How Telemedicine Companies are Changing the State of ER Care
December 22, 2015
First Stop Health
Emergency rooms are often crowded, intimidating, expensive places to be. When used for their original intentions –– to offer rapid medical assistance in emergency situations––they provide an essential service in the medical industry. But according to the American Medical Association, 40-55% of emergency room visits could be avoided if patients could just speak to a physician over the phone before deciding how to get care.
Dr. Mark Friedman, an emergency physician and a co-founder of First Stop Health, sat down with us to talk about the relationship between telemedicine and emergency professionals. His insight will drastically change your experiences with emergency rooms:
Dr. Friedman is Assistant Clinical Professor of Trauma and Emergency Medicine at the University of Connecticut. He is a nationally recognized expert in medical cost containment, serving as an adviser to various government entities on medical billing, fraud and abuse.
Q: Why have emergency care facilities become overcrowded and often misused for minor injuries or illnesses that should be treated by primary care physicians?
A: “When I first went into the emergency department as a medical resident, we actually had a nurse who sat out in front of the emergency room: She was the gatekeeper. She was the triage officer. You would have to get past her to get into the emergency room. If all you had was a runny nose, she’d give you tissues and tell you to go home. And if what you needed was an appointment with your family doctor, she’d pick up the phone and make you an appointment. If you needed a referral, she’d tell you who to call and make an appointment with.
But this was done away with because people were being turned away from emergency departments in for-profit hospitals, mainly because they couldn’t pay. So a federal law was passed––the Emergency Medical Treatment and Labor Act (EMTALA). What this did was ensure that you would not be turned away due to your inability to pay (or really for any other reason) without being screened by a physician. This legislation basically said no one can be turned away from an emergency room anywhere––for any reason whatsoever.
That’s why all emergency rooms now have an open-door policy where no one is turned away. It has this sort of magnetic pull on people. If it’s Saturday night, and you can’t get a hold of a doctor, you think, ‘Oh well, we’ll just go to an emergency room. They’re always open, and they’re not going to turn us away.’”
Q. Why are telemedicine companies changing this now? What is the sudden draw to solving this decades-old problem?
A. “Now, as things are changing, people are suddenly being asked to pay for all of this. Insurance companies are saying, ‘Well, you know, it really wasn’t an emergency.’ Or, ‘You still have a $1,500 deductible or co-pay for emergency care.' People have a financial incentive to decide if this is really an emergency. And who better to tell them if it’s an emergency than an emergency physician?
If you can call an emergency physician, or really any physician, and talk to them for three or four minutes, we can tell you in the first 30 seconds if you need to go to the emergency room or not. If you do, you’re encouraged to go. If you don’t, we just saved you a whole pile of money and a lot of time.”
Q: What do emergency physicians think of how telemedicine companies are affecting the state of emergency care?
A: “There’s sort of a natural conflict of interest here: First-off, [seeing patients with minor injuries or illnesses] is revenue. Second, it’s easier to treat these things faster. But in terms of society, and what’s cost-effective and efficient, no––we don’t want those cases in the emergency room. It’s inconvenient for the patient, and it’s expensive.
From a cost efficiency standpoint, from a societal standpoint, and from a fiscal standpoint, the best thing to do is to send patients to the emergency room only when they have a true emergency that requires emergency medicine or care. We can take care of anything less with a lesser level of complexity, like on the phone.”
Q: Why should employers invest in telemedicine specifically to avoid emergency room claims?
A: “Because the employer, if they’re self-insured, is going to save that money. If they’re not self-insured, then it’s possible (depending on how their rates are figured) they could get a lower rate. And their employees are likely to save money in high deductibles and co-pays, because they might be on the hook for a big chunk of the cost of an emergency room visit.
And then there’s the whole issue of convenience. If your employee has just spent the whole night in the emergency department, how effective will he be at work the next day? Or maybe he’s going to take the day off work to go to the emergency room, where he’ll potentially wait for five hours.”
Emergency rooms are being used by patients to treat illnesses that can be treated with a simple, three- to four-minute consultation with a doctor. Telemedicine has the ability to divert unnecessary ER visits, saving thousands of dollars and hours of time for employers and employees. If you want to save your company money, lower your employees’ healthcare costs each year, and save time for everyone involved, it’s time to consider adding telemedicine to your benefits plan.