A headache. A sudden spat of soreness. Bronchitis. Pink eye.
For those in need of immediate care for a health condition, the closest emergency room can seem like the first and best option. But healthcare professionals are starting to think twice about that and Home Care Aides (HCAs) should, too.
New data show that the tendency to choose the ER over local Urgent Care centers costs patients and insurance networks millions of dollars. More importantly, many conditions may also be treated better and faster at your Primary Care Provider or Urgent Care.
Less personal care and higher costs to patients are just some of the pitfalls of an unnecessary ER visit.
Headaches, common colds, back pain, and urinary tract infections are the most common reasons patients go to the ER when an Urgent Care or doctor visit would be a better option, and less expensive. This wasteful cost is pushed on to patients.
WHY WE GO TO THE ER
Did you know more people visit the ER for a cold than for a broken leg? According to Group Health, 1 in 2 HCAs who visit the ER do not need to be there.
When a sudden injury or illness happens, going to the ER is often our first instinct. You might have a bad cough that won’t stop at 3 a.m. or a back injury and the closest medical center is an emergency room. For some in rural parts of the state, an emergency room might be the only option available.
John Gallagher, director of communications and development for Washington Health Alliance, uses data from insurance claims to take action on wasteful trends in healthcare. Gallagher remembers a recent painful injury where he had to decide where to go for care.
“This past January, on a Saturday, I developed sciatica,” he says. “Horrible pain. Unrelenting pain. I could’ve gone to the ER, where they would do some imaging, or conduct some tests that would lead to more tests. Instead, I went to Urgent Care and was diagnosed fairly quickly.”
Gallagher now wants to help others make the best decision for their own care. “I feel fortunate that I knew what was happening to me, and I knew that the ER probably wasn’t going to make it any better—just more expensive.”
FINDING OTHER OPTIONS
While the ER may be open late and the closest option, a little bit of planning can help you dodge that $200 copay bill when the need arises.
Marissa Brooks, SEIU Healthcare NW Health Benefits Trust’s director of Engaged Sponsorship, sees the opportunity for how Home Care Aides use emergency rooms.
Brooks and her colleagues are working to share this information with HCAs across the state. “E-mails. Postcards. Pretty much everywhere HCAs go to get information about healthcare, we engage them about the importance of making the right choice.”
When a member visits the ER for something that could be better treated elsewhere, the Health Benefits Trust sends the member a postcard reminding them of other options. Brooks reminds us that people with threatening and debilitating issues such as compound fractures, severe burns, and uncontrollable bleeding are always advised to visit the ER.
But Urgent Care or Primary Care Providers can best treat allergies, migraines, and sore throats, where the insurance copay will only be $15 (Group Health) or $30 (Kaiser Permanente), rather than $200 for the ER.
There is also a 24-hour nurse consultant line that HCAs can call for advice about what action to take.
“This is an issue that costs members millions of dollars in unnecessary claims,” Brooks says. “And it costs the HCA $200 out-of-pocket to go to the ER, when the majority of the symptoms that lead people to go there can be treated elsewhere.”
But if we find the best places to get care instead of the ER, it could result in a savings of at least $13 million annually in the Puget Sound region and bring costs down for all HCAs in our community.
Find your nearest Urgent Care Center today:
Group Health members, find a Primary Care Provider here and your nearest Urgent Care here.
Or call the 24-hour consulting nurse line:
- Seattle area: 206-901-2244
- WA State: 1-800-297-6877
Kaiser Permanente members, find a Primary Care Provider here and your nearest Urgent Care here.
Or call the 24-hour consulting nurse line at 1-800-813-2000.
For other types of plan members, check your carrier’s website for provider and Urgent Care information. Thank you for taking the Emergey Room vs Urgent Care Quiz!
