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Tuesday, March 15, 2016

Rajesh Harrykissoon, MD

There has been a long running debate regarding "over utilization" of emergency rooms (ERs) by those seeking lower acuity service such as medication refills and minor ailments which may be attended to through an outpatient clinic. However, over the last three decades we haven't been successful at changing this ER utilization pattern. Indeed, growth of ERs nationwide have skyrocketed. A concern is that such misutilization congests ERs with low acuity ailments and those who have a true emergency may be poorly served as they may be a needle lost in the hay stack of medication refills, coughs, sniffles, nausea, etc. To miss a true emergency is devastating for all...but, when we are ill we are selfish. We desire attention now and to heck with the rest. Human nature. ER utilization is driven by convenience. As the neighborhood corner convenience store is to the supermarket so ERs serve as the convenience stores of medical centers. But, you pay for convenience--just like a gallon of milk at the corner convenience store is likely more expensive than at the actual supermarket. An ER room visit is costly because of the mission of their existence--to identify and remedy "emergencies". When you arrive to an ER, the default assumption is that you have an "emergency"--a potentially life ending or life threatening condition that if not identified may lead to end of life or serious harm. Thus, costly evaluation is undertaken to exclude this concern. It's a costly way to refill a prescription, treat a cold, manage some nausea, etc. But, I don't think utilization patterns will change based on cost concern--the customer has already demonstrated a preference for convenience over price. And, let's face it, your PCP's office is unlikely to be open at 2 a.m. on a school night when your child has a fever and vomiting. Perhaps it's time to move from emergency "rooms" to true emergency "centers". Meaning at these locations, in addition to an ER, there is the option of 24/7 cost-effective primary care and urgent care services for those low acuity issues.
from Rajesh Harrykissoon, MD

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