Business groups seek to pare back ER visits

Through diversions, organizations aim for $100m in savings


WITH THEIR SIGHTS SET on about $100 million in savings, 20 business organizations on Wednesday formally announced the creation of a coalition that aims to reduce the number of avoidable emergency room visits by 20 percent over two years.

The Massachusetts Employer-Led Coalition to Reduce Health Care Costs plans to work with doctors, hospitals, and health insurers to “shift as many avoidable [emergency department] visits as possible to high-value, lower-cost settings to relieve crowded EDs, reduce the cost of care, and improve quality.”

Members of the new coalition are facing rising costs, stalled health care cost containment talks on Beacon Hill, and the prospects of shouldering major new costs stemming from a nurse staffing initiative petition question that’s in the mix for November’s ballot.

The Health Policy Commission reported last year that 42 percent of all emergency department visits in Massachusetts in 2015 were avoidable and that the use of emergency departments (EDs) for non-urgent medical conditions is “a state-wide concern.” The HPC said the most common conditions for which people had avoidable emergency visits in 2015 were sinus infections, stomach pain, rashes or skin conditions, acid reflux, bronchitis, dental pain, back pain, allergies, urinary tract infections, and eye or ear infections.

Led by Associated Industries of Massachusetts President and CEO Richard Lord and Massachusetts Taxpayers Foundation President Eileen McAnneny, the coalition envisions “a health care system that delivers the right care, in the right place, at the right time.”

“As an organization dedicated to the long-term economic and fiscal health of the Commonwealth, the Foundation recognizes the need to address the costs of health care by taking unnecessary cost out of the system,” McAnneny said in a statement. She added, “Not only will this reduce health care costs and provide rate relief for small businesses and patients, it also allows us to optimize resources to ensure quality care for those in need of emergency care.”

The coalition plans to employ four tactics as it works towards its goal. First, the coalition hopes to educate employees about what issues are best handled by an emergency room and which can be addressed at a clinic or urgent care center. The group will track and report the rate of avoidable emergency visits and will advocate for policy changes like the expansion of accountable care organizations, telemedicine and more. And the coalition hopes to work across the health care sector to “reward and encourage the appropriate use of the ED by aligning financial incentives, and bolster the availability of care in the community, especially during nights and weekends.”

“The rising cost of providing health insurance to employees remains one of the most troublesome issues facing the 4,000 employers who are members of Associated Industries of Massachusetts,” Lord said in a statement. “Today, 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.”

A study released in 2016 by the HPC found that Massachusetts had the 13th highest rate of emergency room utilization in the country. The HPC reported that 13.7 percent of emergency visits could be diverted to retail clinics and another 13.4 percent could be diverted to urgent care facilities.

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Most recently, the HPC included reducing avoidable emergency department visits as one of seven strategies for reducing overall health care costs in Massachusetts in a report released in early May. The HPC estimated that its recommendations, which went beyond what the coalition is pitching, could result in $351.7 million in net savings over five years.

Along with AIM and MTF, the coalition includes Associated Subcontractors of Massachusetts, the Boston Municipal Research Bureau, the Greater Boston Chamber of Commerce, Massachusetts Bankers Association, Massachusetts Business Roundtable, Massachusetts Competitive Partnership, Massachusetts Food Association, Massachusetts High Technology Council, Massachusetts Package Stores Association, Massachusetts Restaurant Association, Massachusetts Society of CPAs, NAIOP Massachusetts, the National Federation of Independent Business, North Shore Chamber of Commerce, Retailers Association of Massachusetts, the South Shore Chamber of Commerce, the Springfield Regional Chamber of Commerce, and the Worcester Regional Chamber of Commerce.

In addition to the HPC, the coalition’s “strategic partners” include Blue Cross Blue Shield of Massachusetts, Massachusetts Association of Health Plans, Massachusetts College of Emergency Physicians, and the Massachusetts Health and Hospital Association.