4 ways to reduce non-emergency ER use

Behavioral health, inadequate Medicaid reimbursements among problems to be solved, Scripps CEO says

With emergency departments (EDs) suffocating under increasing loads of non-emergency patient, the CEO of San Diego's Scripps Health highlights several possible solutions in a commentary in Becker's Hospital Review.

Hospitals and healthcare systems including Scripps have been expanding or building new EDs, but it's not enough, Chris Van Gorder wrote in his commentary. The number of emergency room visits for non-emergencies ballooned by 160 percent from 2014 to 2015, he noted.

The 2011 expansion of Medi-Cal, California's Medicaid program, pushed more patients to EDs, he said. Medi-Cal reimbursement rates are so low that many doctors won't accept patients insured through the program, Waits are often long for those who do accept Medi-Cal patients, sending many of those patients to EDs where they can get immediate care.

Several actions need to happen to reduce non-emergency use of emergency departments, Van Gorder said. They include:

  1. Non-emergency patients must seek treatment from their regular doctor, urgent care or other venue.
  2. Hospitals must expand hours and locations, as well as treatment access points including telemedicine. One recent study found that teaming up with senior living communities to offer telemedicine visits reduces ED visits.
  3. Medi-Cal must increase reimbursements.
  4. Organizations must rethink how patients with behavioral-health issues are treated, including developing specialty care sites that can address psychiatric emergency, and foster closer collaboration among providers, payers, government and community services--with more funding.

ED usage and overcrowding spikes when local governments cut back on behavioral treatment services, both in the number of visits and length of stay, according to research previously reported by FierceHealthcare.

 "None of this will be easy to do," Van Gorder said. "But something must be done--and soon--because what's happening in California ERs is a public health crisis, and it's happening now."

To learn more:
- read Van Gorder's commentary

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