In my previous post on health care costs, I argued for further adoption of technology to help alleviate the long term cost issues that are plaguing Medicare. I briefly mentioned the impact the transparent appointment system we are creating at SavvyDoc will help to alleviate the over-crowding in emergency rooms. I was prompted to spend today relating the trickle down effect of web based doctors appointments on the ER because of this Wall Street Journal Health blog post describing recent research showing that the uninsured are NOT to blame for ER overcrowding. This is a common misconception that I am glad the WSJ picked up on. The uninsured unfortunately avoid health care all together. The cost of an ER visit is significantly more expensive than an office visit, so to think that uninsured patients are going to the ER for a bad cold is a false premise. The question then becomes why are insured patients visiting ER’s with such frequency? Thanks to the work being done at the Institute for Health Care Improvement a lot of the reasons for this phenomenon have been illucidated.
Before I go further, the primary source for the statistics in this post come from this JAMA article by Dr. Mark Murray (the link is to the abstract, you will need to visit your local library or have a JAMA account for access to the full paper).
In his paper Dr. Murray argues that issues with health care access are actually due to delays in obtaining care. For instance, in 2001 it was found that 40% of ER visits are not urgent and could in fact be seen in a primary care office setting. I have not seen recent research on this, but as the population ages I would imagine this percentage is increasing. Imagine for a moment the improved wait times in an ER if half of these patients were able to easily obtain a last minute office appointment rather than going to the ER. Realizing that the median ER visit is four to five times more costly than an office visit, think of the economic implications of patients easily finding an open office appointment rather than going to the ER. There are billions of dollars to be saved just by fixing this one problem in our health care system!
The follow-up question: why do patients see it as easier to sit in an ER for hours rather than going to a doctor’s office? Well, at least patients know they can be seen in a somewhat timely fashion in the ER. In 2001 1 in 3 patients reported an inability to find a timely appointment this increased from approximately 1 in 4 patients in 1997. Again, this number is likely rising as our population ages. It does not take a stretch of the imagination to realize patients who cannot find a timely office appointment are deciding to go to the ER for care.
Solution. A transparent wed based appointment system would allow patients to look for any last-minute appointment openings. Patients who desire last-minute care would prefer to see the doctor they are familiar with. Searching for that doctor on SavvyDoc, will allow patients to see if there is availability within the next 24 hours. If that doctor does not happen to be available then further searching will allow patients to find a doctor within their area that is available. The alternative is to walk into a crowded ER waiting room where the patient has no information on who their doctor will be. Our market research to this point has shown that patients overwhelmingly see the value of making on-line appointments with their doctor. Patients are becoming more savvy about how to use the internet for researching information on doctors as well as information on their health. Providing the opportunity for patients to have more control over the appointment making process has wide ranging benefits, this impact on reducing unnecessary ER spending is one of the most significant.