend to go. Triage could then have patients go to the appropriate site.
Comment By: Craig Stevens
Date & Time: March 26, 2010 at 6:56 am
And how will it work now that 30 million more are coming with no plans for expanded services or infrastructure?
Comment By: Jason Vander Weele
Date & Time: March 26, 2010 at 11:02 am
We should be careful arguing that the 30 million people who were not covered by insurance were not using services. I'd imagine many of them were going to the ER with any sort of problem, and often when the problem was as bad as it could get. I'd imagine that being afforded health coverage will allow a good portion of the 30 million to utilize non-emergency services, and in much earlier stages of problems.
And if my intuition is correct, I imagine that emergency room visits are much more costly to health providers and agencies than non-emergency visits.
I think that agencies will adjust based on supply and demand, whether people are going to emergency rooms or urgent care facilities. They will have the right workers in the right place to account for any differences in usage.
Comment By: Tiffany Sewell
Date & Time: March 26, 2010 at 2:23 pm
Jason, that's an excellent point – and given the amount of $$$ hospitals spend on charity/uncompensated care, I agree with you that many of the uninsured were going to the ER simply because that was the only option available to them. If we can insure these folks and provide access to preventative care, I think those types of visits to the ER would decrease.
Comment By: Craig Stevens
Date & Time: March 26, 2010 at 2:49 pm
Tiffany can you help me with any evidence that that will be true?
Comment By: Tiffany Sewell
Date & Time: March 26, 2010 at 3:15 pm
Point #1 – the uninsured are already utilizing the ED:
Dept of Health and Human Services Press Release dated 07/15/2009
"These data indicate that uninsured persons accounted for nearly one-fifth of the 120 million hospital-based emergency department visits in 2006."
Comment By: Tiffany Sewell
Date & Time: March 26, 2010 at 3:16 pm
Point #2 – "inappropriate" use of ERs is due, in part, to lack of a primary care provider:
Nursing Economics, Jan-Feb 1997, "Analysis of emergency room use for primary care needs"
"Inappropriate use of emergency services is inefficient, costly, and wasteful for the patients, the payers, and the delivery system. Nevertheless, it is well documented that emergency rooms are over-used for nonurgent health needs that could be more appropriately addressed in a primary care setting. . . Reasons for ER use for nonurgent care include erroneous self-perception of severity of ailment or injury, 24-hour open-door policy of ERs, convenience, and lack of primary care provider (Liggins, 1993)."
Comment By: Tiffany Sewell
Date & Time: March 26, 2010 at 3:17 pm
Point #3 – when individuals have a primary care provider, their number of visits to the ER drops:
Health Care Financing Review, Spring 1991, "A public health model of Medicaid emergency room use"
"The major finding was that ER visits are negatively associated with primary care visits among the combined total of AFDC, HR, and MA-only recipients in the counties of upstate New York."
Comment By: Tiffany Sewell
Date & Time: March 26, 2010 at 3:17 pm
Taking points 2 and 3: lack of a primary care provider leads to increased "inappropriate" visits to the ED. It stands to reason, then, that having a primary care provider would lead to a decrease in "inappropriate" ED usage.
Comment By: Craig Stevens
Date & Time: March 26, 2010 at 3:22 pm
lol. Ask and you shall receive. Tiffany I guess I'll think twice before asking you for documentation. In the meantime I guess I got some readin' to do.
Comment By: Mary Roney
Date & Time: June 11, 2010 at 12:55 pm
I was one of those people who had to use the ER as a Doctors office. I hated to do it, but I had no choice. I had an absecse tooth, my face swelled up like a grapefruit.I was hurting so bad I was up all night. I hated to got to the ER, because I felt I was taking away from more important things. That brings me to another story. I suffer from chronic pain, I was almost excited to find a clinic that goes by your pay. At the time I was unemployed, so it was only going to cost me $10.00. I was soooo releived to find this place. Geuss what about a week before my appointment, they called to cancel.They said the Doctor had quit……….My guess is he was not making enough money!!!! Any more it is all about the money,they do not do it because they care about people.Doctors and Insurance companies are making so much money !!!!! While we SUFFER !!!