Focus on optometry care shows positive impact of curbing ER visits

Kudos to a coalition of business groups striving to reduce unnecessary emergency room visits (“As health costs rise, a push to curb ER visits,” Page A1, Dec. 12). Health care provided at the appropriate time and setting is always more efficient.

While it is essential to invest more resources in primary care to increase capacity and provide alternatives to the ER, we also need to educate patients about services that are already available. Primary care clinicians provide urgent care daily, yet many patients go to the ER for conditions that could have been managed in a timely manner in their “medical home.”


This model can also apply to specialty care. Through a federally funded University of Massachusetts Medical School project, we have fostered this approach among optometrists, who provide primary care for the eyes. We track data on concerted efforts to reduce use of the ER for eye conditions that are amenable to office-based treatment. In one year, 3,000 unnecessary ER visits have been avoided, demonstrating a savings of $2.7 million in Massachusetts while improving patients’ experience.

These findings suggest that expansion of this approach is worth pursuing. It works best when there is an established patient-physician relationship, and when patients first call their primary care provider to determine whether the ER visit is truly necessary.

Dr. Ronald Adler

Jay Flanagan

Dr. David Polakoff

University of Massachusetts Medical School


The writers have been addressing the ER issue within the Southern New England Practice Transformation Network, as part of an initiative funded by the Centers for Medicare and Medicaid Services.