The Most Expensive Care: Is Visiting the ER Worth it? — July 2013


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Various studies show that half to three-quarters of visits to the emergency room are for non-emergency situations. It’s estimated that about $38 million is wastefully spent on unnecessary ER use every year.*

The use of ERs for non-emergencies is a growing problem among insured and uninsured alike. Besides the cost, it results in overcrowding, long waits, stressed healthcare providers, and potentially compromised care for those with true emergencies.

The three most common reasons for ER visits are for superficial injuries and bruises, sprains and strains, and upper respiratory infections. These conditions generally don’t require emergent care, defined as care needed within 1 minute to 2 hours for very sick people.

It’s not always easy to know when a visit to the ER is warranted. Is the pain in your belly a sign of indigestion or appendicitis? Is that throbbing headache a migraine or a stroke warning sign?

Doctors usually agree on a short list of problems that should be treated as emergencies, such as being unable to breathe, severe bleeding, stroke symptoms and chest pain. If you think you are having a medical emergency, call 911 or go to the emergency room. If you don’t think your situation is dire, consider:

  • Waiting it out and/or using over-the-counter remedies.
  • Calling or visiting your doctor. If after hours, try to reach the on-call provider.
  • Calling KnovaSolutions or other nurse answering service.
  • Visiting an urgent care clinic.

The Downsides of Using the ER for Primary Care

While you certainly don’t want to ignore health problems, most are not emergencies. You may be able to get in without an appointment at an emergency room, but that convenience comes at a high price.

In a study performed at the University of California, San Francisco, researchers identified that $1,233 was the median charge for an outpatient condition at an ER. Upper respiratory infections had the lowest median cost ($740) and kidney stones had the highest ($3,437). Study researcher Renee Y. Hsia, MD said, “Our study shows unpredictable and wide differences in healthcare costs for patients.” The costs ranged widely. For example, treatment for intestinal infections ranged from $29 to $29, 551, and headaches ranged from $15 to $17,797.

Most people would prefer to pay $100 for the treatment of strep or an earache than five times as much at an ER. But there are additional reasons to avoid the ER for these conditions. An ER is likely to run more tests than a primary care provider because they don’t know you and your health history. They don’t have a record of recent lab work, x-rays or other aspects of your situation. And then, when you follow up with your PCP after an ER visit, often tests have to be repeated, adding cost, time and inconvenience. Keep in mind too, the other risks of over treatment like exposure to infection and radiation.

While generally less expensive than ERs, urgent care centers are also not the best place for primary care — for many of the same reasons. When you see a primary care provider, your conditions and health status are monitored over time, allowing for patterns to be identified and valuable working relationships to be established.

“Planning” for Emergencies

There’s just no telling when an emergency situation might arise. While you can’t anticipate every need, it is helpful to know what your provider recommends in case of emergency, especially if you have a chronic medical condition. You can “plan” for an emergency by:

  • Finding out whether your doctor offers evening or weekend hours and if a provider is available for after hours consultation. This is especially important if you have young children.
  • Learning the location and hours of urgent care centers that are covered by your insurance.
  • Discussing a care plan with your provider that will reduce the likelihood of a crisis.

Don’t Wait til the Weekend…or a Holiday!

Lots of things can be put off until the weekend, but if you have an active health issue, it’s better not to wait to seek information because then the ER or an urgent care clinic might be your only option. If you have concerns, but can’t get to your PCP, it’s possible that a phone call can offer temporary solutions until you are able to get in for an appointment.

KnovaSolutions Can Help Too

Your KnovaSolutions nurse can help you assess your symptoms and determine a course of action. We’re available by email and phone, and non-regular office hour appointments are sometimes available. Our team of nurses and pharmacists are waiting for your call — 800/355-0885!

For More About Why the ER is not the Best Place for Primary Care
See the KnovaSolutions June newsletter, Less is More…When it Comes to Some Healthcare Services.

 

* Source: New England Healthcare Institute

 

 

The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.

 

Click here to to view/download the full newsletter.

 

Have a comment or question? Respond below and a KnovaSolutions nurse or pharmacist will reply.

 


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5 Responses to The Most Expensive Care: Is Visiting the ER Worth it? — July 2013

    • Thanks for your question, Heidi.

      Stitches

      According to the Mayo Clinic, a wound that is more than 1/4-inch deep, is gaping, jagged edged, or has fat or muscle showing usually requires stitches. Adhesive strips or butterfly tape may hold a minor cut together, but if you can’t easily close the wound, see your doctor as soon as possible. Proper closure within a few hours reduces the risk of infection.
      Call your family doctor if any of the following things occur:
      • The wound is jagged
      • The wound is on your face
      • The edges of the cut gape open
      • The cut has dirt in it that won’t come out
      • The cut becomes tender or inflamed
      • The cut drains a thick, creamy, grayish fluid
      • You start to run a temperature over 100°F
      • The area around the wound feels numb
      • You can’t move comfortably
      • Red streaks form near the wound
      • It’s a puncture wound or a deep cut and you haven’t had a tetanus shot in the past 5 years
      • The cut bleeds in spurts, blood soaks through the bandage or the bleeding doesn’t stop after 20 minutes of firm, direct pressure

      Resources:
      Mayo Clinic: Cuts and Scrapes: First Aid http://www.mayoclinic.com/health/first-aid-cuts/FA00042/METHOD=print
      FamilyDoctor.org http://familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/first-aid/first-aid-cuts-scrapes-and-stitches.printerview.all.html

      Broken Bones
      You need to get medical care right away for any fracture (broken bone). Symptoms of a fracture (broken bone) are:
      • Out-of-place or misshapen limb or joint
      • Swelling, bruising or bleeding
      • Intense pain
      • Numbness and tingling
      • Limited mobility or inability to move a limb

      To learn about first aid when a broken bone is suspected, read the Mayo Clinic’s article titled, Fractures (Broken Bones): First aid: http://www.mayoclinic.com/health/first-aid-fractures/FA00058/METHOD=print

      Linda Archer, RN, MSN, CNS

  1. Thanks for the tip about how an er is not the best choice for treatments. I had no idea that the cost of treatment could be so wide. I will have to find out what hours my primary doctor works, and see if I can find others that will fill in the gap.

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