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ER Appointments: The Latest in Medical Convenience

Patients prefer to wait at home

In an era of increased competition driven by the Patient Protection and Affordable Care Act (PPACA), hospital executives around the country are hoping online emergency room (ER) appointments will attract patients eager to avoid long waits in a crowded and often chaotic environment.

ER appointments, however, are not intended for patients with serious emergencies, such as those with life-threatening, debilitating, or urgent medical conditions, according to a report from Kaiser Health News.

At the University of California, San Francisco (UCSF) Medical Center, patients must explain in an online form the reason for their visit and check a box indicating that they can wait for treatment until their scheduled appointment. Even then, they may be bumped by more seriously ill patients; but in most cases they will be seen soon after arrival.

The approach makes business sense for hospitals because it lets medical staff know who may be coming through the ER door and helps reduce crowding and decrease wait times, hospital executives say. They say the service also helps build a loyal clientele among patients.

Patients want to access health care the same way they do services in other industries, such as retail or travel, said Chris Song, a spokesman for InQuicker, a Nashville company that offers the online scheduling in California and 25 other states.

“When is the last time someone bought plane tickets at the gate?” he said.

UCSF Medical Center started using InQuicker in its emergency department in 2012 and expanded it a year later to its acute care clinic, where less-critical cases are handled on a same-day, walk-in basis. Now the system is also being used to book primary care appointments.

Some critics say the online check-in system may be convenient but is not necessarily cost-effective. It could encourage patients to seek care in the costliest of settings, ERs, when they should be going to less-expensive urgent care centers or medical offices, they say.

If the country wants to decrease health care costs, patients need to be treated at the right place at the right time, said Dr. Del Morris, president of the California Academy of Family Physicians. Patients who can make appointments should do so at their doctors' offices, he said.

San Ramon Regional Medical Center in California began using InQuicker in 2012 and sees about 33 patients a month through the service. Most are people who have sore throats, ear aches, and stomach pains, said Sue Micheletti, the hospital’s chief operating officer.

Loma Linda University Medical Center in San Bernardino County, however, stopped using InQuicker after too many patients who hadn’t made appointments complained that others were walking in the door and being seen ahead of them. The ER physicians liked the system, but the nurses got tired of dealing with frustrated patients, said Kathleen Clem, chairperson of the emergency medicine department.

Under the PPACA, Medicare reimbursements for hospitals are tied to results on patient surveys. Dignity Health, which runs several hospitals out of its San Francisco headquarters, hopes that the new service will boost those patient satisfaction scores at the same time it minimizes wait times, said chief nursing officer, Page West. The hospital network began offering online reservations with InQuicker about a year ago. Since then, roughly 12,000 patients have scheduled ER visits at hospitals in California, Arizona, and Nevada, according to the company.

Source: Kaiser Health News; July 3, 2014.

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