Senate subcommittee hears ideas for cutting nonurgent ER use

A Senate health subcommittee today examined how diverting nonurgent emergency department visits can help providers deliver better care and reduce costs, as the Government Accountability Office released a report (PDF) detailing strategies that community health centers are implementing to help reduce emergency department use.

Debra Draper, director of healthcare at the GAO, said at a hearing of the Senate Health, Education, Labor and Pensions Subcommittee on Primary Care and Aging that per capita emergency department use in the U.S. rose 11% from 1997 to 2007. In 2007, there were about 117 million visits to emergency departments—and among those, about 8% were deemed nonurgent.

Draper said many of those nonurgent conditions could be treated in other settings, such as community health centers. Community health centers treated about 18.8 million patients at an average cost of $600 per patient in 2009, according to hearing witness Jim Macrae, associate administrator of the bureau of primary healthcare at the Health Resources and Services Administration. The GAO report found that one strategy health centers are employing to lower emergency-department use is to collaborate with hospitals to divert emergency-department patients by educating them about health-center services.

But Peter Cunningham, director of quantitative research at the Center for Studying System Change, said a major issue is hospitals' willingness to shift some of their patients to these facilities.

"In a lot of cases, they're very cooperative, and in other cases, they're not,” Cunningham said after the hearing. "And the reason is because they see the emergency room as a conduit for moving patients into their inpatient so they can they generate revenue," he added. "To the extent that there is a community health center that is trying to encourage more use outside of the emergency room, they might be selective in terms of the patients," he said of the hospitals.