The Overuse of Hospital Emergency Departments for Primary Care

In late December 2019 the members of the Systemwide Emergency and Urgent Care Council (SWEUCC), the council for emergency services at Baptist Health South Florida (BHSF), pored over the emergency department (ED) data usage reports for four of its urban hospitals (Urban 4) for fiscal years 2016-2019. The overuse problem was not getting better. In fact, it was getting worse. The data showed that an increasing number of patients used the Urban 4 hospital EDs for non-urgent care and for medical conditions that could have been treated in a primary care setting Non-urgent care patients were overcrowding the ED resulting in long waits to be seen by a provider, and in some cases, patients left the ED after many hours without having been seen. The overcrowding added stress on ED hospital resources thereby jeopardizing the quality of the delivery of care. If a patient had private commercial insurance, the hospital received payments for the ED visit. Private commercial insurers, however had begun to deny payment for unnecessary ED visits to disincentivize this behavior. The burden shifted to patients to pay the expenses of the ED visit out-of-pocket. Not surprisingly, many patients could not pay the high cost of these medical bills given high policy deductibles or being underinsured. Consequently, the hospitals were sometimes left without reimbursement. SWEUCC convened to evaluate BHSF's options. Their overarching goal was to help standardize care across the organization to increase efficiency and lower costs. "Carevenience" was one of the programs implemented by BHSF in 2017 to solve the patient overutilization problem in the ED. The idea was to provide patients with non-urgent care alternatives including geographically convenient treatment facilities and time-saving appointment options. The Center for Medicare and Medicaid also provided its own best practices recommendations to hospitals to address patient overutilization including broadening access to primary care

• Process improvement
• Healthcare and treatment