A survey of 10,000 Coloradans has found that 44 percent of visits to the emergency room are for ailments that could be treated by a regular doctor, but debunked the idea that many of those non-urgent visits are made by the uninsured.
The study found that uninsured people use emergency rooms less than average.
Still, reducing emergency room use could cut costs significantly for the patient, for taxpayers and even the insured. Prices for treatments vary, but Pacific Source insurance found its average cost of treating a sore throat was $127 in a doctor office, compared to nearly $500 in an emergency room.
Taxpayers are covering this unneeded cost for Medicaid and Medicare patients. And insured patients get higher rates when the uninsured can pay, said Dr. Ned Calonge, president of The Colorado Trust, which sponsored the survey.
The study of emergency room use, released Wednesday, was based on answers in the Colorado Health Access Survey given in 2011.
It found that 79 percent of Coloradans using the E.R. for non-emergencies said they did so because it was after doctors hours.
Nearly as many 63 percent also said they were unable to get an appointment to see a doctor as quickly as needed.
This suggests that patients need a more coordinated system of healthcare, Calonge said. For example, patients in groups like Kaiser Permanente can reach a nurse with access to their medical records 24 hours a day, and get advice on treating the problem at home immediately, or making an appointment or going to a hospital, Calonge said.
Patients without such options can seek out doctors with longer office hours, or urgent care clinics.
Francisco Martinez ended up in an E.R. this week because his 7-year-old son Joseph left school at midday with a severe headache, which has been an ongoing ailment. Martinez, a single father who works 60 hours a week as a cook, had to leave his job to pick up his son.
told the boss, I sorry, I got to go, said Martinez, a single father. A doctor appointment would take days, so they headed to Denver Health Medical Center.
He said he knows the emergency room is more expensive, but when it comes to taking care of his kids, can wait until the next day or something.
Dr. Christopher Colwell, head of emergency medicine at Denver Health, said he sees many patients like Joseph Martinez, who come to the ER with sore throats and runny noses. Patients or their parents tell him, don have a primary care physician, or I don have an appointment for six months or whatever, or they can see me after 5 p.m.
Routine medical care is , for many patients, he said. The U.S. health system has failed them, he said. need to adapt to our patients needs, more than trying to make them adapt to our needs.
Denver Health, like St. Mary Hospital in Grand Junction, now has an urgent care clinic next door to its E.R. Patients coming into emergency are checked out and diverted to the clinic if the problem is not serious. Poudre Valley Hospital in Fort Collins has an urgent care clinic across the street.
Denver Health also is considering adding weeknight and weekend hours to its primary care clinics, Colwell said.
Dr. Jerry Solot, who works in that urgent care clinic, says there a long waiting list for appointments in the Denver Health primary care clinics, which treat people who can afford care elsewhere.
So the urgent care clinic was created to ease the burden on the E.R., Solot said.
Hospital emergency rooms make money on paying patients who come in for minor ailments. So there no financial incentive for the hospital to move those patients to a less expensive urgent care clinic, Calonge said.
Solot blamed the problem, in part, on a shortage of family doctors, both nationwide and in Colorado.
probably see too many people who could be seen in primary care but by the same token, we also know that there are not enough primary care doctors in our country to take care of these patients.
That is a shortage expected to worsen in 2014, when the new healthcare law is to provide coverage for millions more patients.
The numbers of people using the E.R. for non-emergency care varied widely among different areas of the state. In the mountain counties of Eagle, Garfield, Grand, Pitkin and Summit, only 12.3 percent of respondents visited an emergency room in the previous year, and only 30 percent of the visits could have been treated by a regular doctor.
Grand Junction Mesa County had the highest percentage of respondents reporting a rush visit to the hospital with 31.5 percent, and nearly half that could have been treated in a doctor office. In the northeastern corner of the state Logan, Morgan, Philips, Sedgwick, Washington and Yuma counties 60 percent of emergency room users said they could have gone to a general doctor had one been available.
People on Medicare, the government health insurance program for people 65 and over, and Medicaid, the government health insurance program for people with low income, use E.R.s more than the uninsured. The study suggested that might be the result of a shortage of doctors who accept new patients from those lower-paying federal insurance programs.
High users were children under 5, who typically need quick care for asthma, ear and respiratory infections; people 65 and over; non-Hispanic blacks; low-income, and people with poor health status or health issues that limited their activities. As incomes rose, use of emergency facilities dropped.