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Broker News | April 2016 | Vol. 11 No. 4
Broker News | April 2016 | Vol. 11 No. 4

Potentially Preventable Emergency Room Visits in New York State

Ten common conditions represent more than 2 million annual visits to hospital emergency rooms statewide at an estimated cost of about $1.3 billion, and nine out of 10 of them could have been avoided or treated elsewhere, according to research issued by Excellus BlueCross BlueShield.

The health plan analyzed “potentially preventable” ER visit data issued by the New York State Department of Health.  Out of 6.4 million visits made to New York state hospital ERs in 2013, more than 2 million were for common conditions such as ear or sinus infections and sore throats.

“Compared to treatment received in a primary care setting, a telemedicine visit, or an urgent care facility, the ER has the longest wait times and highest expenses, including out-of-pocket costs,” said Jamie Kerr, MD, medical director, Excellus BCBS. “Emergency departments are vital community resources and should be reserved for patients with significant trauma and conditions that are potentially serious.”

The state considers “potentially preventable” ER visits to be when patients could have been treated outside of the ER or their conditions could have been avoided altogether through better care coordination and quicker access to primary and preventive care

Findings from the Excellus BCBS analysis are summarized in an infographic that includes a listing of the number of ER visits by common condition. The $1.3 billion estimated cost of the statewide visits was conservatively based on an extrapolation of Excellus BCBS upstate New York claims data. Spending is likely to be much higher because costs in the New York City metropolitan area are typically greater.

“The best method of care for nearly all of these cases is for patients to see their primary care doctors in office visits,” said Kerr.  “But when the physician isn’t available, many of these potentially preventable ER cases can be addressed with telemedicine visits or going to urgent care centers at considerably greater convenience and less cost.”

Using an independent price transparency tool from healthcarebluebook.com, the infographic compares the average costs of a doctor visit, an urgent care visit and a telemedicine visit (about $49) to the average cost of a potentially preventable ER visit. 

The cost analysis assumes that if a patient were to skip the ER and go see his or her doctor for a minor condition, the office visit with the physician would take about 10 minutes and include a limited exam and treatment. The infographic shows that an ER visit for a potentially preventable condition was nearly eight times the cost of seeing a doctor, 3.5 times the cost of an urgent care center visit and about 15 times the cost of using telemedicine. 

“For the ten common conditions, telemedicine demonstrates itself to be the most convenient and cost effective alternative when your physician isn’t available,” said Kerr. “Many may not realize that telemedicine providers can write prescriptions,” she added.

Effective January 1, 2016, health insurers in New York state are mandated to cover telemedicine visits by members who are enrolled in their commercial products. New York state describes telemedicine as the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured individual who is located at a different site than where the health care provider is located.

View a mobile friendly infographic on Potentially Preventable Emergency Room Visits.

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