AFTER-HOURS CARE: Gaps in Access Drive Patients to ER
Despite managed care's efforts to reduce emergency room visits, many "plans have left their members no place to go but the ER" due to the difficulty of obtaining appointments with booked primary care doctors and the lack of after-hours walk-in clinics, the Wall Street Journal reports. Nancy Auer, vice president for medical affairs at Seattle-based Swedish Medical Center, said, "Waylaid managed-care patients contributed to a 20% increase in ER visits for the first four months of this year" at her facility. Margaret Stanley, executive director of Seattle- based Regence BlueShield's HMO, said, "I don't think anyone would say we have an optimal situation for patients to get care after-hours and on weekends." Adding insult to injury, managed care plans sometimes refuse to pay for ER care -- a situation the patient-protection bill passed by the Senate last week seeks to halt by requiring self-insured "health plans to cover ER bills in" emergency situations. Health plans typically hire an on-call doctor to respond to after-hours and weekend calls and refer patients to the ER if necessary, while physicians under indemnity plans often pool their resources to offer extended hours. However, Princeton University economist Uwe Reinhardt argues that sending patients to the ER is "more efficient than building a new system," adding, "By threatening not to pay for it, you create what I call a 'psychological co- payment.' The jawboning and bullying reduces the use." One exception is Puget Sound-based Group Health Cooperative, a not-for-profit HMO that features a walk-in clinic open until midnight seven days a week (Jeffrey, 7/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.