Business leaders in Massachusetts often list rising health care costs as a top concern. Now 20 groups -- representing restaurants, retailers, manufacturers and bankers -- have formed a coalition to reduce health costs. And they've selected their first target: avoidable emergency room visits.
The goal of the Massachusetts Employer-Led Coalition to Reduce Health Care Costs is to save $100 million by 2020 by reducing "avoidable" trips to an emergency department (ED) for ailments that don't need hospital-level care. Those include sinus, ear or urinary tract infections, and stomach, back or dental pain.
One problem: It's often hard to tell, in advance, if your crippling stomach cramps will pass, or if you have appendicitis.
That's one of the reasons there's a dispute about just how many ED visits are avoidable. The new coalition, using research from the state's Health Policy Commission (HPC), puts that number at 42 percent, or nearly 1 million visits a year. But the American College of Emergency Physicians says only 3.3 percent of visits are avoidable, with dental problems and mental health issues being the most common.
The Massachusetts College of Emergency Physicians (MACEP) is one of five "strategic partners" that will work with the coalition to try and bridge these differences and develop a strategy for redirecting patients to lower cost urgent care centers or their primary care doctor. The other partners are health insurers, the Massachusetts Health and Hospital Association and the HPC.
MACEP leaders say they are committed to controlling health care costs, but have expressed worry about whether cutting ED revenues would erode the viability of emergency rooms for patients who really need that care.
To hit that $100 million savings target, the coalition will need to cut ED visits by about 20 percent. That's a significant change in behavior within two years — and not just for patients. Doctors routinely refer patients to EDs after 5 or 6 p.m. on weekdays, and on weekends. That makes EDs often the best option for patients who can't get off work during regular business hours and don't live near a standalone urgent care center.
"Reducing avoidable visits is a lot harder than it sounds. If it could be done so readily it would have been done," says Dr. Scott Weiner, president of MACEP. "Co-pays are already higher for ED visits and patients still come, so we have to figure out what need isn’t being met."
The tactics for pushing this major change sound more like carrots than sticks: educating employers and employees, highlighting "best practices," and sharing data in real time.
There is the hint of a stick in the coalition's statement. Hospitals, health plans and employers, it says, will "align financial incentives" to "reward and encourage the timely delivery of care in the most appropriate setting." Does that mean free use of urgent care centers versus big bills for ED visits that are determined to be "avoidable" after the fact?
Coalition leaders say they do not expect to impose penalties on patients or hospitals.
"We can achieve these ambitious targets without having to make this a punitive effort in any way," says Health Policy Commission Executive Director David Seltz. "This is really going to be about providing better care to patients."
Rick Lord, president of Associated Industries of Massachusetts, which represents 4,000 employers, says education works. He mentions a large retail member who noticed a high volume of ER visits among employees. That member mapped alternatives for workers and explained why they might get better care with shorter wait times and reduced ER use. Lord expects to see that example repeated as employers, hospitals and health plans zero in on trips to the ER.
"We are taking this collaborative step to ensure that employers and their workers can access the right care in the right place, maximizing both health care quality and affordability," Lord said.
This article was originally published on May 30, 2018.