Patients Increasingly Spelling Primary Care ‘E.R.’

By Gillentine, Amy

As it becomes harder to schedule an appointment with a primary care physician, more people are turning to the emergency room for routine treatment — and those visits are driving up health care costs, creating long waiting times and tying up resources.

And it isn’t just the uninsured or medically indigent who visit emergency rooms to treat a cold or a cough. The Annals of Emergency Medicine studied the problem and found that the percentage of emergency room visits by high-income patients increased from 21.9 percent during 1996 to 29 percent during 2004.

“It doesn’t matter what their income is, or if they have insurance,” said Venita Pine, director of nursing at Peak Vista. “Everyone is using the emergency department in ways that drive up costs.”

Teri Mandell, director of emergency services at Penrose-St. Francis Health Center said one reason for the increase in emergency room visits is that patients don’t want to wait to see their primary care physicians.

“If they’re new in town, it could be two months before they can see a doctor — the waiting time for new patients can be that long,” she said. “We don’t have enough doctors available. It’s about access, and this is the only way they can access care.”

Patients know that an emergency department visit can take hours, but they also know that any additional tests, such as X-rays or blood work, will be done before they leave. Prescription medicine also is available without a having to go to a pharmacy.

“All the components of service have to be there, regardless of whether or not there is an actual emergency,” Mandell said. “The lab work, the CAT scans, the x-rays — it all drives up the costs. Having trauma doctors available also drives up the costs.”

Patients also are being referred to emergency rooms to reduce the workload at busy primary care practices.

“No one does house calls,” said George Hertner, medical director at Memorial North’s emergency department. “So doctors are becoming increasingly more likely to rely on the emergency room.”

Creative alternatives

Peak Vista and Memorial Health Services have received a grant from the Centers for Medicare and Medicaid Services to provide patients with information about emergency room alternatives.

“We’ll have outreach staff members from Peak Vista at the emergency department … (to) introduce them to Peak Vista and to a primary care doctor within the system,” Pine said.

While the pilot project only involves people who have Medicaid or are eligible for the program, the hospital hopes that it will reduce emergency room costs.

Mandell said that some large emergency rooms have created clinics to treat pediatric, diabetes or asthma patients, keeping them out of the emergency department. But Memorial doesn’t have that capability.

Despite efforts like clinics and the Peak Vista and Memorial partnership, the problem is only getting worse, said Steve Berkshire, a health administration professor at Regis University.

“When I was in hospital administration, it was always a problem,” he said. “People who didn’t have a private physician would show up for anything, everything. And it’s getting worse. People look at it as a way of getting care — not as a place to have real, serious emergencies treated.”

Hertner said that some patients also feel a sense of entitlement to health care services.

“Some people feel that health care is a right, and they have the right to access it at any time,” he said. “Sometimes, people just don’t know that there are other options out there.”

And some patients also are simply using emergency rooms because of convenience.

“There’s a high percentage who use the E.D. on the weekends because they don’t want to wait until Monday morning,” Mandell said. “It’s a community problem — and we have to recognize it as one.”

In addition to added costs, Berkshire said that providing routine treatment at emergency rooms also increases the risk of bad debt.

“You have to put them through the triage system before you know if it’s an emergency,” he said. “Even people who have insurance, something like an HSA, can be surprised by how expensive care in the E.D. can be.”

Credit: Amy Gillentine

(Copyright 2008 Dolan Media Newswires)

(c) 2008 Colorado Springs Business Journal, The. Provided by ProQuest Information and Learning. All rights Reserved.