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6:04pm August 15, 2012

First Stop: Primary Care Physician

emergency_room_wait

Helping Emergency Rooms be Emergency Rooms

By Earlexia M. Norwood, M.D. Physician- In-Charge, Henry Ford Health System

Emergency rooms are facing an overcrowding problem.  This problem is not the result of a dramatic increase in medical emergencies that truly warrant emergency room treatment.  Rather, it is the result of more and more people with non-emergent medical care needs that go to the emergency room for treatment instead of a primary care physician.

According to NEHI – formally known as the New England Healthcare Institute - 56 percent of emergency room visits are potentially avoidable.  Here lies the root of the problem: many patients insured and uninsured are using the emergency room as their primary care center.

Emergency room overcrowding costs around $38 billion annually, according to NEHI.  It’s a significant cost with a broad impact that includes higher premiums and co-payments, longer waits, and patient care occurring in inappropriate and high cost structure settings.  The public, private, and non-profit sectors are well-aware of this problem and implementing solutions that are helping to make a positive difference.

For example, the national dialogue about healthcare reform and ultimate passage of the Affordable Care Act invigorated a renewed appreciation for and emphasis on primary care.  As healthcare becomes more affordable and accessible to millions of Americans who are currently uninsured, primary care physicians should be a patient’s first stop – not the emergency room.

More importantly, these newly insured Americans should “doctor shop” to find the primary care physician who they feel most comfortable with.  I’m not the only one who thinks so.  When Consumer Reports surveyed primary care physicians, over three-fourths of them said a long-term relationship with a primary care physician is the most important thing a patient can do.  This is the basis and premise of the medical home where the patient is provided with the proper care, from the most appropriate provider.

Consider this fact from the Centers for Disease Control and Prevention (CDC): “Chronic diseases are the most common and costly of all health problems, but they are also the most preventable.”  People who regularly go to their primary care physicians for checkups and preventative screenings are more likely to have control of their chronic diseases which increases longevity and decreases further complications. Their primary care physicians have a much better handle on their health and lifestyles and are therefore much better equipped to make recommendations that keep them healthy and out of the emergency room.

In addition to the nation’s renewed appreciation for and emphasis on primary care, hospitals are taking actions to address the overcrowding problem.  For example, some hospitals post emergency room wait times on their websites.  This information allows people who have non-emergent situations to look for alternative options such as making evening or weekend appointments with their primary care physician, which is being encouraged in the marketplace.

Another action that hospitals and insurers are taking is charging an upfront emergency room fee for providing non-emergent care.  The Healthcare Financial Management Association says “at least half of all hospitals nationwide now charge upfront ER fees.”  These fees and policies promote care to occur in the primary setting where there is a lower cost structure and continuity of care can be provided. As a result, hospitals will have more of the resources they need to provide the best emergency care possible.

Emergency room overcrowding is a problem we can overcome.  Encouraging a greater emphasis on primary care – and providing much-needed access to preventative care to millions of uninsured Americans – is a significant step in the right direction.  Other solutions from the private, public, and non-profit sectors should be encouraged too and examined through a lens of the broader picture: the status of healthcare in our country.  We are moving in the right direction.

Earlexia M. Norwood, M.D. is the Physician- In-Charge, Henry Ford Health System.



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