When Allie Van Deusen fell four years ago and broke her left arm, it didn't occur to her mother to take her to the emergency room.
She took Allie to Excelsior Orthopaedics Express instead.
Several other parents whose kids took similar spills in the same Lancaster neighborhood, and had taken their loved ones to the orthopedic urgent care center in Amherst, recommended Danielle Van Deusen do the same if it became necessary.
“When we walked in, it wasn't like a hospital or ER,” Van Deusen said. A specialist saw them within a few minutes, eased the fears of mother and daughter (in Allie's case, a Teddy Bear helped) and got them quickly back to the Excelsior X-ray room. When the fracture was confirmed, Allie got to pick the color of her cast: hot pink.
“We were on our way in a couple hours start to finish,” her mother said. “It was wonderful.”
Excelsior Express is among several emergency room alternatives on the Western New York health care landscape, though many have yet to discover them. Roughly one in three visits to New York State hospital emergency rooms could be avoided or treated elsewhere, according to a Univera Healthcare report released this month.
The insurer analyzed “potentially preventable” ER visit data from the state health department and found that of 6.4 million visits to hospital ERs in 2013, more than 2 million were for common conditions that included ear infections, headaches, back and neck problems, abdominal pain, nausea, constipation and diarrhea, urinary tract infections, bumps and bruises, and joint and muscle aches, pains, strains and sprains.
“Compared to treatment received in a primary care setting, a telemedicine visit, or an urgent care facility, the ER has the longest wait times and highest expenses, including out-of-pocket costs,” said Dr. Richard Vienne, Univera vice president and chief medical officer. “Emergency departments are vital community resources and should be reserved for patients with significant trauma and conditions that are potentially serious.”
An ER visit costs nearly eight times more than seeing a doctor, 3.5 times more than going to urgent care and about 15 times more than telemedicine, Vienne said.
Like it or hate it, the health care system emerging from the Affordable Care Act was designed to prevent and treat sickness, disease and trauma in ways that are effective, but least costly. Those who learn to move through the system best will save money, time and aggravation. Here's how to do so in an emergency.
FIRST LINE OF DEFENSE
Those who suspect they have a condition that falls within a potentially preventable emergency room visit should generally look for medical advice from their primary care doctor.
“There's always somebody on call and they can do some triage over the phone and determine whether it's OK for you to be seen in the office or go to an emergency department or to an urgent care,” said Dr. Richard Elman, chairman of the Catholic Health Department of Emergency Medicine.“We don't discourage anyone from coming to the emergency department. Our doors are always open. We will be happy to see, evaluate and treat anybody who crosses our threshold. That being said, there are people who come to the ER that probably could be managed in a doctor's office or urgent care setting.”
Still, he stressed, “If somebody's having chest pains or signs of a stroke, or if they're acutely short of breath or having significant belly pain, those patients should come directly to the emergency department. Symptom complexes like that can often be very serious and they don't belong in urgent care.”
Telemedicine has been used in Western New York for the last decade, but mostly to get patients with stroke symptoms in rural areas on screen and quickly in front of a neurologist, Elman said. Psychiatrists and other specialists also have used the technology for online mental health assessments.
A new state law requires insurers to cover the cost of a telemedicine visit, so Elman and other emergency medicine specialists expect the service to become a growing tool provided by primary care doctors, specialists, emergency rooms and urgent care centers.
Insurers already have entered the mix. Those covered by Univera have access to MD Live, a service that costs $49 to consult with a doctor by computer or smartphone. The arrangement can address many conditions identified in the Univera report that can be remedied with a prescription and sound medical advice, said Dr. Marybeth McCall, a medical director with the insurer in the Utica region and the insurer's expert on telemedicine.
McCall talked about a pilot program that connected sick babies in Utica with a pediatric cardiologist in Syracuse. “He would see the baby and a pediatric echocardiogram via a webcam, and decide whether to put the baby in an ambulance or not. We reduced our transport of new babies from Utica to Syracuse by 80 percent.”
Dr. Mark Pundt is CEO of the Medical Division of MASH Care Network, which runs six urgent care centers in Erie County and one in Olean, and emergency departments at Gates Vascular Institute and Brooks Memorial Hospital.
“We are considering becoming involved in telemedicine,” Pundt said. “We feel it's part of the continuum of episodic care.”
Pundt said he also sees a day when state lawmakers will approve a “limited services clinic” model, used in grocery and drugstores in other states, which allows physician assistants and nurse practitioners to diagnose minor ailments and handle treatment.
Meanwhile, urgent care settings gain in popularity. Co-pays at these sites can cost as little as $20 but run up to $100, depending on your health insurance, and often cost about one-third of emergency department care. In some cases, you can see a specialist.
Excelsior Express is one of at least three medical practice-based clinics that handle emergency orthopedic cases that include strains, sprains, minor dislocations and closed fractures. Its staff advises emergency room visits for those with potentially life-threatening injuries, head trauma or fractures in which a bone breaks the skin.
“It's not a back door into the office for someone who's had knee pain for a few weeks; it's designed for acute injuries – the slips and falls, athletic injuries, work injuries,” said Dr. Lisa Daye
See related stories, Pages 4, 15