Health Groups Target Potentially Avoidable ER Visits

ROCHESTER, NY (11/29/2011)(readMedia)-- Local health care groups launched a campaign today tackling potentially avoidable emergency rooms visits after an analysis shows that upstate New Yorkers make more than 700,000 ER trips annually for minor medical problems such as sore throats and earaches.

"For the second year in a row, our detailed analysis of ER visits in which patients don't stay overnight found that two out of five visits are potentially avoidable," said Jamie Kerr, M.D., vice president and chief medical officer, utilization management, Excellus BlueCross BlueShield.

"True emergencies belong in the ER," said Frank Dubeck, M.D., vice president and chief medical officer, medical policy, Excellus BlueCross BlueShield. "But most sore throats and earaches, for example, should be seen by your primary care doctor. Your doctor will likely see you more quickly and your copay for a doctor visit will be less."

As a result, the Medical Societies of Monroe, Herkimer and Oneida counties; the Finger Lakes Health Systems Agency (FLHSA), and Excellus BCBS are today launching a public service campaign in the Rochester and Utica regions. The campaign features television and radio advertisements urging people to first call their physician for non-urgent issues. The campaign is modeled after a similar campaign by the Baptist Memorial Health Care hospital system based in Memphis, Tenn.

"The quality of health care is greatly improved when doctors and patients work together as partners," said Joseph DiPoala Jr., M.D., a primary care physician in Irondequoit and member of the Monroe County Medical Society Quality Collaborative. "Patients should call their primary care doctor first when deciding the best place to receive care for medical problems."

"The goal of effective health care policy is providing to patients the highest quality of care at the lowest possible cost in the most appropriate environment," said Paul A. Hamlin, M.D., FCCP, president, Medical Society of the State of New York. "Educating the public to use the emergency room only when necessary and appropriate is absolutely consistent with this laudable goal. The Medical Society of the State of New York is proud to work with our colleagues at the Monroe, Herkimer and Oneida medical societies, Finger Lakes Health Systems Agency and Excellus BlueCross BlueShield on this important public service endeavor."

The report

The Excellus BCBS analysis that was also released today - The Facts About Potentially Avoidable ER Visits in Upstate New York - took a New York University formula used to classify ER visits and applied it to hospital data collected by the New York State Department of Health to determine the number of ER visits that were potentially avoidable.

According to the report:

• One out of four ER visits in 2009 in which patients were treated and released on the same day was for a medical issue, such as a back problem, that didn't need care within 12 hours.
• Another 19 percent of visits were for medical conditions that needed treatment soon - such as ear infections - but could have been treated in a primary care setting.
• A significant amount of health care dollars could be saved in upstate New York if patients went to the physician's office instead of the ER for minor problems. Potential annual savings for commercially insured patients range from $8.1 million to $10.7 million if 5 percent of patients currently going to an ER for minor problems instead went to a physician's office and from $40.5 million to $53.5 million if 25 percent of patients currently going to an ER for minor problems instead went to a physician's office.

The analysis

"Many of the figures in the analysis are conservative," Kerr added. "The number of potentially unnecessary ER visits in upstate New York is likely larger, because the report did not include visits the NYU formula deemed 'unclassifiable,' such as injuries."

The report also looked at health insurer payments for care rendered to commercially insured patients to see how much would be saved if these patients went to a physician's office instead of the ER for minor medical issues. More health care dollars would likely be saved if the analysis also looked at the uninsured and those who have Medicare and Medicaid.

Tackling the problem

The report highlights efforts locally and nationwide to reduce the number of potentially avoidable ER visits, including efforts by The Rochester 2020 Performance Commission.

"Efforts under way in Rochester include projects to help patients manage their own minor medical problems and initiatives to increase access to ER alternatives, such as telemedicine programs," said Tom Mahoney, M.D., director of community health improvement, FLHSA, which is running the 2020 commission. "The campaign announced today is the latest community effort to help people determine the best places to receive medical care."

"There are many directions our community could go in responding to this data," said Joseph Booth, M.D., president, Oneida County Medical Society, who was joined by Suresh K. Sharma, M.D., president, Herkimer County Medical Society and Stephen D. Eadline, M.D., president, Slocum-Dickson Medical Group. "The findings aren't unique to the Mohawk Valley. However, all health care is delivered locally, so we believe the issue is best addressed by physicians, hospitals, health insurers, and other members of the health care system working collaboratively together. The campaign announced today is a major step in helping people determine the best places to receive appropriate medical care."

Kerr also urged patients to talk to their doctor about where to go for care when the doctor is unavailable. "Your doctor may refer you to an urgent care center, and you can find the closest one at findanurgentcarecenter.com."

To view the report, go to excellusbcbs.com/factsheets or click HERE. To view the Utica and Rochester campaign advertisements, go to youtube.com/excellusbcbs .

Contacts:

Rochester: Jim Redmond (585) 238-4579 or Joy Davia Auch (585) 238-4374 - Excellus BlueCross BlueShield; Nancy Adams, Monroe County Medical Society, (585) 473-7573; Dr. Tom Mahoney, Finger Lakes Health Systems Agency, (585) 224-3113

Utica: Stephanie Davis, Excellus BlueCross BlueShield, (315) 792-8897; Kathi Dyman, Medical Societies of Herkimer and Oneida Counties, (315) 735-2204

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Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, is part of a family of companies that finances and delivers vital health care services to 1.8 million people across upstate New York. Excellus BlueCross BlueShield provides access to high-quality, affordable health coverage, including valuable health-related resources that our members use every day, such as cost-saving prescription drug discounts and wellness tracking tools in our Step Up program. To learn more, visit http://www.excellusbcbs.com.