Zurik: Non-emergency ER visits draining public coffers

Zurik: Non-emergency ER visits draining public coffers

NEW ORLEANS (WVUE) - From gunshot wounds to heart attacks: When people fight for their lives, an emergency room can be their last chance for help. But some Louisianans go to the ER for hangnails, blisters, warts, even sunburn.

"It's clearly abuse," says State Treasurer John Kennedy. "This is outrageously expensive."

And these ER trips have a catch - you're paying for it.

"When someone goes to an ER to have a wart removed or talk about their insomnia, that takes taxpayer money away from low-income people who really need it," Kennedy warns. "It's all taxpayer money."

State and federal money fund the Medicaid program. Our review of one year's worth of Medicaid emergency room trips found tens of thousands of apparent non-emergency visits.

Medicaid recipients visited the ER for fussy infants, throat pain, postnasal drip, patients feigning illness, even routine health exams.

"All of these things could be treated at about one-fifth of the cost at a private clinic," Kennedy says.  "And that's just a fact."

"In a best practice, those patients would be treated in a clinical setting, not an ER setting," says Jefferson Parish Coroner Gerry Cvitanovich.  "Much cheaper."

Take a typical upper respiratory infection.  In addition to his public duties, Cvitanovich is also the chief medical officer of 13 local urgent care clinics.  Cvitanovich says a physician in an office can treat that infection for $75 to $125. In an urgent care, the cost will run $100 to $150.

And Cvitanovich says an ER cost could be between $600 and $1000. That's a significant difference.

"But the ER's got a lot of costs to be open 24 hours a day, fully staffed, 365 days a year," Cvitanovich notes.

A bill filed in this legislative session would add an $8 co-pay to any Medicaid recipient who visits the ER for a non-emergency.

"If you don't have an emergency and you go to an ER, you're going to have to pay for part of that care," says Rebecca Gee, who now leads the state's Department of Health and Hospitals. "So we support measures that help individuals take responsibility for using ER's when it's not an emergency."

That bill has stalled in the legislature.

"The poorest of the poor can't afford higher co-pay," says Rep. Kenny Cox, a Natchitoches Democrat who sits on the House Health & Welfare Committee.  "I think what we do is, they get better access, then we educate them so they understand that the times that they have to go to the emergency room has to be an emergency."

According to the Legislative Fiscal Office, 131,000 Medicaid ER visits last year were for non-emergency services. What's unclear is the actual cost to taxpayers.

"Until you put the message out and educate them, you're going to continue to have that happen," Cox says.

According to state leaders, part of that education should include stopping some hospitals from enticing patients.  Some have an app or a website that displays current ER wait times.

"Listen: If you really have a true emergency, do you have time to look at an app and see who has the quickest wait time?" Gee asks. "No, you're going to go to the nearest facility and you're going to get triage, and if you're really sick you're going to get in quickly.  So there shouldn't be a reason for these apps."

Among our findings was a patient who went to the ER 120 times in one year. Sometimes this patient went three times in one day. Most of the time, the reason: abdominal pain.

"We need to establish a database so that emergency rooms talk to each other across the state," says the state treasurer, "so we can identify this relatively small universe of chronic abusers, and try and manage their care better."

These are millions of taxpayer dollars spent on acne, sprains, coughs and headaches that could instead go to people who really need the help for real life emergencies that could mean the difference between life or death.

"This is something both conservatives and liberals ought to agree to," says Kennedy, a Republican.  "When people abuse emergency rooms using taxpayer dollars, obviously it costs money and adds insult to every taxpayer in this state. But it also takes away resources from poor people who really, really need the help."

DHH says, when Medicaid is expanded, those ER numbers should go drop some as more clients learn of more options for their medical care. The Public Affairs Research Council says non-medical ER visits, while still a problem, have been reduced over the last 10 years.

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