ER overuse: Have Seattle healthcare organizations found the solution?

Where government-led reform appears to have failed, a partnership between two healthcare organizations in Seattle may have solved the stubborn problem of rising emergency department use, according to a New York Times opinion piece.

Research released this week by the American College of Emergency Physicians (ACEP) dealt a blow to the Affordable Care Act's aim to ease patients' reliance on the ED, as physicians polled by the organization indicated that patient volume actually has increased since the ACA's insurance mandate went into effect.

What these findings mean, however, is largely open to interpretation. ACEP President Michael Gerardi, M.D., told FierceHealthcare that the data show how valuable EDs are to the healthcare landscape, but Ezekiel J. Emanuel, an oncologist and former White House adviser, writes in the Times that "these failures do not mean that the emergency room problem is unsolvable, just that insurance coverage alone is insufficient."

What does work, he writes, is a strategy pioneered by the Group Health Cooperative of Puget Sound, a nonprofit organization that provides both healthcare and insurance coverage, and SEIU Healthcare NW Health Benefits Trust, which provides insurance to home healthcare workers. To curb ED use among the groups' members, they adopted a range of strategies that include: cash incentives to complete certain wellness and preventive care steps; a social media campaign to emphasize proper use of the ED; and a concerted effort to redirect patients to urgent care centers for non-life-threatening conditions.

The groups also increased the co-pay for an ED visit to $200 and kept the out-of-pocket charge for an urgent care center visit at $15, according to Emanuel. Some have criticized similar efforts on the state level, however, arguing that "punitive policies toward Medicaid patients in the ER may be discouraging low-income patients with serious medical conditions from seeking necessary care, which is dangerous and wrong," Orlee Panitch, M.D., an emergency physician for MEPHealth in Germantown, Maryland, wrote in an ACEP statement.

Still, the results of the Seattle groups' efforts are encouraging, as they helped the workers involved avoid nearly 1,200 unnecessary ED visits since 2010, Emanuel writes, adding "this is how we'll finally deliver on the president's promise--and save all of us billions of dollars."

To learn more:
- read the opinion piece
- here's the ACEP statement

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