Excellus report: many emergency room visits in New York could be avoided

DeWITT, N.Y. — Patients seeking treatment for 10 “common” conditions represent more than 2 million annual visits to hospital emergency rooms (ERs) in New York state at an estimated cost of about $1.3 billion.

Research that Excellus BlueCross BlueShield conducted found that nine out of 10 visits to the ER for these conditions “could have been avoided or treated elsewhere,” the health insurer said in a news release issued Wednesday.

Rochester–based Excellus is the largest health insurer in Central New York.

The health plan analyzed “potentially preventable” emergency room visit data issued by the New York State Department of Health.

Of the 6.4 million visits made to New York hospital ERs in 2013, more than 2 million involved “common” conditions such as ear or sinus infections and sore throats.

The other conditions that New York state places in this category are headaches; back and neck problems; abdominal pain; nausea, constipation, and diarrhea; urinary-tract infections; bumps and bruises; and joint aches and pains, according to an infographic Excellus included with its news release.

The state considers “potentially preventable” ER visits as ones in which patients “could have been” treated outside of the emergency room, or their conditions “could have been” avoided altogether through “better” care coordination and “quicker” access to primary and preventive care.

“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,” Dr. Richard Lockwood, VP and chief medical officer at Excellus, said in the release. “Emergency departments are vital community resources and should be reserved for patients with significant trauma and conditions that are potentially serious.”

Excellus said it used an extrapolation of its upstate New York health-insurance claims data to “conservatively” determine the $1.3 billion estimated cost of the statewide visits.

Spending is “likely” to be much higher because costs in the New York City metropolitan area are “typically greater,” the insurer added.

“The best method of care for nearly all of these cases is for patients to see their primary-care doctors in office visits,” said Lockwood. “But when the physician isn’t available, many of these potentially preventable ER cases can be addressed with telemedicine visits or going to urgent-care centers at considerably greater convenience and less cost.”

The cost analysis assumes that if a patient were to skip the ER and see his or her doctor for a minor condition, the office visit with the physician would take about 10 minutes and include a limited exam and treatment.

“For the 10 common conditions, telemedicine demonstrates itself to be the most convenient and cost effective alternative when your physician isn’t available,” said Lockwood. “Many may not realize that telemedicine providers can write prescriptions,” he added.

Effective this past Jan. 1, health insurers in New York are mandated to cover telemedicine visits by customers who are enrolled in their commercial products, Excellus said.

New York describes telemedicine as “the use of electronic information and communication technologies by a health-care provider to deliver health-care services to an insured individual who is located at a different site than where the health-care provider is located,” according to the Excellus news release.

Contact Reinhardt at ereinhardt@cnybj.com