WakeMed seeks a smarter, cheaper emergency room

WakeMed seeks approval for plan to divert non-emergencies to clinics, doctors

jneff@newsobserver.com April 26, 2012 

With the competing interests of doctors, health-insurance companies, hospitals and patients, cutting health care costs can be close to impossible. WakeMed, though, wants to start in its emergency room.

The Raleigh hospital says it has a plan that could save millions in costs by diverting low-risk patients from expensive emergency care. But so far, it can’t get the go-ahead from federal officials.

Under federal law, hospitals must treat anyone who shows up in an emergency room. Before that law was enacted, some hospitals wouldn’t treat uninsured patients or transferred them without treatment to other hospitals, a practice known as “patient dumping.”

One unintended side effect of the law: People use the emergency room for purposes better suited to a health clinic or family doctor.

“Patients come to the emergency room complaining of a bad cold or a headache or wanting a physical,” said Dr. Susan Weaver, WakeMed’s head of medical affairs. “A doctor has to see them and discharge them.”

Emergency rooms are expensive to operate. They are open 24 hours a day and have to be staffed with doctors, nurses, pharmacists and more.

A doctor must conduct a medical exam for everyone entering the emergency room. Weaver has been pushing for approval for WakeMed to treat patients with non-emergency medical conditions in a less expensive setting.

If a person came in with a bad cold or headache, a triage nurse could offer to make an appointment for the patient at a clinic or doctor’s office. The patient would have to sign a waiver.

WakeMed estimates it has 35,000 emergency room visits yearly with non-emergency conditions.

The average emergency room visit runs up a cost of $524, according to Debbie Laughery, a hospital spokeswoman. Sending a patient to a community clinic such as Alliance Medical Ministry, in the shadow of the WakeMed complex, costs $92 a visit with lab tests and medicine; it is inexpensive because many providers donate staff time and supplies. A visit to a primary care doctor, with no tests or medicine, averages about $140.

Diverting half the non-emergency patients from WakeMed could save $5 million or more a year.

The program would also have another benefit: Patients who typically go to the emergency room would connect with a primary care doctor for preventive health care services.

WakeMed officials said they proposed a project with officials at the federal Center for Medicaid Services. They said they received a positive response but no commitment to change regulations. They failed to get the plan included in the national health care reform bill.

Everyone seems to agree with the approach, said Weaver, who built the Alliance Medical program before joining WakeMed. The only doubt expressed is that some hospitals might revert to patient dumping.

Weaver said that WakeMed has designed safeguards to ensure that patients are diverted because of their non-emergency status and not on the patient’s ability to pay. But so far, it doesn’t have the OK to proceed.

“We are stalled,” she said.

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