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VOL. 128 | NO. 57 | Friday, March 22, 2013

Forum Highlights Concerns With Non-Urgent ER Visits

MICHAEL WADDELL | Special to The Daily News

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Healthy Memphis Common Table and the League of Womens Voters hosted a public forum Monday, March 18, at the Great Hall and Conference Center in Germantown to discuss findings from the seventh Take Charge For Better Health Report released earlier this week.

The report examines the misuse of hospital emergency departments and how it impacts the quality of care and the overall cost of care for the entire community.

A panel of speakers included lead researcher for the report, Dr. Cyril Chang, professor of economics at the University of Memphis. Chang was joined by Dr. Anne Sullivan of Baptist Medical Group, Darla Belt of Baptist Memorial Hospital, Carolyn Wade of Methodist South Hospital and Betsy Freidman of Healthy Memphis Common Table. Attendees included Germantown Mayor Sharon Goldsworthy.

“My real intention is to bring attention to the delivery of health care in the community in terms of primary care,” said Chang, who specializes in health care economics. “There is a distinct link between the delivery of primary care and what happens at the hospital ER.”

In 2009, Tennesseans made more than 2.3 million trips to emergency departments, with Shelby County accounting for 14.4 percent of the total (340,000 visits).

More than half (52 percent) of those emergency room visits were found to be non-urgent, and 57 percent were primary-care-sensitive and potentially avoidable, according to the report.

Chang pointed out that Shelby County is doing better than the state of Tennessee as a whole but lags well behind other areas of the country.

Non-urgent visits resulted in more than $434.7 million in billed services to patients and their third-party payers in Shelby County during 2009.

The newest Take Charge report suggests a wide range of measures that patients and hospitals can do to reduce the number of emergency room visits.

Sullivan believes there is a need for more patient-centered medical homes with a network of physicians that communicate better with each other.

“Everyone should have a medical home, a place to go for continuous, comprehensive, collaborative, compassionate, cost-effective primary care,” Sullivan said.

Wade would like to see more primary care physicians in certain ZIP codes around the city, including 38109 and 38116, where there are currently only a total of three primary care practices. She believes it would alleviate some of the non-urgent ER visits from those areas.

“We had 66,000 emergency department visits in 2012 and only 10 percent of those patients were admitted,” Belt said. “Case management is my passion. We need to talk patients through the clinical and financial aspects of care, and help them explore options and resources available to them.”

Belt agrees that creating case management programs to help patients manage chronic diseases will be a very effective way to help lessen unnecessary ER visits.

“Personal accountability when taking advantage of ER access is also a big problem here in Memphis,” said Belt, a registered nurse at Baptist. One health care professional in attendance pointed out that some local patients have used ambulance transport for non-urgent care as an excuse to simply get a free ride across the city.

Friedman promotes the development of patient-centered medical practices across the city, including educating patients on appropriate emergency department visits.

“I use a style called motivational interviewing that helps evoke from patients what is important to them about their health and health care,” said Friedman, who believes behavioral changes are needed for most patients to take charge of their health and health management.

She believed a policy change could be needed, since for many low-income families the fact that there is no co-pay needed for ER visits versus a $20 co-pay for primary care doctor visits can be the determining factor in visiting the hospital for a non-urgent problem.

The Take Charge report debunks the myth that only uninsured patients use hospital emergency rooms for non-urgent and primary-care sensitive problems. In fact, insured patients were responsible for nearly 80 percent of all non-urgent and primary-care-sensitive visits.

Many participants suggested some form of triage unit at the hospital to redirect patients with non-urgent conditions to primary care providers instead of the ER.

The League of Womens Voters hosts monthly forums to discuss issues that are of importance to the community. Next month’s meeting will feature a forum on understanding the effect of charter schools and vouchers on public education, and it will be held April 15 at the Benjamin L. Hooks Central Library on Poplar Avenue.

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