As an employer are you educating your employees about the appropriate use of the Emergency Room, Urgent Care and Telemedicine?

One in five Americans will visit the Emergency Room (ER) at least once a year. Between one-third and one-half of all ER visits are for non-urgent matters.

Many conditions can be treated at Urgent Care centers. A recent review of the top 100 diagnosis codes from a self-insured employer revealed that 83 percent of them were in the top 100 diagnoses seen at a nearby urgent care center.

Unnecessary and inappropriate use of the ER causes multiple systemic issues and wastes scarce resources. The average cost for an ER visit is $1400 — compared to $125 for an urgent care visit.

Chronic conditions — which affect 45 percent of Americans — account for 75 percent of health care expenditures in the US. Diabetes, heart disease, asthma, and other chronic illnesses are also responsible for a large portion of ER visits. Asthma alone precipitated 1.8 million ER visits in 2004.  The ER visits resulting from unmanaged chronic conditions are avoidable. Proactive disease management, effective patient and caregiver education and simple lifestyle changes, can reduce ER usage for this group by up to 69%.

Appropriate use of the ER could save the U.S. healthcare system more than $18 billion a year. Patients with avoidable or non-urgent conditions who use urgent care centers, primary care physicians, or a telemedicine service can contribute significantly to creating a sustainable healthcare system.

How do you divert your employees to Urgent Care or Telemedicine?

An effective ER diversion program begins and ends with employee education. If you, as an employer, are serious about reducing your health care spend you need to think about the following;

Education Campaigns: Educational messaging creates an awareness of cost consciousness, reinforcing how to use urgent care, emergency room care, telemedicine and primary care. Campaigns leverage long-standing trusted relationships in order to have the greatest impact in changing the behavior of inappropriate ER use. If you partner with a Telemedicine service make sure your employees know how to use this benefit – provide examples, maybe a wallet-sized card with the 1-800 number, a list of appropriate ailments etc. Provide an online map to the nearest Urgent Care.

Member Engagement through Incentives: It may take the use of incentives to encourage members to change their behavior about the correct use of the ER. To reinforce behavior change, a great way to keep people engaged is to provide incentives to employees who seek appropriate care, including gift cards, coupons, and vouchers for dining, entertainment, and other goods and services.

The use of good data is the key to success.

It is essential to use Data to define the Initiatives: Use data analytics to establish a baseline reading of ER, Urgent Care, Telemedicine and primary care use. This information guides initiatives revealing the hotspots for intervention. Your data analytics should measure the impact of initiatives and allow for adjustments as needed. Use claims analysis to alert employees about a previous ER visit and show them the financial advantage of that visit when compared to using Urgent Care or Telemedicine. The employee will be forever grateful – particularly if they are responsible for large ‘out of pocket’ costs.

Take the time to explain all the benefits to your employees

Employees who manage their health and seek Urgent Care treatment instead of ER services (when appropriate) can expect to enjoy several benefits:

·      Save Time: The average wait time in urgent care centers is a door through door time of 45 minutes. Walk-in patients receive high-quality treatment quickly and efficiently. Very often issues can be addressed via Telemedicine in less than 10 minutes.

·      Save Money: Compare the $140 price tag of an urgent care visit to the $1400 price tag of the average ER visit. Even if a member’s insurance covers these costs completely, members learn that inappropriate use of the ER drives up the cost of healthcare and inevitably the consumer will pay for it. Employers are known to cover the cost of a Telemedicine consult 100%.

·      Reduce stress: Using an urgent care center when an illness or injury strike relieves the stress of handling an unscheduled crisis. When families have easy access to affordable, high-quality and convenient care when they need it, they go home happier and satisfied.

The Obeo Health Organizer module can help you reduce your ER costs – take a test drive of this module today.

10 Things you need to know about Compliance in a Healthcare Setting

In this world of instant access to social media, the issue of privacy has expanded into new territories. Data is no longer locked down. It is shared through multiple offices, providers, hospitals, and specialists. This new environment carries increase risk and consequence. Here are ten things to consider about organizational compliance:

1.Privacy policies are too easy to break. All it takes is one frustrating patient and a louder than normal conversation of “venting” between employees. Always be aware of your surroundings, patient care areas, waiting rooms, and other high traffic centers. Some of the most dangerous violations can come from the most innocent intentions.

2. Be wary of gifts. The normal week in a medical office contains a flow of vendors with samples and presentations. They will often attempt to sweeten the dealings with food or other offerings. This practice can extend to patients that mean well. Accepting gifts can land an employee and office on rough legal waters. Know where the line lies and keep the overzealous salesmen in check.

3. File reports. A patient falls getting out of bed. An employee stays an extra hour to help finish a large project. A lunch break is cut short for a meeting. All of these must be reflected in filed reports and accurate time counts. The consequences of falsifying records are much larger than the documentation and scrutiny from management. If legal proceedings occur down the line, you’ll want your files in order.

4. Legal Cooperation. The subpoena may come from different sources but, the minute it arrives, be ready to hold relevant records and provide all needed information. Stop the flow of paperwork until you are prepared to respond and keep to your developed process. It will smooth out any headaches.

5. Keep Current Training. It may be year one or year fifty, either way be sure to keep up with your training courses. OSHA requires yearly sessions in regard to employee and patient safety, along with other relevant issues. When an emergency happens, you’ll know the training works as it is handled in a professional manor.

6. Sharing passwords- In a nod to the first entry on this list, security is highly important for any practice. One day someone may call out sick or a new hire will start without login information. With the pressure and speed of daily operations, this may temp fellow employees to share login information or, even worse, keep them displayed on notes around workstations. Keep access keys secure at all times and let the new employee wait to get their own digital identification in the system.

7. Dangerous Friends- One day the phone will ring and it will be a favorite aunt or grandfather wondering about their test results. The matriarch of the family may have been admitted after a stroke and, for an hour, relatives from out of state are burning up the phone lines begging for information. Be sure the limits are known and posted throughout any areas of medical records and patient contact. Friends and family of patients mean well and can get frustrated at a lack of answers but, staying vigilant will only help your practice and show the empathy for the patient that you value and their loved ones should respect.

8. Protect Yourself- Physical security is just as important as data security. Have PPD ready and available when needed. Know what issues patients present when they arrive and whether or not they should be in an isolation room. The moment ignored often becomes lost time and illness (consider the recent Ebola outbreak). If you work evening hours, be aware of your surroundings in parking areas and other dark environments.

9. Protect Your Claims- “But I swear, it was a car accident.” Be sure to document everything that patient says and presents in terms of their condition. How often have they requested pain medications this month? Do visual symptoms match up with clinical findings? Insurance fraud is a common occurrence. Enact all possible measures to prevent this from happening in your practice and, when in doubt, document in detail.

10. Be Prepared- The audits will come. The Joint Commission will make announced and unannounced appearances. State and local inspectors will show up and your practice must be ready. Keep all parts up to code and stay on top of changes within the survey process. Nothing can derail patient service, profit, and satisfaction like a failing inspection. It is common sense and the quickest headline to make the news when an office fails for something that was an easy fix.

This list is only ten of many issues of compliance that are present on a daily basis. Do your best in all areas and you will find an increase of patient and employee satisfaction, a smoother workflow, higher profits and success.