Only One Third?

Study: One-third of N.J. emergency room visitors aren’t sick enough to be there

TRENTON — One out of three people who went to emergency rooms at two hospitals in Newark and Long Branch didn’t actually have medical emergencies and could have been treated at less-costly doctor’s offices or clinics, according to a study released today.

And a comprehensive effort to educate and follow up on these patients reduced emergency room visits at Newark Beth Israel Medical Center and Monmouth Medical Center in Long Branch by more than 20 percent by the end of the study.

The second part is encouraging, but the bigger question is if that effort can be expanded throughout the system. I’d wager that the numbers are the same or maybe higher in most other urban areas.

The most frequent ER visitors had health coverage through Medicaid and FamilyCare, but said they couldn’t get an appointment with their doctor, or did not understand what constituted an emergency, according to the study, which was also conducted by the state Department of Human Services and the New Jersey Primary Care Association, which represents health clinics.

Is it cynical of me to suggest that a lot of the patients on Medicaid don’t have primary care physicians or just find it inconvenient to work around the doctor’s schedule as opposed to just calling 9-1-1 for a (free) ride to the ER (also free), where they can get their prescriptions refilled for (free)? In other words how much is lack of education and how much is just lack of incentive to see a primary care physician. My son has pretty decent health insurance through his employer. Still he has a $200.00 co pay for ER visits. That’s on the high end, mine is only $30.00. I know other people who have $100.00 co pay. People on welfare have no co pay. Therefore there is absolutely no reason for them to not use the ER. That’s human nature, not education.

I, and I’ll bet just about any provider who reads this blog, can tell stories about people who have called 9-1-1 for an ambulance ride to the ER to get prescriptions for over the counter drugs such as Tylenol, Motrin, Aspirin, and decongestants. Why? Because if they walk into their local big box pharmacy and pick those items off the shelf, they have to pay for them. However, if they get a prescription for the same medication, it’s free, free, free. Not for us of course, but for them. They not only don’t have to pay, but unlike you and me, there is no co pay for prescriptions.

The team “made sure they had follow-up appointments, and education on what’s an appropriate use of the emergency room without turning people off,” Eric J. Wasserman said, chairman and medical director for Newark Beth Israel’s Emergency Department. The team was trained to explain “there’s a better way of doing this – to get care just as efficiently without the wait and having to come to a crowded emergency room.”

Intensive (and expensive) one on one follow up resulted in the improvement. So, what will happen now that the $4.8 Million dollar federal grant is gone? Will the hospitals fund those staff positions that were covered by the grant? My guess would be not without reimbursement. So, the program will fall by the wayside and soon things will go back to the status quo.

If anyone in the government were serious about reforming health care finance then they would impose co pays and other financial penalties for abusing 9-1-1 and ERs. Only they aren’t so they won’t.