700,000 Trips to Upstate New York ERs for Sore Throats, Earaches and Other Potentially Avoidable Issues

Patients with minor medical problems will likely receive better care by visiting their doctor instead of the ER. Such moves will also help control rising health care costs.

Upstate New Yorkers make more than 700,000 potentially avoidable trips to emergency rooms for sore throats, earaches and other minor medical problems annually, according to an analysis issued today by Excellus BlueCross BlueShield.

“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 Marybeth McCall, M.D., vice president and chief medical officer, Excellus BlueCross BlueShield.

“True emergencies belong in the ER,” McCall added. “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.”

The Facts About Potentially Avoidable Emergency Room 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.

The results
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 emergency room 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 emergency room for minor problems instead went to a physician’s office.

The analysis
“Many of the figures in the analysis are conservative,” McCall 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 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.

Excellus BlueCross BlueShield shared the findings with the Medical Society of the State of New York. The medical societies of Monroe, Herkimer and Oneida counties, the Finger Lakes Health Systems Agency and Excellus BlueCross BlueShield also launched a public service campaign today in the Utica and Rochester 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 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.”

McCall 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. To view the Utica and Rochester campaign advertisements, go to youtube.com/excellusbcbs

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 excellusbcbs.com.