ER visits in Indianapolis - New hard lines to reduce non-emergency cases

Because of the frustrating situation at the emergency room, Anthem Inc, Indiana largest health insurer, launched the message to save ER from false emergencies. People will be responsible for the cost of the care if hte reason is not a real emergency.

Often ER attendants assist patients who have not so serious emergencies, like people that feel chest pain only because of an indigestion. So the use of ER heavily incresed.

However, some physiciansare afraid that patients might avoid going to the ER for a true emergency if they are frightened by the prospect of receiving a large medical bill.

Dr. Richard Fogel, the cardiologist and chief clinical officer at St. Vincent Health declares:

“We shouldn’t put the onus on patients to make potentially very difficult medical determinations. If somebody has chest discomforts they’re concerned about, we think the ER is the best place for that to be evaluated.”

But as we said, he believes also that ER should not be a catch-all for minor non-emergencies, such as cuts, scrapes and sore throats. Like most large health systems, St. Vincent has an extensive network of hospitals, urgent-care centers and doctors’ offices to treat various types and levels of medical problems.

Anthem calculated that currently, in the whole nation, nearly three-quarters of ER visits are for non-emergencies. That is why insurers have been trying to discourage unnecessary use of the ER for years, sending brochures and letters to members, employers and benefits managers.

So about 18 months ago, Anthem began to consider other options, and decided to clamp down on reimbursements for unnecessary ER visits.

“It’s not a draconian program that we’re rolling out here,” Fox said. “We don’t want that to be misunderstood or misconstrued.”


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