April 2, 2019
Assessing Efforts to Curb Inappropriate Use of the Emergency Room
The rising costs of health care in the United States have led some insurers and Medicaid programs to implement incentives to discourage the inappropriate use of emergency rooms. While these incentives reasonably try to shift patients toward high-value care, AAF’s Deputy Director of Health Care Policy Tara O’Neill Hayes notes that they could instead discourage appropriate use of ERs in true emergency situations.
If the primary reason for inappropriate use of ERs is a lack of access to alternative, more appropriate care settings, then the best way to shift care away from ERs is likely by providing greater access to other care settings at all times of the day. Insurer inducements for patients to become familiar with these alternative sites of care and confirm a primary care provider, for example, are now commonplace. These initiatives may require additional care locations or extended hours and/or staffing at existing locations. It may also entail providing transportation options, such as through ride-sharing services, to individuals unable to get to a doctor’s office or urgent care center.