Business groups aim to curb emergency room use, and save money, too

The emergency room of Morton Hospital in TauntonJonathan Wiggs/Globe Staff

Hospital emergency rooms are supposed to be for patients with severe medical conditions who need care right away.

But in Massachusetts, emergency rooms are too often used by people who don’t have emergencies at all and instead could be seen in a doctor’s office or other clinic, according to new state data.

On Tuesday, a coalition of business groups representing thousands of employers kicked off an ambitious new effort to reduce these potentially avoidable emergency room visits, and in the process lower health care costs by up to $100 million.

Companies in the coalition will pepper their employees with fliers, memos, and meetings about alternatives to emergency rooms, such as walk-in clinics and telehealth services. Companies might also decide to change copays to encourage their workers to use lower-cost health care settings — charging more for emergency rooms, for example, or less for primary care.

“It’s telling the employees how to use the health care system in a smart and efficient way,” said Richard Lord, president of Associated Industries of Massachusetts, one of the business groups leading the effort.

Efforts to tackle emergency room visits have been tried before, but Massachusetts business leaders said this latest attempt is more likely to succeed because it has the backing of a broad coalition of employers, hospitals, insurers, emergency physicians, and the state Health Policy Commission.

A similar effort by businesses in St. Louis is starting to show results, according to Louise Y. Probst, executive director of the St. Louis Area Business Health Coalition. After local employers raised copays for emergency room visits to $150 to $350 or more, and took steps to educate workers and build relationships with local doctors, emergency room visits declined 5 percent by the end of 2017. “We felt that was pretty positive,” Probst said.

The Massachusetts Health Policy Commission, a state agency that studies health care costs, said Tuesday that 39 percent, or about 1 million Massachusetts emergency room visits in 2016, could have been avoided — meaning patients didn’t need immediate care, or could have been treated in a lower-cost setting such as a physician’s office. The commission also found Massachusetts residents use emergency rooms at a higher rate than the country as a whole.

In a 2017 state survey, Massachusetts families who get health coverage through their employers acknowledged that 1 out of 3 of their recent emergency-room visits were for nonemergencies, the commission said.

The commission noticed similar trends in emergency room use for people of different ages and income levels, and among those covered by both public and private insurers.

“This is not an urban problem, a suburban problem, or a rural problem — this is a problem that spans the entire Commonwealth,” said David Seltz, executive director of the commission. “This is an opportunity to drive savings in the Commonwealth.”

David Seltz, executive director of the Health Policy Commission, at a commission meeting in October.The Boston Globe

The business coalition set a goal of reducing avoidable emergency room visits by 20 percent in two years, potentially saving up to $100 million in health care spending statewide.

The effort, if successful, could have implications for millions of people who get their health coverage through an employer and could help slow the increase in insurance premiums — a growing burden both for companies and their workers.

But the lofty plan is likely to face serious challenges. Many people end up in emergency rooms because they don’t have other options. The state survey last year found that in 62 percent of cases, families went to the emergency room for nonemergencies because they were unable to get a doctor’s appointment as soon as needed.

Urgent care clinics have been proliferating across Massachusetts and the country, providing new options for many patients. But these clinics are typically closed at night, prompting some people needing medical attention to continue visiting the emergency room.

To reduce unnecessary emergency room visits, Dr. Scott G. Weiner, president of the Massachusetts College of Emergency Physicians, said employers also should work to make sure their workers have access to primary care and urgent care, especially on nights and weekends.

“This is a much bigger issue than it sounds like on the surface, Weiner said. “Solving it will be a challenge.”

Christopher F. Koller, president of the New York-based Milbank Memorial Fund, which focuses on health care, said employers should also help workers develop relationships with primary care providers.

“Patients with a trusting relationship with their primary care doctors are going to call them before they go to the emergency room,” Koller said. “Employers can facilitate that. [They should] not only discourage emergency rooms — but encourage primary care.”

Convincing people to change behavior is difficult, and employers on Tuesday acknowledged their efforts could face pushback from workers who may be worried that “Big Brother” is second-guessing their health care decisions.

Dr. Ateev Mehrotra, a professor at Harvard Medical School who has studied emergency room use, said even defining “avoidable” visits is tricky. Sometimes a patient arrives at the hospital feeling incredibly sick, but their diagnosis doesn’t reflect it.

“When a patient is told they have sinusitis, it could have been a headache that was so severe they could barely talk, or a person who comes in with strep throat who couldn’t swallow because the pain was so bad,” he noted. Mehrotra said employers should focus not on the number of visits to emergency rooms, but on the prices hospitals charge for emergency services. “The price per visit is going through the roof,” he said.

Still, Eileen McAnneny, president of the Massachusetts Taxpayers Foundation, is hopeful the initiative will curb costs. The effort also includes the Greater Boston Chamber of Commerce, the Massachusetts Business Roundtable, the Massachusetts Competitive Partnership, and other business groups.

“If we connect the dots for patients about why using an emergency room might not make sense for them . . . I’m confident we will change their behavior and take unnecessary cost out of the system,” McAnneny said.