November 14, 2017

Avoidable ER—When should you go to Urgent Care?

The emergency room can be an overwhelming place. It’s crowded, doctors are running in and out of rooms and the waiting can be incredibly long and frustrating.

As a benefits manager, you know that emergency room (ER) visits can and will happen, but are your members educated on the differences between ER visits and urgent care? Do they know when to visit one or the other? Avoiding the ER can not only save the employee time and energy, but it will also save your organization in hefty benefits spending.

At Artemis, we help self-insured employers save money on their health insurance. Our Benefits Optimization Platform uses a number of proprietary data models to find wasted spending and identify areas for improvement in our customers’ benefits offerings. For this post, we’ll take a closer look at our Avoidable ER model and how we calculate which claims could have been treated else.

On average, employers using Artemis have spent 1.7 million dollars on avoidable ER visits. These visits are for conditions that are not life threatening and can be managed either in the urgent care office, with a primary care physician or using a telemedicine benefit.

Let’s take a look at the most common reason people go to the ER: abdominal pain.

Picture this, you wake up in the middle of the night with some stomach pain. You can’t keep anything down, so your first thought is food poisoning. You become a little nervous when your symptoms don’t subside after a few hours. You’re tempted to drive to the ER, bucket in hand, just to make sure it’s nothing serious.

Like a choose your own adventure story, you have two options: should you go to the ER or stay home?

If you chose the ER, you are not alone. In fact, according to the Centers for Disease Control and Prevention (CDC), abdominal pain is the single most common reason that American patients visit the ER, accounting for 7 million visits per year. If we look at our customer benefits data, we also see the same trend.

The ER is the place people think to go first because emergency rooms are open 24 hours a day.

However, urgent care, sometimes called “instacare,” also operates outside regular business hours, with some closing as late as nine or ten in the evening. They’re often open on the weekends, too.

The benefits of going to the urgent care is less time spent in the waiting room and more time spent seeing doctors. Co-pays are lower because urgent care centers can be billed similarly to a primary care visit. They can refill prescriptions, offer immunizations, treat infections like strep throat, and many have imaging and lab testing capabilities.

The CDC estimates that only 17% of all ER visits for abdominal pain are serious diagnoses, meaning they didn’t require immediate attention. This means that 83% of those people could have gone to urgent care or stayed home.

When educating employees about their benefits, use these tips to help them avoid costly ER visits:
  • Employees should ask themselves, "Is this life-threatening? Or am I just very uncomfortable?" The ER should be your primary choice if your condition may be life threatening. Common colds and flu symptoms, for example, can be treated in urgent care.
  • Encourage employees to check urgent care opening hours before they visit the ER. They might save themselves both time and money. Urgent care centers are usually open later than regular business hours, and some will post estimated wait times on their websites.  Patients may even have the option of placing themselves on an electronic waitlist, cutting the time spent in the waiting room.  
  • Telemedicine is another great tool to help reduce costs on expensive ER visits. With telemedicine, employees can speak to a physician on the phone or through a web chat, explain their symptoms, and get advice. Telemedicine doctors can prescribe medication or determine if the patient really should head to the ER, urgent care, or wait for a primary care visit.

Educating your employees on the benefits of alternatives to the ER can not only help control benefits spending, but it can also help your employees get cheaper, faster care.

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