By Jeremiah McWilliams
The Atlanta Journal-Constitution
ATLANTA — Facing steadily rising health care bills, metro area governments are trying to convince employees not to use hospital emergency rooms as their doctor’s offices.
The state of Georgia, city of Atlanta and Cobb County — along with some private employers — want to change the behavior of thousands of insured employees, steering them toward primary care physicians and urgent care clinics instead of the more expensive option of the emergency room.
Employees in Atlanta and Cobb now must shell out for higher co-pays for emergency room visits. And state workers who visit the ER frequently can expect a phone call or text from a registered nurse armed with information about nearby doctors or clinics.
While emergency room visits by uninsured patients are the focus of debates over health care policy, government officials say workers with coverage also rely on them too heavily for routine ailments.
“This is going to be a big cultural shift,” Atlanta Mayor Kasim Reed said. “The emergency room approach obviously is the most expensive way to receive this health care. We’re going to have to have people go out and educate our work force and say, ‘You have a very good insurance program; please use it in a different fashion.’ ”
For Atlanta employees, emergency room visits cost more than $600 on average. The cost of the visits, for both minor problems and true emergencies, totaled $1.85 million in the first six months of the 2011 plan year.
That cost was borne by employees, insurers and — through the city’s budget — taxpayers.
Unnecessary trips to emergency rooms are expensive for counties and cities, both through direct costs and higher premiums. Except in serious emergencies, they can be slow and inefficient places to get care.
About one in five of Atlanta’s roughly 7,500 current employees went to emergency rooms in the past 20 months, according to an initial analysis. The city uses Blue Cross Blue Shield and Kaiser Permanente to insure about 19,000 employees, retirees and eligible dependents.
The city’s contribution to dental, health and life insurance costs hit $80 million last year, up 8 percent in two years, according to the city. Emergency room visits were one ingredient.
Reed told The Atlanta Journal-Constitution that the number of ER trips “is not consistent with any large organization of similar size and complexity that I’m aware of in the state of Georgia. ... It’s way too much, considering all our full- time employees have excellent health care.”
In September, the city doubled the co-pay on emergency room visits to $150 from $75. The new rate was more than four times higher than the $35 co-pay for an insured employee to visit an urgent care clinic.
Emergency room usage dropped by more than half in the first half of plan year 2012 from a year earlier. The number of frequent users — those making more than one visit to the ER — dropped by more than 75 percent.
The new rules were not meant to make the ER cost-prohibitive, said Yvonne Cowser Yancy, the city’s human resources commissioner. But it touches employees’ pocketbooks and makes them think about costs, she said.
“We feel like it’s doing what it needed to do,” Yancy said.
Active employees of Georgia’s state government, as well as early retirees and dependents, might receive a call from a registered nurse at UnitedHealthcare or Cigna if they use the emergency room often.
The idea is to educate the employees about alternatives such as primary care physicians, urgent care facilities and the state’s 24-hour nurse line, said Pam Keene, spokeswoman for the Georgia Department of Community Health.
Emergency room visits by the state’s employees, retirees and dependents dropped 2.3 percent in 2010 and rose less than 1 percent in the first half of 2011. Visits to urgent care facilities spiked by 38 percent in 2010 and another 22 percent in the first half of 2011.
Cobb County recently raised its co-pay for emergency room visits by 50 percent, to $150 from $100.
“We’d like it to be used for its intended purpose,” Tony Hagler, the county’s human resources director, said of the emergency room option. “We obviously would like it to be as [infrequent] as it can.”
Cobb County spent $1.9 million, or 5.9 percent of its employee health care budget, on emergency room visits last year. Hagler said it was unclear how many of the emergency room trips could be attributed to true emergencies.
Employer-sponsored insurance policies typically charge significantly higher co-pays for the use of emergency rooms than for urgent care facilities. Co-pays for the ER are generally $250 or more, while co-pays for urgent care facilities are often about $50, according to the Society for Human Resource Management.
Gwinnett, Georgia’s second-largest county, does not track the number of emergency room visits or ambulance rides by employees, spokesman Joe Sorenson said.
But two of the county’s three health plans either don’t cover nonemergency visits to the ER or charge significantly more than a visit to a doctor’s office. A third plan requires employees to pay the cost of an ER trip until catastrophic coverage kicks in.
“It basically puts [employees] in the driver’s seat in terms of controlling their costs and taking responsibility,” Sorenson said. “We want to make sure we are responsible with taxpayers’ money.”
Copyright 2012 The Atlanta Journal-Constitution