Steering patients away from needless ER visits

Betting on Reno(Editor’s Note: This is the sixth in a series of articles on the Athens uninsured initiative, produced by graduate students in the Health and Medical Journalism Program at the University of Georgia. Visit the previous articles by clicking on the red button to the left.)

When Alvin Dye Jr. of Athens has a health problem, and over-the-counter treatments don’t help, he doesn’t make an appointment with a doctor. He heads for the nearest hospital emergency room.

“A regular doctor visit for me was probably about 10 years ago,” says Dye, 35.


Dye isn’t the only uninsured person who uses the ER for non-life-threatening emergencies. Research shows that uninsured people are more likely to postpone needed care and avoid preventive care, such as annual exams and routine check-ups, because of costs. As a result, medical conditions can worsen, forcing these people to seek treatment, often in the ER.

Providing uninsured working people with affordable primary care is one way to keep them out of the ER, says Josh Cole, member services manager for Access to Healthcare Network (AHN) in Reno, Nev.

AHN is a nonprofit medical discount program for uninsured Nevada residents who meet income guidelines. AHN members pay a monthly fee and in return gain access to a wide range of health and medical services at discounted rates. Athens residents such as Dye may soon have access to similarly discounted health care services as the city is moving to replicate the Nevada plan.

The average cost of a follow-up visit with a primary care physician in Nevada is about $95, but an AHN member would have to pay only $40 to $45 for the visit.

The list of AHN providers in the Reno area is 31 pages long, giving members affordable options for primary care and specialist care, such as cardiology and dermatology. AHN members also have options for discounted vision, dental and urgent care.

“Our goal is to keep people out of the ER, however possible,” Cole says.

Athens Health Network plans to run the replicated medical discount program, which they are calling Athens Health Assurance Program, here in Georgia. However, because the Athens version of the program is still in its planning stages, the costs and procedures for an ER visit for members are still unknown. But the hope is to greatly cut down on the number of emergency visits in the first place.

Members of the Nevada program are required to be evaluated at a freestanding urgent care center first, at $70 per visit, before going to the ER, which is $400 per day/visit. In either case, members are required to pay at the end of their visit or the discount does not apply.

The goal behind this fee structure is to steer patients toward the most appropriate care and to make sure providers are compensated for it on the spot. But having patients who pay when they get their care isn’t the only convenience for physicians and clinics, says Lise Mousel, director of provider and community development at AHN.

“One of the beauties of this program is that it’s so paperwork-light,” Mousel says.

AHN care coordinators process all members’ paperwork, relieving physicians’ offices of that administrative burden, which can save them both time and money.

Paperwork is one of many details that will have to be considered in the Athens program. ER physicians in both Athens and Reno are independent contractors, so the bill for those physicians is separate from that of the hospital where they work.

Members who visit the ER are responsible for at least two bills — one from the hospital and the other from the ER physician. Only the hospital’s portion of the bill is due at discharge, but AHN notifies members that another bill is on the way and that they have a limited time to pay it.

Saint Mary’s Hospital and Athens Regional Medical Center are already members of the Athens Health Network, but the ER physicians will need to be recruited separately for the health assurance program.

April Bailey is in her first year of a master’s degree in telecommunications at Grady College of Journalism and Mass Communications.