The emergency room has become the preferred clinic of choice for the uninsured. This we know. But a group of Florida businesses discovered an alarming new trend: employees with full coverage were going to the ER for minor medical events instead of making clinic appointments that would have been covered.
The reason, reported the Daytona Beach News-Journal, was convenience. If an employee had a minor medical need — flu symptoms, a cut, ankle sprain, etc. – they knew from experience that they couldn't get in to see their primary care doctor or another medic at their clinic for several days at best. So they checked in to the ER, and ran up the bills for the company health plan. (Treatment at an ER can be 10 times as costly as treatment at a clinic where employees' costs are covered by company insurance, the newspaper said.)
The 35 businesses, located in Volusia and Flagler counties in Florida, took action beginning in 2012. As participants in Florida Health Care Plans' Worksite Wellness program, they identified ways to incentivize their employees to stop using the ER as a quickie clinic.
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The newspaper reported that ER trips have been cut by 15 percent to 20 percent. The city of Port Orange, also a plan member, saw trips drop by one-third.
Among the actions taken by plan members: guaranteed same-day appointments at clinics covered by the insurance, which were aided by longer clinic hours; reduced co-pays at the clinics; and inclusion of designated urgent care centers that employees can visit, where they were offered a reduced co-pay of $10. The typical urgent care co-pay, the newspaper said, is $50.
"Our employees have the ability to tend to their health care needs more quickly than they could elsewhere," Port Orange Administrative Services Director Donna Steinebach told the newspaper. "One of the key items that drives insurance rates is emergency room visits. The lower emergency room utilization rate you have, the better rate providers will give you."
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
