By Dennis Archambault
When the Patient Protection and Affordable Care Act became law, its detractors presented a litany of reasons it would fail. Among them: “You’ll never educate the expanded Medicaid population to stop using emergency services for primary care, chronic disease management, and minor injuries.” It was difficult to argue the point – in the short term. This area of behavior modification, coupled with health literacy, would require several years and a lot of support.
Until recently, hospitals had little incentive to prevent or redirect “avoidable” emergency visits. They were reimbursable and the volume was good for medical residency training programs. Emergency physicians and hospital administrators have long known that a large portion of emergency visits could and should be treated elsewhere. Despite assurances of being seen by a physician in many emergency departments, reasonably educated, insured people have increasingly selected urgent care as an alternative to the emergency visit and their busy primary care provider. But many people still think “E.R.” when they become sick or injured after hours.
Health insurers are being to scrutinize the “avoidable” treatment. As noted in a recent New York Times article (https://www.nytimes.com/2018/05/19/upshot/anthem-insurer-resists-paying-emergency-room-visits-if-avoidable.html) at least one has floated a trial balloon to get people talking about what is bound to occur in time. Some health systems, like the Detroit Medical Center, have tested the efficiency of primary care practices adjacent to emergency departments, for referral and ongoing care of patients with “avoidable” conditions. There is also a public health track within the Emergency Medicine Department of the Wayne State University School of Medicine to address chronically ill people whose care could be better managed in ambulatory setting.
The best way to avoid an emergency visit is to prevent injuries, manage chronic disease, and use an urgent care center if the primary care provider isn’t available. But when you’ve been using emergency services for much of your life, you’re not likely to change your behavior quickly – especially without support and incentives.
Dennis Archambault is vice president, Public Affairs, at Authority Health.