Using appropriate level of care provides savings

Happy New Year! It is now 2005 and we live in a fast-paced society that keeps us moving to the point that we don’t have time to wait. We know what we need, and we need it now. That includes fast food, cell phones, automated teller machines and medical services.

How long would it take you to get an appointment with your primary care physician? What if it is after 5 p.m., on a weekend, or even a holiday? Although more and more primary care physicians are utilizing urgent care centers, they usually direct patients to an emergency department at one of the local hospitals.

Then, there are those people out there who are typically healthy individuals – statistics show that 85 percent of people are in that category – and don’t have illnesses that need ongoing care. More often than not, these people haven’t even established themselves with a primary care physician. When they do have a minor illness or injury, they often go to the emergency departments because they don’t know where else to go.

Emergency departments continue to struggle with the problem of patients tying up the ER for minor illnesses or injuries. During the past decade, many ERs have closed due to financial constraints, but the number of people using the ER has continued to increase, according to National Hospital Ambulatory Medical Care Survey. In that report, published in June 2003, the 2002 Emergency Department Summary showed that the number of emergency departments in operation decreased by about 15 percent, leaving those that were still open with a larger patient volume.

This translates into longer wait times for everyone. The answer to this problem nationally has come in the form of urgent care centers.

Springfield has joined this trend; we have hospital-based urgent care as well as independent urgent care centers. By definition, an urgent care center serves walk-in patients and does not require an appointment prior to service. Urgent care centers are typically open seven days a week for at least 10 hours a day. They are relieving the overburdened ERs by treating patients who come in for flu, respiratory illness, minor cuts, sprains/strains, sinus infections, etc. When patients do develop chronic or severe conditions, they often use urgent care providers to facilitate appropriate referrals to primary care physicians or specialists for ongoing health care. Urgent care has profoundly reduced visits to emergency departments for acute injuries and illnesses that are not true emergencies. Consequently, urgent care centers reduce American health care expenditures and long wait times in the ER, while at the same time allowing consumers to take personal control of their health care.

It is important to point out that there are times when a visit to the ER is necessary. Someone with chest pains, loss of consciousness, obvious broken bones or traumatic injuries should always make the emergency room their first choice. On the other hand, patients with an ongoing illness such as diabetes, heart disease or high blood pressure, for example, would be best treated by their primary care physician or a specialist. Primary care physicians, urgent care providers and emergency departments all work together to offer varying levels of care to area residents. A lot of communities do not have that middle piece of the puzzle. If an urgent care center is not available in an area, people with nonemergency problems are often forced to utilize the expensive and intense services of the emergency department of a hospital. This drives up health care costs, prolongs waits for services and diverts resources in emergency departments away from true emergency cases.

Looking at data available both nationally and locally demonstrates mathematically the surprising differences for an area that has access to and uses urgent care. According to our own research and to data from the North American Association for Ambulatory Urgent care, an average urgent care visit is three to four times less expensive than an ER visit for the same diagnosis. In our area, that represents approximately $354 per patient. Springfield Business Journal recently reported that the three largest emergency rooms in our area saw about 254,450 patients in 2003. The National Hospital Ambulatory Medical Care survey also found that 75 percent of patients seen in emergency departments were not emergency visits. By taking national statistics and applying them to our local area, you can determine that 190,838 local patients could have been seen for $354 less – resulting in $67.5 million dollars in unnecessary charges. Keep in mind, this $67.5 million dollars is just in Springfield in only one year.

Now we can all begin to understand why health care costs and insurance premiums continue to rise year after year. Working together by using primary care physicians, urgent care clinics and emergency departments for the appropriate level of care will clearly benefit the health care industry, employers and their employees.

Brian Casey is a clinic services representative for Family Medical Walk-in Clinics. This column was co-authored by Tammy Mallow-Elly, director of operations for Family Medical Walk-In Clinics.