Anthem tries to curb unnecessary ER use [Richmond Times-Dispatch, Va.]

July 22--HENRICO, Va. -- With hospital emergency departments luring patients by advertising short wait times, the state's largest health insurer is asking its members to consider cheaper care at urgent-care centers and in-store clinics when appropriate.

Anthem Blue Cross Blue Shield in Virginia yesterday launched a Google Maps tool on its website that lets consumers search for options such as MinuteClinic, Patient First and doctor's offices that take unscheduled walk-ins.

"From our perspective, if you have a true emergency, the best place to be is the emergency room," said Dr. Jay Schukman, Anthem's regional vice president and medical director.

"But for those conditions where it could be treated in an urgent-care center or a physician's office, that's the most appropriate place to go," Schukman said.

Anthem officials say a review of the plan's fully insured members' ER use for 2008 found that more than 60 percent of visits were "avoidable visits" or visits for problems that could have been treated in an urgent-care or other setting.

Anthem is advising plan members that some conditions, including sore throat, sprains and strains, minor headaches, ear or sinus pain, minor animal bites, stitches and minor allergic reactions, generally can be treated in less expensive settings.

HCA Virginia and Bon Secours Richmond health systems promote short ER waits.

Bon Secours promotes "no wait" emergency care at St. Mary's, St. Francis, Memorial Regional and Richmond Community.

In May, HCA Virginia's Chippenham, Johnston-Willis, Henrico Doctors' and John Randolph hospitals began posting the estimated ER wait times on the hospitals' websites. The estimated times also are displayed on electronic billboards around the metro area.

The Anthem review found the average cost of an ER visit was $441, compared with $98 for urgent-care centers and $52 for clinics inside stores. These costs include what the patient and health plan paid.

"There are times when I am sure [the patient] will get charged the full fare," Schukman said. "There are some hospitals that will transition you over to their urgent-care area as opposed to their emergency area, but generally speaking the charges there are still higher than going to an urgent-care center . . . or a physician's office or a retail health clinic."

Schukman said people may go to emergency rooms out of habit or convenience.

Hospitals get a significant share of their inpatients from people who get admitted from emergency department visits.

"We encourage [patients] to learn when to go to primary care, when to go to emergency care and when to go to urgent care," said Dr. James Dudley, an emergency physician at Riverside Tappahannock Hospital.

"It's important to remember that the [emergency room] is the only place that's always there," said Dudley, a former president of the Virginia chapter of the American College of Emergency Physicians.

In the new Anthem initiative, patients can go to an Anthem website, plug in an address and find nearby retail clinics and urgent-care centers. The website also advises consumers that they can call Anthem's 24-hour nurse information line for guidance.

Anthem also is reaching out to doctor's offices, spokesman Scott Golden said.

"A lot of times they may get a call after hours, and I think the standard response was 'Well, if you feel it's an emergency, go to the emergency room,' which by all means everybody should," Golden said.

The outreach to doctors will focus on medical situations where urgent care and retail clinics are options.

Contact Tammie Smith at (804) 649-6572 or [email protected].

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