Experts discuss problems and possible solutions for improving the system
Increasing the use of primary care physicians for preventative health care is a simple yet important component to reigning in the high cost of health care, panelists agreed at the recent Healthcare Summit 2018 presented by Dayton Magazine.
The cost of seeing a primary care physician for a medical issue vs. an emergency room visit is significantly less, says Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association and one of the four Healthcare Summit panelists. Yet many people go to the hospital for nonemergencies, he says.
“One of the things that our hospitals I think are very surprised at is when we looked at the number of nonemergent cases going to our emergency rooms over half of the nonemergent cases were people who have insurance,” says Bucklew. “It wasn’t the uninsured. It wasn’t people on Medicaid that were utilizing the emergency rooms. It was insured people. People who had insurance and who also had access to primary care physicians.”
And emergency room visits are expensive—about $400 for an average visit, says Steve Martenet, president of Anthem Blue Cross Blue Shield of Ohio and the moderator of the Healthcare Summit.
“We have one employer that had one person go to the emergency room 49 times in a year,” says Martenet. “We’ve had other situations where folks go to the emergency room for a pregnancy test. One individual went three times to get a pregnancy test.”
There are plenty of other less-expensive options for heath care besides an emergency room, he says. Those options include traditional physician’s offices, health care clinics at grocery stores and pharmacies, and even online visits with a doctor, says Martenet.
Another panelist, Michael Dohn, medical director for Public Health in Dayton and Montgomery County, agrees that there are plenty of options for health care instead of visiting the emergency room in the Dayton region, including nurse practitioners at clinics. “We’ve got a lot of different providers out there,” he says. “We have a number of people that can take care of things.”
If more people would go to their primary care physician or health care clinic then emergency room visits would decrease, says panelist Ted Inman, CEO of PriMed Physicians. “We have coordinators in all of our offices to try to stay connected with the symptoms of our patients to keep them from getting sick,” he says. “What we need to focus on is chronic disease and wellness to keep people from going to (emergency rooms).”
The problem is that the emergency room is often the most convenient option, says Bucklew. “It is challenging if you’re a single mom or if you’re in a household where both parents are working it is hard to take time off to go to the doctor,” he says.
“It may be more beneficial from a convenience point to go to the emergency room or go to an urgent care center at 8 o’clock at night or 9 o’clock at night because they don’t have the luxury of taking time off during the middle of the day,” says Bucklew.
Another luxury is the number of new hospitals and other health care facilities being built in the area. Panelist Scott McGohan, CEO of McGohan Brabender, one of the nation’s largest independent employee benefits brokers, says the health care facilities are expanding because people are getting sicker.
“Ohio was ranked 40th in regards to the health status of the rest of the country,” says McGohan. “And then we look at Montgomery County we’re in the bottom 10 percent of 88 counties. If we get healthier the building slows down.”
The expansion of hospitals and health care facilities in the region is increasing the cost of health care, says Inman. “From our perspective of the growth of all the bricks and mortar is problematic,” he says. “Our patients pay a lot for that for health care.”
But hospitals are building new facilities simply to provide services where people want them, says Bucklew. In addition, people are living longer than at any time in the past, which means there’s a need for more medical services, he says.
Another health care issue discussed was the lack of transparency in the cost of medical procedures. “I don’t know any other industry … where the ultimate consumer of the product or service has really no idea how much it truly costs,” says Bucklew. “They are totally shielded from those costs.”
It’s also important for physicians to understand the cost of medical procedures since they are ultimately held responsible by insurers for controlling the cost, says Inman. “Sometimes we don’t know what the cost is when we’re sending somebody for something fairly simple,” says Inman. “So transparency I think is important.”
Bucklew says the incentives for all of the players in health care need to be aligned. “You’re not going to have true health care reform until all the players in health care have the same incentives … either from a regulatory or public policy standpoint.”
The Healthcare Summit 2018 presented by Dayton Magazine was sponsored by Anthem BlueCross BlueShield, Superior Dental Care and Premier Health. Community partners of the event included the Dayton Area Chamber of Commerce and the Greater Dayton Area Hospital Association.