JOHNSON CITY, TN (WJHL) – While TennCare patients are costing taxpayers tens of millions of dollars for what are often unnecessary trips to the emergency room, health experts say those non-emergent ER visits are an indication of a much larger problem. Our investigation found the problem cost taxpayers in Tennessee almost $85 million in one year alone.
“It isn’t just a Medicaid problem,” TennCare Chief Medical Officer Dr. Victor Wu said. “It’s across the country. All different insurers and states are struggling with this issue.”
TennCare data revealed patients went to the ER for common colds, fevers, toothaches and other non-emergencies in fiscal year 2016. Health experts say primary care or urgent care doctors are better trained and suited to treat those conditions, while the ER should be used only for life or limb threatening health problems.
They say not only can patients get better care for their chronic and non-emergent problems outside of the ER, that care is also less expensive at a doctor’s office or urgent care facility. For example, while Medicare pays a doctor’s office or urgent care facility $92 to treat a common cold, Medicare pays an ER $264, which is almost three times as much.
A 2014 Centers for Medicare and Medicaid Services bulletin suggested three strategies for reducing non-urgent use of emergency departments. Those strategies include broadening access to primary care services, focusing on frequent emergency department users who make up 4.5% to 8% of all ED patients but account for 21% to 28% of all visits and targeting the needs of people with behavioral health problems.
Doctors say one of the top things you can do to help the situation is to schedule regular appointments with a primary care doctor throughout the year, even when you’re not sick.
For those who are uninsured or underinsured, we’ve compiled a list of organizations that can help patients achieve that goal and provide care for non-emergencies.
Health experts say if you are unsure whether your health problem is life threatening, you should always err on the side of caution and go to the emergency room.
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