Univera: Not all ER visits emergencies

December 2, 2011 Updated Dec 2, 2011 at 8:22 AM EDT

By WKBW News
By Business First by Tracey Drury, Buffalo Business First Reporter

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December 2, 2011 Updated Dec 2, 2011 at 8:22 AM EDT

More than 200,000 trips to Western New York emergency rooms in 2009 were likely unnecessary and could have been avoided, according to a new analysis by Univera Healthcare.

The analysis was part of a fact sheet issued by the insurer that identified more than 700,000 ER visits across the upstate region for such minor medical problems as sore throats and earaches, problems that could have been treated at a primary care physician office.

If just 5 percent of commercially-insured patients instead went to their physician, the savings could range from $8.1 million to $10.7 million. If a quarter of all those patients avoided the ER, the savings potential reaches $40.5 million to $53.5 million.

The analysis, The Facts About Potentially Avoidable ER Visits in Upstate New York, was determined using a New York University formula used to classify ER visits and applied it to hospital data collected by the state Department of Health to determine the number of ER visits that were potentially avoidable.

Univera found two out of every five ER visits were potentially avoidable.

"True emergencies belong in the ER," said Dr. Richard Vienne, vice president and chief medical officer. "But most sore throats and earaches, for example, should be seen by your primary care doctor. Your doctor will likely see you more quickly and your copay for a doctor visit will be less."

According to the report, one out of four ER visits in 2009 in which patients were treated and released on the same day was for a medical issue, such as a back problem, that didn't need care within 12 hours. Another 19 percent of visits were for medical conditions that needed treatment soon - such as ear infections - but could have been treated in a primary care setting.

Univera acknowledges the problem could be even worse: The report did not include visits for injuries deemed unclassifiable by the NYU formula.

Additionally, the total health care dollars that could potentially be saved is likely higher: The report looked at health insurance payments for commercially-insured patients, and did not include the uninsured and those who have Medicare and Medicaid.

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