Patients without Patience – Are ERs Taking Advantage?

| | Utilization Review

Emergency Room wait times
With opportunistic business models and aggressive marketing plans, free-standing emergency rooms (ERs) are opening in large numbers. At the same time, hospital ERs are capitalizing on today’s consumer – a consumer no longer content to wait for anything, including healthcare.

Primary care physicians are a diminishing specialty and carry high patient loads. When they can’t make same or next-day appointments they tell their patients that if they feel they need to be seen right away they will need to go to the ER. What does this say about the condition of many patients in the ER?  How many triaged patients at an ER are not emergencies? Or should we ask, “what is an emergency?”

Onslaught of advertising to medical consumers
To be sure, free-standing ERs have saved lives and delivered babies, sometimes in situations where the patient did not have time to get to a hospital. But with advertising campaigns emphasizing the no-wait feature, many believe these ERs are creating and distorting demand.

Advertisements with a laser focus on no-wait beg the question, are ERs misleading people to come to them for minor emergencies and then charging emergency room prices? Notice the use of “mini” emergency from a hospital’s website:
MINI EMERGENCY? “We understand that some emergencies are more like mini emergencies (emphasis added). Reduce your wait in the Emergency Room by choosing a scheduled arrival time below. You’ll be seen by a healthcare professional within 15 minutes of it.”

Licensure as an ER comes with high overhead costs when compared to urgent care licensure. So free-standing ERs need to charge emergency room prices, even when treating minor emergencies.

A full page ad for another hospital system shows a stopwatch along with a map – a map to all the locations of their area hospital ERs, free-standing ERs, and to their credit, urgent care centers. The headline is “Quality Care Quicker.”

Free-standing ERs look like urgent care centers and are situated in the same types of settings typically occupied by urgent care centers. This confuses medical consumers who may think they are visiting an urgent care or “minor emergency” center. Is the location a coincidence?

A sense of urgency may not equal an emergency
Is there a difference between an emergency and a life-threatening emergency? Maybe. When I worked for Austin EMS, we observed a clear difference. On a Code One, we drove with no lights or sirens and stopped at the red lights. On a Code Three, we blasted through intersections, and traffic parted to let us through. Why, on a Code One, would someone need an ambulance?

The sense of urgency a person feels may be different from the treatment the patient needs. A dispatcher understands the difference in those scenarios, and so does the triage nurse at an ER.

The conflict we have is that a patient’s “lights and sirens” may be very different than the medical definition, and patients are easily attracted to “Quality Care Quicker.”

What does this have to do with the UR Nation?
Treatment on the day of an injury may be necessary, but the setting may be unnecessary. Visits to an ER when an urgent care center is more appropriate unnecessarily increase the cost of a claim. The group health system can mitigate this behavior with higher copays in an ER ($250 or more) versus in urgent care (around $50), hoping patients will self-select appropriately.

Fast forward to treatment long after the date of the injury – no lights, no sirens, no emergency and typically no urgency. Non-emergency care such as an MRI, or even now opioid drugs, requires utilization review in many states. So when does non-emergency care performed in an emergency setting require UR?

Freestanding ERs are popping up in every corner. I think they may have taken a page out of Walgreen’s model. Cork Walgreen III re-positioned Walgreens to become “the most convenient drug store.” He wanted every person to be able to think of a Walgreen’s location in every direction when leaving their neighborhood.

Convenient ERs are easing the burden of overcrowded trauma centers and increasing patient satisfaction with reduced wait times – but at what cost? With easy access to “Quality Care Quicker,” we need to watch the impact of this opportunistic business model to ensure we don’t see unnecessary treatment disguised by the setting.

Lisa Hannusch

Lisa Hannusch is CEO of UniMed Direct and founder of UR Nation. With experience in virtually every aspect of workers' compensation medical management, she is a nationally recognized authority on effectively managing utilization and medical claim issues. Lisa has direct experience as a healthcare provider, has conducted healthcare fraud investigations leading to prosecution, designed claims and medical software applications, and has worked as an insurance regulator and state agency rule and guideline author. She was an influential leader for requiring evidence-based medical determinations. At UniMed Direct, Lisa has built an industry leading managed care company specializing in ReviewStat – a leader in hosted medical management software, supported with services for UR and a national independent Peer Review Panel.