Employers Push to Cut ER Visits
By Katie Lannan
State House News Service
BOSTON -- One out of every three Massachusetts residents who get health insurance through their employers reported making their last visit to an emergency room for a condition that wasn’t actually an emergency, according to a new analysis presented to a business group Tuesday morning.
Of those non-emergency visits, Health Policy Commission Executive Director David Seltz said 71.6 percent were for care needed outside of a doctor’s office’s normal operating hours, and 62.3 percent were because the respondent couldn’t get an appointment with a doctor soon enough.
Members of the Massachusetts Employer Health Coalition, a group aiming to reduce health care costs by shifting avoidable emergency room visits to less expensive settings, gathered at the University of Massachusetts Club in Boston to discuss strategies and hear the commission’s new data.
The group’s kickoff breakfast comes about four months after a major health care reform bill that aimed to financially stabilize struggling community hospitals collapsed on Beacon Hill, leaving the issue to be addressed in the new session that begins in January.
“Not all that’s broken in our health care system can be fixed legislatively,” said Massachusetts Taxpayers Foundation President Eileen McAnneny, who co-chairs the coalition with Rick Lord, the president of Associated Industries of Massachusetts. “Sometimes, it requires private sector action and intervention, and I firmly believe -- and I know my dear friend Rick Lord, who is the president and CEO of AIM and the cofounder of the coalition -- I know he firmly believes too, that the best way to effectuate change in the health care marketplace, particularly for the commercially insured, is to help educate consumers and to better inform them on the consequences of their choices.”
McAnneny said the coalition hopes to “connect the dots for patients,” educating them on options and showing them why using the emergency room might not make sense for them personally, as well as for the health care system at large.
The cost of an emergency department visit can be five to six times higher than other care options, with greater cost sharing for patients, Seltz said.
Average total spending for an emergency department visit in 2015 was $1,220, with $164 in patient cost-sharing, according to the commission. In comparison, average total spending at a physician’s office, retail clinic or urgent care center ranged from $69 to $172, with cost-sharing ranging from $20 to $35.
The coalition has developed resources for employers, including a poster, sample newsletter article and social media posts, to help show workers what kinds of conditions -- mild burns, allergies, and sprains, for example -- can be treated in settings other than emergency rooms with lower copays, and which conditions -- like severe bleeding, chest pain and head trauma -- necessitate an emergency room trip. A full toolkit is expected to be released next year.
Lisa Collentro, chief administrative officer at the property management company Chestnut Hill Realty, suggested that employers focus not just on the financial reasons to avoid the emergency room when possible, but also show their workers “a lot of really good practical reasons” that another facilities, such urgent care centers, make sense for them.
“I think for us, it’s about the value proposition for the individual employee,” Collentro said. “Why is it better for them, why do they have to be so involved in saving money for the health insurance companies or for the doctors, or whatever, so I think that’s our biggest challenge, truthfully, is what’s in it for them.”
Louise Probst, the executive director for the Midwest Health Initiative and the St. Louis Area Business Health Coalition, said a similar employer effort in Missouri’s largest metropolitan area has involved outreach to primary care physicians, asking them to help their patients come up with action plans to avoid unnecessary emergency room care.
Emergency department use there dropped by about 5 percent from 2016 to 2017, Probst said.
“This is really a great area for community focus,” Probst said. “There are so many layers to this and so much opportunity.”