The Virginian-Pilot
NORFOLK, Va. — Medical care costs have been soaring for many reasons, but one persistent problem creates considerable expense: treating people with non-emergency problems in emergency departments.
Some folks compound the costs by calling 911 for routine medical help, tying up an ambulance and a team of first responders and adding to the price tag.
Persuading such people to instead use regular doctor visits for treatment is critical to the medical cost savings outlined by the Affordable Care Act.
It’s supposed to work this way: People who finally have insurance will go to a doctor’s office to manage chronic problems, rather than head to the emergency room, where some measure of treatment is mandated by law.
Some states, including Virginia, have refused so far to expand Medicaid, ensuring that people without insurance will use emergency rooms for all health care.
Those visits prove costly in many ways - doctors and rooms occupied with non-emergency patients, treatable conditions left unmanaged until crisis, and paramedics using their extensive training and costly equipment for what amounts to a ride to the hospital.
Cities around the country have begun to address the costs such “frequent fliers” cause for first responders and emergency departments.
Programs known as “Mobile Integrated Healthcare” provide training to paramedics and other first responders to help them evaluate people who dial 911 to seek treatment for chronic health ailments, addiction or mental health care, and to find more appropriate settings for their care.
Other programs aim to monitor patients discharged from the hospital to ensure they don’t relapse and return.
Portsmouth has a trial program; Chesapeake plans to spend $75,000 to assess whether such a program would work there.
Cities that have implemented programs to assess habitual emergency room denizens and divert them when possible have begun to make progress.
In Raleigh, for example, Wake County paramedics with special training evaluate patients with mental illness who are judged not to be in need of emergency medical care.
Those patients then have the option of transport to a psychiatric care facility rather than the emergency room. Last year, hundreds of them chose non-emergency treatment. It’s better care for the patient, and savings for the paramedic team and the hospital.
The efforts mark a shift in thinking, from finding more efficient ways to treat non-emergency patients in emergency departments to finding ways to keep them out of the emergency department altogether.