Is a Visit to the ER Necessary?

Are all trips to a hospital emergency room true emergencies? The New York State Department of Health tracks data on what it calls “potentially preventable” ER visits. Researchers at Excellus BlueCross BlueShield reviewed the state data, and here’s what it revealed.


The New York State Department of Health calls “potentially preventable” ER visits, situations in which 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.

This is an issue because, in a given year in New York state, ten common conditions represent more than 2 million visits to the ER, at an estimated cost of $1.3 billion in health care spending. The Department of Health says that 90 percent of those ER visits could have been avoided or treated elsewhere. They can be treated at a doctor’s office, an urgent care center, or even with a telemedicine visit. 

Examples of non-emergency ER visits tracked by New York state (in one year):

  • Bumps & Bruises – 311,000 ER visits
  • Sinus Infections & Sore Throats – 305,000 visits
  • Sprains & Strains – 286,000 visits
  • Abdominal Pain – 271,000 visits
  • Back & Neck Problems – 216,000 visits
  • Nausea, Constipation & Diarrhea – 171,000 visits
  • Headaches – 135,000 visits
  • Urinary Tract Infections – 127,000 visits
  • Joint Aches & Pains – 127,000 visits
  • Ear infections – 84,000 visits

This is a big deal because, compared to treatment received in a primary care setting, a telemedicine visit, or treatment at an urgent care center; the ER has the longest wait times and highest expenses, including out-of-pocket costs.

The ER should be reserved for patients with significant trauma and conditions that are potentially serious. They should not be overcrowded with non-emergency patients.

Telemedicine can be an option.

Telemedicine is when a health care provider at one location uses communication technologies to deliver health care services to a patient at another location…such as using a telephone, or having a video conference on a smart phone or computer.

  • For the ten common conditions that present most often to the ER, telemedicine can be the most convenient and cost effective alternative when your physician isn’t available.

 

  • Many people may not realize that telemedicine providers can also write prescriptions and send them to a nearby pharmacy.

 

  • Health insurers in New York State are mandated to cover telemedicine visits by members who are enrolled in their commercial products.

 

  • Cost of care?
    • An ER visit for a potentially preventable condition costs
      • About 8 times more than seeing your primary care doctor        
      • 3 times more than an urgent care center visit
      • 15 times more than the cost of using telemedicine. 

 

Excellus BCBS advises that the best method of care in nearly all cases is for patients to see their primary care doctors in office visits. When the physician isn’t available, many of these “potentially preventable” ER cases can be addressed with telemedicine visits or by going to urgent care centers at considerably greater convenience, and less cost than going to an emergency room.

 

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 about 1.5 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. To learn more, visit ExcellusBCBS.com.