When someone covered by your health plan makes an unnecessary trip to the emergency room, everyone pays. Unnecessary visits to an emergency room — instead of to a family physician — can drive up the cost of health plan premiums, co-pays and deductibles. In addition to costs being higher for everyone, the result may also be uncoordinated care for the patient.
“The cost of emergency room care directly relates to the cost of the premium and that trickles down to the insured,” says Annette Ruby, the vice president of health services management for SummaCare, Inc.
Smart Business spoke with Ruby about how employers can save health care dollars by educating employees on when and where to seek proper care.
Why is eliminating unnecessary emergency-room trips important to employers?
While some medical emergencies are obvious and clearly call for an immediate trip to a hospital, many are not. Consider this statistic from the Centers for Disease Control: of the 119.2 million visits to hospital emergency rooms in 2006, only 15.9 million were considered emergent or urgent. And worse, the typical emergency room visit costs two to five times more than a physician’s office to treat non-emergency conditions. The end result is not only a lot of wasted time, but also a lot of unnecessary expense as a result of unnecessary emergency-room treatment.
How can employers help their employees better understand what medical issues constitute true emergencies?
Simply put, a medical emergency is an accident or unexpected illness that is either life or limb-threatening, which requires immediate treatment. Compare this with urgent care, which means that a person has an illness or injury that has the potential of becoming more serious if treatment is delayed.
Education is key to helping employees understand what constitutes a true emergency. While there are many different indicators of a medical emergency, some are more serious than others. Many health insurance companies have tools employees can use to determine immediately, at the moment of crisis, whether or not they or their family members are experiencing a true medical emergency. These tools include things like an online symptom checker, 24-hour nurse line or other online and mobile self-care options.
Employers can encourage employees to become familiar with the general guidelines for when to seek emergency care. These include symptoms such as loss of consciousness; signs of a heart attack that last two minutes or more; signs of a stroke; severe shortness of breath; bleeding that does not stop after 10 minutes of direct pressure; sudden, severe pain; poisoning; a severe or worsening reaction to an insect bite or sting or to a medication; a major injury (such as head trauma); unexplained stupor, drowsiness or disorientation; coughing up or vomiting blood; severe or persistent vomiting; or suicidal or homicidal feelings.
