Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care. This post first appeared on his blog, Lets Talk Health Care.
A few months ago, the New England Healthcare Institute (NEHI) issued a report on non-urgent use of Emergency Departments. It didn’t get that much public attention, which is too bad. It offered some interesting insights.
First of all, inappropriate — or non-urgent — use of the Emergency Room was not limited to uninsured populations. It showed up across the board. People covered by private insurance, Medicaid and Medicare were just as likely to use the ER for non-urgent care as people without health insurance. About 20 percent of all ER visits by privately insured and Medicare patients were for non-urgent purposes. About 24 percent of all ER visits by Medicaid beneficiaries and people without any insurance were for non-urgent purposes.
Second, another 25 percent of all ER visits for each group were for primary care treatable/preventable maladies. In other words, almost half of all ER visits were either for conditions that could have waited at least 24 hours to be addressed, or could have been solved in a doctor’s office.
Hmmm … We all read stories all the time about how crowded the ER is at many local hospitals, and the burden this puts on the care delivery system. We usually assume this is due to inappropriate use that’s driven by uninsured people seeking the only source of open access care that’s available to them. We also assume, correctly, that this is a pretty expensive and inefficient use of health care delivery resources. ER’s typically cost about 2 to 5 times more than a physician’s office to treat non-emergency conditions.
National statistics put the cost of treating non-urgent conditions in ERs at about $21 BILLION. In 2005, non-urgent care in the ER in Massachusetts cost about $1 Billion — or around 40 percent of all ER charges.
These stats, all by themselves, make Minute Clinics and their various clinical incarnations a no-brainer. How can anyone who believes that health care costs are too high look at this data and presume that a Minute Clinic is a bad idea?
But these data also illustrate the limits of a care delivery system that’s built increasingly on a specialty care model. If 70 percent of all physicians are specialists and only 30 percent are in primary care — and some 40 percent of what goes on in an ER belongs in the office a primary care provider, something is wrong. NEHI is discussing a demonstration/research project they will do in conjunction with the Institute for Healthcare Improvement and some of the IHI’s member hospitals and physicians to figure out if there’s a better way to handle the delivery of non-urgent care.