Study: Pushing patients from ER to primary care could save $400M in N.J.

More than $400 million could be saved in New Jersey each year by treating nonemergency primary-care ailments in a doctor's office or medical center, instead of a hospital ER, according to a report released today by the New Jersey Hospital Association.

In the study, funded by a $4.8 million grant from the federal Centers for Medicare and Medicaid Services, the NJHA, the state Department of Human Services and the New Jersey Primary Care Association examined the use of emergency departments in Newark Beth Israel Medical Center and Monmouth Medical Center from September 2008 to April 2011.

The health groups found emergency rooms were used for nonurgent conditions in more than one-third of the two hospitals' 195,000 ER cases during that time, and 73 percent of the nonemergency patients who returned for four or more visits were either uninsured or covered by Medicaid or NJ FamilyCare HMOs.

In addition to monitoring ER visits, the group tested an express-care process to help nonurgent patients who arrived at the ER receive more appropriate primary-care services in a less-expensive setting, like a doctor's office or, if the patient had no regular physician, a federally qualified community health center. According to the report, the referral model caused ER visits for primary-care reasons to decrease by 22 percent, even while overall ER visits increased by 1 percent.

As a result, the study found, patient turnaround time was cut by 15 percent, and patient volume at community health centers increased by 19 percent, with a 30 percent increase for Medicaid patients.

"This is one of those scenarios in which doing the right thing for the patient also can produce savings in health care costs. It's a win-win," said NJHA President and CEO Betsy Ryan in a statement.

The report recommended the state create economic incentives for patients to use primary-care sites, since low-income patients are more inclined to go to ERs for nonurgent care, rather than pay fees at federally qualified health centers.