With increasing focus from Medicare on reducing rehospitalizations and shorter stays, eliminating unnecessary emergency department visits (such as visits that could have been handled safely in an urgent care clinic or a primary care setting) and avoiding the need to use the emergency department in the first place is paramount.
71% percent of emergency department visits could have been treated safely in an urgent care clinic or primary care setting, or did not require urgent care, according to a 2013 study by Truven Health Analytics. The average cost of an emergency department visit was $1,233 in 2013—around 40 percent more than a month’s rent at that time. One in five Americans with private health insurance still struggle with medical bills.
Why Are Emergency Departments So Crowded and Costly?
Not only are emergency department visits costly, the department itself may be overcrowded, leading to long wait times. Life-threatening injuries and conditions must be prioritized, leaving those with less urgent needs to wait, often for hours.
Long wait times at an emergency department are driven by a few factors. Sometimes, consumers may use the emergency room for conditions such as a high fever, broken bones, and severe bleeding, without knowing that they may have other options (such as their primary care provider or an urgent care clinic) open to them. Uninsured patients may use the emergency department for care that is available through other channels, since emergency departments are always open and don’t turn patients away. This can also feed into high costs; if one patient can’t pay for their care, costs will rise for everyone else as the hospital tries to break even.
Mental Health Crisis Emergency Department Visits
For mental health patients, the necessity is often even stronger, yet emergency departments often don’t know what to do with a person in a mental health crisis. Mental health patients may be discharged abruptly and without warning, early or when the department runs out of beds.
Often, mental health patients will go to the emergency room because they don’t know where to go, or they don’t have anywhere else to go. While they may be on a waitlist (often up to 3 months long) to see a psychiatrist, if they undergo a crisis, they may go to the emergency room because the psychiatric provider does not have the time to see them, or they may not have insurance.
However, emergency departments can be loud, crowded, and may not have enough beds or a psychiatrist on staff. An individual with a mental illness should not hesitate to use the emergency department, as this may save his or her life. However, if any better course is open to him or her, the emergency department should be considered a last resort.
How Telehealth Can Help
With quality ongoing behavioral healthcare, many emergency department visits may be prevented. Relationships between psychiatric providers and patients make it possible to catch mental health problems long before the patient ends up in the emergency room.
Telehealth, particularly telepsychiatry, can help reduce hospital visits by building relationships with residents. This often leads to residents sharing symptoms they might not otherwise talk about with medical staff, for physical as well as mental health conditions.
Another way telehealth can reduce emergency department visits is through a program similar to the one in use by American Medical Response in New Mexico. American Medical Response identifies patients in need of proactive care and performs assessments of multiple dimensions of risk to avoid preventable hospitalizations.
To read more about similar programs, visit https://www.nejm.org/doi/10.1056/NEJMp1516100.
Memorial Hermann Health System in Texas uses patient navigation to reduce use of the emergency room for primary care. Telehealth can do the same—in urgent situations, calling a nurse hotline can help patients determine whether they should go to the emergency department, to an urgent care clinic, or to their primary provider. For mental health, the telehealth provider can act as a last resort before taking the patient to the hospital.
To read more about situations in which the emergency department should always be used, visit https://www.parentgiving.com/elder-care/avoiding-unnecessary-emergency-room-visits/.
Even some police departments use variants of telehealth to reduce emergency department utilization by using other resources and trying to resolve mental health crises in the field.
Integrating Mental and Physical Healthcare
Comorbidity between mental and physical health conditions is well-documented. People with mental health conditions are more likely to die of physical illnesses. When the mental health condition is treated, not only is quality of life improved; physical health is also improved, further reducing the potential need to visit the emergency department.
To read more about the benefits of integrating mental and physical healthcare, visit https://www.healthcare-informatics.com/news-item/population-health/study-integrating-mental-and-physical-healthcare-services-leads-better.
Reducing emergency department visits does not only reduce costs and time spent in the waiting room. It also reduces stress on residents, since they do not have to wait in long lines in a loud and crowded room for their turn to receive care. A psychiatric provider, partnering via telehealth, may identify many health conditions before they can reach the point of needing an emergency department visit, as well as improving both mental and physical health by addressing mental health needs.
To read more about emergency department medical costs, visit https://www.consumerreports.org/money/avoid-big-medical-bill-from-emergency-room/. To learn how to determine when it’s better to visit an urgent care clinic or your primary provider, visit https://thebenefitsguide.com/cost-care-emergency-room-cost-usage/ or talk to a primary care provider or a nurse practitioner.
Katherine Hartner is Encounter Telehealth’s Social Media and Marketing Intern. She is studying journalism, with a concentration in PR and advertising, at UNO. She has written multiple articles for the Gateway, UNO’s student-run newspaper, and is active with MavRadio, UNO’s college radio station. In her free time, she enjoys writing fiction, gardening, and volunteering.