Nonemergencies in Colo. an urgent problem

STEPHEN SWOFFORD/Colorado Public News

Nonemergencies such as flu or an ongoing headache may bring a patient to the emergency room. Dr. Patrick Maloney, attending physician at Denver Health’s pediatric emergency room, discusses a patient with physician’s assistant Cherie Spinks.

By Ann Imse
Colorado Public News

A survey of 10,000 Coloradans has found that 44 percent of visits to the emergency room are for ailments that could be treated by a regular doctor.

Reducing this figure could cut costs significantly – for the patient, for taxpayers and even the insured. Prices for treatments vary, but Pacific Source insurance found its average cost of treating a sore throat was $127 in a doctor’s office, compared to nearly $500 in an emergency room.

Taxpayers are covering this unneeded cost for Medicaid and Medicare patients. And insured patients get higher rates when the uninsured can’t pay, said Dr. Ned Calonge, president of The Colorado Trust, which sponsored the survey. The study of emergency room use, released Oct. 24, was based on answers in the Colorado Health Access Survey given in 2011. The survey also found that 79 percent of Coloradans using the ER for nonemergencies said they did so because it was after doctors’ hours.

Nearly as many – 63 percent – also said they were unable to get an appointment to see a doctor as quickly as they needed.

This suggests that patients need a more coordinated system of health care, Calonge said. For example, patients in groups like Kaiser Permanente can reach a nurse with access to their medical records 24 hours a day, and get advice on treating the problem at home immediately, or making an appointment or going to a hospital, Calonge said.

Patients without such options can seek doctors with longer office hours, or urgent care clinics.

Francisco Martinez is one of the many Coloradans who ended up in an ER last month, because his 7-year-old son Joseph left school at midday with a severe headache, which has been an ongoing ailment. Martinez, a single father who works 60 hours a week as a cook, had to leave his job to pick up his son.

“I told the boss, I’m sorry, I’ve got to go,” said Martinez. A doctor’s appointment would take days, so they headed to Denver Health Medical Center.

He said he knows the emergency room is more expensive than a doctor’s office, but when it comes to taking care of his kids, “I can’t wait until the next day or something.”

Dr. Christopher Colwell, head of emergency medicine at Denver Health, said he sees many patients like Joseph Martinez, who come to the ER with sore throats and runny noses. Patients or their parents tell him, “‘I don’t have a primary-care physician,’ or ‘I don’t have an appointment for six months’ or whatever, or they can’t see me after 5 p.m.”

Routine medical care is just “impractical” for many patients, he said. The U.S. health system has failed them, he said. “We need to adapt to our patients’ needs, more than trying to make them adapt to our needs.”

Denver Health, like St. Mary’s Hospital in Grand Junction, now has an urgent-care clinic next door to its ER. Patients coming into emergency are checked out and diverted to the clinic if the problem is not serious. Poudre Valley Hospital in Fort Collins has an urgent-care clinic across the street.

Denver Health also is considering adding weeknight and weekend hours to its primary-care clinics, Colwell said.

Dr. Jerry Solot, who works in that urgent-care clinic, says there’s a long waiting list for appointments in the Denver Health primary-care clinics, which treat people who can’t afford care elsewhere. “It can take awhile to get in,” he said.

So the urgent-care clinic was created to ease the burden on the ER and “take care of the urgent, and sometimes the not-so-urgent patients, quite frankly,” Solot said.

The findings of the study contrast with statements from representatives of the American Congress of Emergency Physicians, which recently convened in Denver. Spokesman Dr. Robert O’Connor of the University of Virginia said it was “a myth” that many patients go to the emergency room for minor problems. He cited a study showing less than 10 percent of patients could wait 24 hours to be seen. That doesn’t actually conflict with the Colorado results showing patients said they had minor ailments that needed urgent attention.

Hospital emergency rooms make money on paying patients who come in for minor ailments. So there’s no financial incentive for the hospital to move those patients to a less expensive urgent care clinic, Calonge said.

Solot also blamed part of the problem on a shortage of family doctors, both nationwide and in Colorado.

“We probably see too many people who could be seen in primary care but by the same token, we also know that there are not enough primary care doctors in our country to take care of these patients.”

That is a shortage expected to worsen in 2014, when the new health-care law is to provide coverage for millions more patients.

The survey released this week also found 22.3 percent of respondents statewide had been to an emergency room in the previous year.

The numbers of people using the ER for nonemergency care varied widely among different areas of the state. In the mountain counties of Eagle, Garfield, Grand, Pitkin and Summit, only 12.3 percent of respondents visited an emergency room in the previous year, and only 30 percent of the visits could have been treated by a regular doctor.

Grand Junction’s Mesa County had the highest percentage of respondents reporting a rush visit to the hospital with 31.5 percent, and nearly half that could have been treated in a doctor’s office. In the northeastern corner of the state – Logan, Morgan, Philips, Sedgwick, Washington and Yuma counties – 60 percent of emergency room users said they could have gone to a general doctor had one been available.

The study found that uninsured people actually use emergency rooms less than average.

Higher use was found among people on Medicare, the government health-insurance program for people 65 and older, and Medicaid, the government health-insurance program for people with low income. The study suggested that might be the result of a shortage of doctors who accept new patients from those lower-paying federal insurance programs.

High users were children younger than 5, who typically need quick care for asthma, ear and respiratory infections; people 65 and older than; non-Hispanic blacks; low-income; and people with poor health status or health issues that limited their activities. As incomes rose, use of emergency facilities dropped.

Colorado Public News, a nonprofit news organization, reports on issues of statewide interest. It partners with Colorado Public Television 12, Denver’s independent PBS station.

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