“LOWERING YOUR
EMERGENCY
DEPARTMENT COST”
Jacob Meza, MBA
Corporate Director, Valley Health Urgent Care and Occupational Health
Employee Benefits…The Problem
 Healthcare costs have risen an average of 11.1% and now comprise
14.6% of employees’ mean gross annual salary according to a recent
survey from ‘Salary.com.’
 The high cost of health insurance is the #1 concern among small
business owners, according to a study released in August by the
National Federation on Independent Business.
 1/3 of Americans say, not having enough to pay for healthcare is the
biggest concern facing our nation in retirement, according to a new
survey from Edward Jones.
 While employee benefit costs increase, the ability to continue to
participate in retirement plans become challenged.
National Premium Increases
$0
$2,000
$4,000
$6,000
$11,480
$10,880
$3,695
2004
$9,950
$3,383
2003
1999
$12,106
$4,024
2005
$9,068
$3,083
$2,196
Single Coverage
$8,003
$2,689
$2,471
$14,000
$12,680
$4,242
2006
2000
$12,000
$4,479
2007
2001
$10,000
$4,704
2008
2002
$8,000
$7,061
Family Coverage
$6,438
$5,791
Estimate is statistically different from estimate for the previous year shown (p,.05).
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2008
Premium Factors
Non-controllable
 Geographical Location & Employee Demographics
 High dollar claimants…20% of the population drive 80% of the
claims
Controllable
 Plan design DRIVES utilization…utilization drives premium
increases
 Generic vs. Brand name drug utilization
 Usage: Emergency Room versus Urgent Care versus Primary Care
Access to Care (PCP)
(Current Physician Access vs. Patient Demand)
 According to the Department of Health and Human Services (HHS), as
of June 2011, there are nearly 67 million people living in a primary care
Health Professional Shortage Area in the United States.1
 For American’s who do have a regular physician:
• only 57% of Americans report having access to same or next-day
•
appointments with their physicians
63% report difficulty getting access to care on nights, weekends or
holidays without going to the emergency room.2
 Twenty percent (20%) of adults waited six (6) days or more to see a
doctor when they were sick in 2010.3
1.
2.
3.
Designated Health Professional Shortage Area Statistics. Office of Shortage Designation, Bureau of Health Resources and Services Administration (HRSA), U.S.
Department of Health & Human Services. Accessed July 5, 2011.
http://ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR50_Smry&rs:Format=HTML3.2
Primary Care Access: An Essential Building Block of Health Reform. March 2009. National Association of Community Health Centers. Accessed June 22, 2011.
http://www.nachc.org/client/documents/pressreleases/PrimaryCareAccessRPT.pdf
2010 Health Policy Survey in Eleven Countries. Schoen, C. and Osborn, R. The Commonwealth Fund. Accessed July 5, 2011.
http://www.commonwealthfund.org/Content/Surveys/2010/Nov/2010]International]Survey.aspx
Access to Care (ED)
(Current Emergency Department Realities)
 The majority of the nation’s emergency departments report they are
operating “at or over capacity.”1
 Emergency department visit rates increased at twice the rate of US
population growth from 1997 to 2007.2
 Average ED visit wait times have increased in each of the past several
years, rising to over 4 hours in 2009.3
 In addition to patient boarding, a documented contributor to
overcrowding is non-emergency care delivered in the emergency
department. (Recently, several state Medicaid directors have begun
organizing state-funded programs to reduce ED visits used for primary
care.)4
1.
2.
3.
How Overcrowding Affects Your Access to Emergency Care. n.d. American College of Emergency Physicians. Accessed July 6, 2011.
http://www.acep.org/Content.aspx?id=25906&terms=overcrowding
2010 Emergency Department Pulse Report. Press Ganey. Accessed August 17, 2011.
http://www.pressganey.com/newsLanding/10]09]19/Emergency_Department_Pulse_Report_2010.aspx
As Hospitals Push ERs, States Medicaid Budgets Pressured. August 22, 2011. Galewitz, P. Kaiser Health News. Accessed August 24, 2011.
http://www.kaiserhealthnews.org/Stories/2011/August/23/ER]Diversions]Washington]Post.aspx
Access to Care (UC)
Since the mid-90’s the industry has grown rapidly to between 4,000 &
9,000 facilities according to the Urgent Care Association of America, the
industry's trade association.1
 Urgent Cares provide walk-in, no-appointment basis for acute illness or
injury that is not life or limb threatening, and is either beyond the scope
or availability of the typical primary care practice or retail clinic.
 Patient Centers:
More than 350 new urgent care centers opened
between 2008-2009; and from 2009-2010, 380+ were added.
 Patient Wait Times:
57% of patients wait 15 minutes or less to be seen;
About 80% of all visits are 60 minutes or less.2
 Average Urgent Care cost are significantly lower then Emergent Care
cost.
1.
2.
Urgent Care Association of America. Accessed July 19, 2011. http://www.ucaoa.org/home_abouturgentcare.php
http://www.ucaoa.org/resources_stats.php
Emergency Room vs. Urgent Care
Cost Case Study
Franz Ritucci, MD, president of the American Academy of
Urgent Care Medicine, saw a Florida woman in her 40s who
came to him with shortness of breath and dizziness.
Urgent Care Cost: Less than $400
Emergency Room: $2,000 or more
Cost Comparisons on Minor Care
Minor Care Services
Average ED
Cost
Average Urgent
Care Cost
Sprains
Influenza
Minor Lacerations
Headaches – Migraine/Tension
$1,313
$662
$1,215
$976
$250
$150
$320
$200
Emergency Department Utilization
Centers for Disease Control (CDC)
The CDC figures there are about 116.8 million
ED visits per year and about 32 million of
those visits are considered non-emergency
care.
1
1. National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary. Pitts S, Niska R, Xu J, Burt C. National health statistics
reports; August 6, 2010. no 7. National Center for Health Statistics. 2008
Emergency Department Utilization
Anthem BCBS Virginia
Found that more than 60% of ED visits for its
members were for diagnoses that could have
been treated in urgent care centers.
1
After launching a patient education initiative,
Anthem saw a 14% decrease in ED visits in
ONE year!
2
1,2. Emergency Room Interventions Using Google Maps and Education Empower Consumers to Choose ER Alternatives for Non-Emergency
Conditions. June 23, 2011. Wellpoint, Inc. Accessed July 8, 2011.
Winchester UC vs. WMC ER
3000
2500
2183
2182
2095
2094
2093
2016
1991
2075
2297
2285
2254
2143
2141
2195
2000
2006
2008
2202
2184
2081
1999
1655
1368
1500
1424
1250
1235
1000
1310
1233
1217
1213
1301
1340
1236 1105
1125
1140 1267 1300
1250
1228
1108
1097
991
UC-Winchester
500
WMC E.D. East
0
Jan-10
Mar-10
May-10
Jul-10
Sep-10
Nov-10
Jan-11
Mar-11
May-11
Low Acuity Patient Volume Comparison (2010-2011)
Jul-11
Sep-11
7 GREAT REASONS FOR YOUR
EMPLOYEES TO TRY URGENT CARE
1. No appointments needed: Just walk right in!
2. Convenient hours: Clinics are open 7 days a week, with extended
evening, weekend and holiday hours, just like the ER.
3. Less waiting: The average ER visit tops 4 hours; while urgent care
visits are generally an hour or less.
4. Lower prices: Lower copays and out-of-pocket costs, with prices
averaging $110-$250, compared to ER costs of $600 to $2,000.1
5. Many locations: With approximately 9,000 (and growing) centers
nationwide, you can find a location quickly near your home or
job.
6. Fully staffed by doctors: VH UC clinics are always overseen by
doctors.
7. Connections with local ERs: If you need more extensive care,
you’ll be referred to the closest ER.
1 Average Urgent Care and Emergency Room Pricing. Samples pulled from random charts within Valley Health.
Actual costs may vary.
4 GREAT REASONS FOR EMPLOYERS TO
PROMOTE URGENT CARES
 Over 450% less cost on 30%-60% of ED visits annually
 A lower annual utilization cost = less premium increase
 Less premium increase = better benefits with less
employee out-of-pocket expenses
 Better benefits mean happier
employees and less stressed
employers
607 E. Jubal Early Drive, Winchester, VA
Valley Health Urgent Care, Front Royal
WMH Outpatient Center , 120 N. Commerce Avenue
Hours:
Weekdays
8 a.m. to 8 p.m.
Weekends
9 a.m. to 6 p.m.
On-site Digital Radiology
On-site Lab Services
Make the Right Choice…
Head to the Emergency
Department
Loss of consciousness or head injury
Loss of breath
Chest pain
Congestive Heart Failure
Severe bleeding (internal or external)
Obvious fractures
Head to Urgent Care:
Colds, coughs, sinus infections, bronchitis, flu, fever, ear aches
Aches/pains, sprains, strains, bruises, muscle pulls, low back pain
Skin conditions, rashes, small cuts, lacerations
Small foreign bodies in eye, conjunctivitis, corneal abrasion
1st degree burns, small 2nd degree burns
Gastroenteritis of less than 1 day’s duration
Bladder or urinary tract infection
Thank You!!
Questions?