Archive for July, 2012

Reduce Readmission Rates or Pay a Penalty:
12 Effective Strategies

July 30th, 2012 by Jackie Lyons

Beginning in 2013, CMS will penalize hospitals for excess readmission rates, starting with those related to heart failure, acute myocardial infarction and pneumonia. To combat this, hospitals are more focused than ever on reducing avoidable utilization. Programs include care transitions, post-discharge support, medication adherence, telehealth and more.

HIN’s 2012 Reducing Hospital Readmissions e-survey conducted in February 2012 documented the highest rates of targeted programs to reduce readmissions in the survey’s three-year history. Respondents also listed effective strategies they utilize to keep readmission rates down and penalties to a minimum:

1. “Calling [the discharged patient] within 72 hours, and engaging the patient post-discharge.”

2. “Transition coaches having a face-to-face appointment with a patient while still in the facility.”

3. “Medication reconciliation, care transitions: outreach once a week for four weeks, and close monitoring of high-cost claims.”

4. “Education and collaboration of plan of care between hospital, long-term facilities, home health and hospice agencies.”

5. “Engage in group physical activity sessions that focus on the physical, social and emotional well-being dimensions.”

6. “Early referrals from discharge planners so we can assess the patient for safety in the home and provide safety modifications and training.”

7. “Calling and reminders. Checking on regular medication adherence and telephonic health coaching with triage to the nurse practitioner in case of requirement for medical management.”

8. “Front-loading our visits, use of telehealth, fall risk assessments, order physical therapy.”

9. “Follow-up appointment within 14 days of discharge.”

10. “An electronic HIPAA-compliant server that uploads patient data for doctors, nurses and patient to see their glucose levels, blood pressure, and weight so these can be managed before they get out of control.”

11. “Providing more acute services at nursing home.”

12. “Close integration with multi-disciplinary team.”

Advocate Physician Partners’ Contract Strategy Promotes Value Over Volume

July 24th, 2012 by Patricia Donovan

Dr. Carrie Nelson, APP Medical Director for Special Projects

Anticipating the advent of accountable care organizations, Advocate Physician Partners (APP) has crafted a value-based payment contract on its strong foundation of clinical integration.

Advocate is entering the second year of this contract with Blue Cross Blue Shield of Illinois (BCBSIL), explained Carrie E. Nelson, MD, MS, FAAFA, APP’s medical director for special projects. The contract continues APP’s mission of aligning quality and incentives, she noted during a recent webinar on Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners.

APP is a care management and managed care contracting joint venture between 10 Advocate hospitals and more than 4,000 physicians. In what has been referred to as the largest clinical integration program and ACO in the nation, APP physicians are evaluated and incented on about 156 clinical measures. APP’s clinical integration program is described in detail in
Case Study in Clinical Integration: The Advocate Physician Partners Experience.

APP’s strategic framework is built on a platform of care coordination, data and analytics. This philosophy has necessitated a cultural shift among APP physicians toward delivering value over volume, as well as a new “mental model. ” For example, APP encourages its providers to think not in terms of hospital discharges, but of transitions.

Advocate is “trying to move to a mindset that focuses more on how we can enable smoother transitions, so that we don’t have a perception that somehow we’re just dumping the patient off into another environment and its someone else’s job to make sure that the care is delivered effectively,” explained Dr. Nelson.

Choosing to expend its energies on the top 2 to 5 percent of heavy utilizers, APP relies on care coordinators across the continuum, from case managers embedded in physician practices on the outpatient side to “SNF-ists” who work with advanced practice nurses to decrease readmissions and achieve appropriate lengths of stay by SNF patients.

To get physicians on board with this premise, APP relies on a combination of “data and success stories,” she added.

Moving forward in the contracting process, APP would like to see more data on patients who go out of network to seek care, and specifics on where they seek care, so APP can try to bring them back in-network.

APP will also recalibrate its embedded care management model, with the intention of substituting telephonic case management support in certain instances. Advocate will also zero in on the hospital stay, which it sees “as the biggest business opportunity, even compared to ED overuse,” Dr. Nelson notes.

Listen to an interview with Dr. Nelson on the role of clinical integration as foundation for value-based payment contracting.

Physical Health Problems Spur More Patients to Seek Mental Health Services

July 23rd, 2012 by Cheryl Miller

Mental health issues like depression alone are not enough to make people seek help, given the results of a new study from Oregon State University (OSU) linking physical ailments to mental healthcare.

But depression stemming from back pain or chronic diseases like diabetes are sending people to their nearest mental health practitioner. And this is good news in a way, say researchers, because early mental healthcare can significantly lower healthcare costs in the long run.

More good news on ways to lower healthcare costs: a global budget program, an alternative to traditional fee-for-service (FFS) reimbursement models, can lower the costs of medical spending and improve care quality for patients, according to a study from Harvard Medical School’s Department of Health Care Policy.

The study, based on two years of claims data from Blue Cross Blue Shield of Massachusetts’ (BCBSMA) Alternative Quality Contract (AQC), found that healthcare provider groups participating in the AQC spent nearly 2 percent less than FFS groups in the first year, and more than 3 percent less in the second year. Reduced spending was attributed to changing referral patterns, among other things, and quality of care improvements were also greater in the second year than in the first.

Care quality is at issue when it comes to hospitals’ risk-standardized stroke-care rankings; they can be unfairly impacted if the severity of strokes are not considered, says a new study from UCLA.

Hospitals and medical centers must report their quality-of-care and risk-standardized outcomes for stroke and other common medical conditions. But reporting models for mortality that don’t consider stroke severity may unfairly skew these results. And this could have worse implications for patient care if hospitals start turning away those with more severe strokes or transferring them to other hospitals after they’ve been assessed by the ED to avoid being misclassified as having a higher mortality risk, researchers note.

Participation in ACOs continues to grow; CMS has announced 15 new ACOs that will receive advance payments to help them with care coordination costs. The advanced payment model is designed to support physician-based and rural ACOs who will provide coordinated high quality care to Medicare patients.

You can find more information on ACOs in our latest video, which documents their growth in the last year, based on our market research.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

11 Innovations in Healthcare Case Management

July 23rd, 2012 by Jackie Lyons

According to respondents from HIN’s third annual healthcare case management survey, successful case management efforts focus on transition coaching, discharge planning, reward programs and a patient-centered approach to case management.

Despite the challenges of staffing and operating a successful case management company brought on by healthcare reform and the changing industry, respondents contributed innovative interventions that improve health and reduce costs in the populations they serve.

Eleven case management program interventions that proved to be successful are:

1. Working with local community collaboratives for transition coaching. For example, respondents collaborate with a company that performs in-home health assessments on members identified with chronic diseases. The information is sent to them and they use it to direct care for their members.

2. Scheduling home visits by nurse practitioners for selected patients.

3. Redirecting to in-network providers and coordinating services in an efficient manner to prevent delay in discharges.

4. Holding case conference meetings with the treating physicians, case managers, medical directors and other related parties to address issues related to challenging or high-risk patients.

5. Verifying medication and home healthcare strategies to prevent readmission for chronic illness within 24 to 48 hours.

6. Partnering with social workers who will spend time dealing with complex family problems and end-of-life care.

7. Getting high-risk obstetrical clients to assume greater accountability for the outcome of their pregnancies and communicating with providers and educators. Respondents noted a significant decrease in low birth weight infants for RN case-managed programs focused on these objectives.

8. Utilizing diabetes reward programs to keep measures in line.

9. Integrating case management (medical and behavioral health) for a patient-centered approach.

10. Using neutral assessment and family trust to establish realization that case managers can identify affordable and appropriate resources.

11. Attaining the Advanced Achievement in Transplant Management Certification (through Interlink Health Services) so case managers better understand and educate patients about the benefits of using a Transplant Center of Excellence for the best possible clinical and financial outcomes when a transplant is needed. Respondents report successful clinical outcomes and savings range in the 40-50 percent range.

Case Managers Gratified by Daily Lessons from Care Coordination

July 18th, 2012 by Jackie Lyons

Helping patients and learning new concepts on a daily basis are at the very top of the list of satisfying aspects of case management, according to recent HIN case manager interviews.

“I truly feel humbled to have people allow us into their lives and share the details with us at such a stressful time. That is the best thing about being a nurse,” said Helen Schreiber, executive VP of S&H Medical Management Services, Inc.

Another gratifying aspect of case management is treating patients and families with respect and kindness, especially at the end of life, added Sonia Morrison, case manager at Salinas Valley Memorial Healthcare System (SVMHCS), nurse assessment consultant and educator for veterans at Visiting Angels of Santa Cruz.

“It is most satisfying when the client I am working with reaches full potential and returns to life with the tools to be successful,” said Barbara King, co-founder and president of NurseValue, Inc.

Helping clients return to work is also a key part of case management. “Ensuring a win-win opportunity for all parties is satisfying. When the injured worker obtains excellent, goal-directed care, they return to work in a more timely and effective manner. In this society, we need to work, and facilitating a successful return to work ensures a good ongoing quality of life for the worker,” said Linda Van Dillen, executive VP/partner of S&H Medical Management Services, Inc.

Case managers identified other gratifying elements of their career:

“The knowledge base, the liaison role that a case manager has in communicating with the patient, family, administration, payors and post-acute providers. Problem solving, it’s like a puzzle,” said Hillary Calderon, senior manager of Corporate Case Management for HCA.

Victoria Powell, founder and president of VP Medical Consulting, LLC, said she is always learning, whether it is about a disease or condition, a new treatment option or a new resource for information. “Meeting new patients from all walks of life and discovering what makes them special and unique is also satisfying to me,” she said.

Stacey B. Hodgman, district director of case management for Kindred Healthcare, said, “I learn something new every day of my practice. It is continually both challenging and rewarding, and there is never a day where I look at the clock and say, ‘It’s only 3:00?’ On the contrary, I look at the clock and say ‘It’s already 3:00?!’”

New Video Documents ACO Activity: Accountable Care Doubles in Last Year

July 17th, 2012 by Patricia Donovan

Along with bundled payments, the accountable care organization would be the healthcare model to watch in 2012, predicted healthcare consultant Steven T. Valentine late last fall.

And as this new ACO video from the Healthcare Intelligence Network can attest, The Camden Group president knew what he was talking about. According to 200 healthcare companies who took the HIN ACO survey in May, participation in accountable care organizations doubled in the last year.

The survey also found that today’s ACO is leaner and more efficient, with more physicians at the helm than hospitals and less time necessary to get the ACO up and running.

For the uninitiated, ACOs create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. Built into the ACO model is a business opportunity: provide a focal point of care while attaining health and cost containment goals.

The bundled payment method referenced by Valentine refers to the practice of aligning payments for services delivered across episodes of care or “bundled” care.

Narrated by HIN COO and Executive VP Melanie Matthews, HIN’s second annual ACO analysis delves into ACO administration, size, and the model’s impact on healthcare utilization and care delivery. And in case you missed Valentine’s forecast last fall, his comments are included here.

If you prefer to read an executive summary of the survey results, download it here. A more detailed analysis is available in the HIN bookstore.

Federally Funded Clinics as Effective as Private Practices on Most Quality Measures

July 17th, 2012 by Cheryl Miller

Federally qualified health centers (FQHC) and their “look-alikes” are as effective as primary care practices, and better on some quality measures, according to a new study from the University of California, San Francisco. Because they serve the poor and uninsured, there have been concerns that they provide less effective care because they are serving more medically and socially complex patients. Researchers refute this, and the clinics will receive $11 billion from the federal government to expand their operations in the wake of anticipated primary care shortages as an estimated 32 million people seek healthcare under the ACA.

Family and primary care physicians could receive as much as 7 percent increases in payments under a proposed ruling from the CMS. The ruling is Intended to help primary care doctors improve patient care and lower healthcare costs long term by helping to transition patients back into the community following a hospitalization or SNF stay. If passed, CMS will make separate payments to a patient’s community physician or practitioner to coordinate the patient’s care after they are discharged.

More good news for primary care: of the 89 new ACOs selected to participate in the Medicare Shared Saving Program (MSSP), half are physician-driven, serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. This correlates to our research, conducted in March 2012, that found that physician-led ACOs were the most common.

Following several years of slowing growth, global spending on pharmaceuticals could reach nearly $1.2 trillion by 2016, according to a report from the IMS Institute for Healthcare Informatics. Studies indicate that the market for drugs will nearly double by 2016, reaching $1.2 trillion compared with about $956 billion in 2011, an annual growth rate of 3 to 6 percent. Suggested factors for the growth are volume increases in the pharmerging markets and an uptick in spending in developed nations.

Looking for new ideas on cost reductions in the ER? We present several stories on this topic, from Mina Chang’s detailed pre-ER interventions, to those presented in our blog post on the nonelderly Medicaid’s use of ER.

It’s not too late to participate in our survey on asthma management. Describe your organization’s efforts to manage asthma in your population by July 27, 2012 and you’ll receive a free e-summary of the survey results once it is compiled

10 Ways Health IT Can Enhance Patient Care, Reduce Costs

July 16th, 2012 by Jackie Lyons

Caught between emerging advances in health information technology and the weight of the struggling economy, it is difficult to improve the provision of care and enhance the patient experience and outcome.

But what if there were a way to improve the quality of care without increasing costs? Verizon Connected Healthcare recently identified list 10 areas where it believes strategic use of technology will enhance patient care and reduce cost:

1. Telemedicine Removes the Geographic Barriers to Quality Care— Through telemedicine, hospitals can reduce preventable hospitalizations, which amount to $31 billion in annual costs. Telemedicine also brings the promise of providing remote care for the aging population, and patients with chronic conditions and difficulties in traveling. This technology can deliver new service to previously unserved markets, helping improve care for those markets, and bring in new revenue for providers.

2. Health Takes Flexibility to the Next Level in Caring for Patients— The rise in mobile health applications for smart phones has fostered more than 10,000 health applications in the iTunes store alone. According to Research2Guidance, the world market for mHealth apps will reach more than $1.2 billion in 2012. Healthcare providers now can leverage many applications to help patients better manage chronic disease, weight loss and other conditions, and medication reminders and heart rate monitors.

3. Chronic Disease is e-ManageableChronic disease accounts for 75 percent of every dollar spent on healthcare. At current growth rates, chronic disease spending, which is currently at $1.3 trillion, will more than double, to $2.2 trillion, by 2020. By leveraging health IT, providers can help patients better manage their conditions from anywhere at any time. For example, 95 percent of diabetes care is done by the patient at home, work or on the go, not by a clinic. Empowering the patient can be replicated in other areas of chronic care by harnessing telemedicine and mHealth applications to help provide patients with remote support and disease management.

4. Wellness and Preventative Care are Keystones of Health Education Encouraging health and well-being will help reduce the 70 percent of deaths in the United States stemming from preventable diseases. Many diseases can be prevented through education, and health IT is the new gateway to help modify unhealthy behaviors. For example, smart apps can help patients manage their health and well-being in real time, providing alerts to take medications, exercise or follow a recommended diet.

5. Fraud Solutions Shift from ‘Chasing’ to ‘Prevention’ — Healthcare fraud, waste and abuse are estimated to cost the United States $226 billion annually. Medicare fraud alone is estimated to cost the government $70 billion annually. Changing from a “pay-and-chase-model” to an “identify-and-intervene” approach is the first step in trying to stop fraud. Today’s technology-driven solutions, such as Verizon’s fraud management solution, monitor healthcare claims to identify fraudulent patterns before claims are paid — not after, when it is much more difficult to recoup dollars.

6. Data Breach Awareness Pays Off — According to the “Verizon 2012 Data Breach Investigations Report,” data breaches in the healthcare and social assistance industry groups represented more than 7 percent of the total breaches Verizon analyzed in 2011. The protection of patient information could help save billions yearly for the healthcare industry. Many healthcare breaches stem from simple mistakes such as lost or stolen laptops containing patient data. This can be prevented in several ways, including encrypting all devices carrying sensitive information and securing the network.

7. Cloud Computing Gives Patient Information a Shot in the Arm — Verizon believes the cloud will impact healthcare industry in many forms. Well-established cloud service providers can help healthcare businesses reduce operational costs and improve sharing of patient electronic health records. Cloud service providers are able to offer cloud-based services for the healthcare industry to help monitor, analyze and react to real-time patient information.

8. Electronic Health Records are the Building BlocksDigitized patient data can help reduce duplicate tests, administrative inefficiency and redundant paperwork, which equate to some $120 billion in annual spending. According to Verizon’s Tippett, “Because of regulations, the healthcare sector is 10 years behind the financial services industry when it comes to utilizing IT. To reduce costs and improve care, exchanging patient information digitally — from payors and providers to pharma and patients — must be embraced.”

9. Big Data Yields New Way to Look at Science— The widespread adoption of health IT will bring a new era of science in harnessing “big data” to improve quality of care. This will help doctors tap a new science of healthcare by aggregating and analyzing large amounts of patient data on treatments, conditions and more.

10. Data Pool Integration Makes for a Healthy System— Removing the silos of patient information will help enable better communications. Utilizing a common platform can unite the pharmaceutical, physician, patient, and provider for better information sharing. Creating a common data pool for these otherwise disenfranchised silos will transform the healthcare sector into a technology leader in storing, accessing and sharing critical information. This will ultimately help reduce redundant testing and paperwork, and reduce the chance of medical errors.

Are Payment Tides Turning for Primary Care?

July 16th, 2012 by Patricia Donovan
Primary Care Pay

Value-Based Payments

Several indicators this month point to more dollars flowing into primary care offices, either in the form of higher provider salaries, increased reimbursement, or both. And new market data finds physicians leading the majority of accountable care organizations (ACO).

A study released last week by Medical Group Management Association found that median pay for primary care physicians (PCPs) grew 5 percent last year to $212,840, capping a five-year increase of 16.7 percent from 2007 to 2011. While an actual PCP paycheck pales next to a specialist’s, of note is MGMA’s finding that PCP compensation grew at a faster rate than specialist pay over the last five years.

The reimbursement stage is being set for patient-centered care delivery models like the patient-centered medical home and the ACO that put a premium on care coordination, with many payors offering a combination of traditional fee for service (FFS) payment topped off with a care coordination fee, with possibly a little shared savings thrown in to sweeten the payment pot.

Sixty-one percent of respondents to the sixth annual HIN 2012 Patient-Centered Medical Home survey reported they operate under an FFS plus care coordination fee model.

And earlier this month, CMS proposed payment increases for family physicians of approximately 7 percent and for other practitioners providing primary care services of between 3 and 5 percent. As it has in other initiatives resulting from healthcare reform, the proposed rule offers additional financial incentives for care coordinated during critical transitions in care, such as when a patient is discharged from the hospital:

For 2013, CMS is proposing for the first time to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility. The proposals calls for CMS to make a separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay.

Dr. Carrie Nelson, medical director of special projects for Advocate Physician Partners (APP), lauds CMS’s proposal. “It’s a long time coming that that kind of recognition has translated into reimbursement for primary care physicians,” notes Dr. Nelson, a family physician herself. “I know first-hand the amount of work that goes into making sure your patients aren’t falling through the cracks and getting the care they need in an efficient manner, especially after a hospitalization or major clinical situation.”

However, it’s critical that those dollars given to primary care for care coordination actually go toward that function, Dr. Nelson cautioned, and that quality measures are established in parallel with this funding. “There’s a risk that these funds could be seen as ‘new money,’ she said. “I think primary care feels undervalued and underpaid, and there is some validity to that. But at the same time, reimbursement for care coordination may not translate into actual care coordination unless there are some quality measures associated with that in order to make sure that the dollars go toward the purpose for which they were intended.”

With eight years of clinical integration (CI) under its belt, involving more than 4,000 physicians and 10 hospitals, APP can speak from experience. Its nationally recognized CI effort has achieved record performance in almost all measured areas, resulting in improved patient outcomes and significant cost savings. The CI program laid the groundwork for a value-based payment contract between APP and Blue Cross Blue Shield of Illinois. Dr. Nelson will share lessons learned from contract implementation during a July 18, 2012 webinar, Bending the Cost Curve with a Commercial Value-Based Payment Contract.

Nonelderly Medicaid Patients Utilizing ED for Urgent Problems

July 13th, 2012 by Cheryl Miller

While non-elderly Medicaid patients do use the ED more than their privately insured counterparts, the majority of visits are for urgent or more serious medical problems, according to a national study from the Center for Studying Health System Change (HSC).

Based on evaluations of patients prior to and after treatment, the study found the following:

  • For emergent visits, or those needing immediate attention, nonelderly Medicaid patients were seen in EDs at the rate of 5.6 visits per 100 enrollees vs. 3.6 visits per 100 privately insured people.
  • For urgent visits, or those needing attention within an hour, the rate for nonelderly people covered by Medicaid was 18.1 visits per 100 enrollees vs. 9.6 visits per 100 privately insured people.
  • For semi-urgent visits, or those needing care in 1 to 2 hours, the Medicaid rate was 10.4 visits per 100 nonelderly enrollees vs. 5.5 visits for privately insured people.
  • While these findings may be contrary to popular opinion, they aren’t a surprise to emergency physicians, says Dr. David C. Seaberg, president of the American College of Emergency Physicians.

    “People who go to the emergency department, for the most part, need to be there,” he says, “because they tend to be sicker.” Among Medicaid patients there is a higher prevalence of chronic disease and disability than among people with private insurance, he said. And for those Medicaid patients with chronic disease and urgent healthcare needs, the ED is probably the best place for them to receive care, because the hospital has the right staff and equipment to treat them quickly and appropriately.

    And concentrating on limiting ER access to non-urgent patients won’t necessarily do much to decrease healthcare costs overall, according to a paper published in the Annals of Emergency Medicine.

    “The focus on non-urgent ER visits distracts from the potential savings that do exist in the area of hospital admissions,” said lead study author Peter Smulowitz, MD, FACEP, of Beth Israel Deaconess Medical Center in Boston, MA. “Emergency department patients are responsible for about half of all hospital admissions, and those admissions account for about 15 percent of all healthcare expenses. Many patients are admitted to the hospital from the ER either because the gaps in the rest of the healthcare system leave patients without other good care options, or because a fragmented system has failed to care for their complex chronic disease.”

    Dividing ED visits into three categories – emergencies, intermediate/complex conditions and minor injuries/illnesses – researchers assessed the potential cost savings for each. While savings were minimal for minor injuries and illnesses and emergencies, for intermediate/complex conditions:

    The potential savings amounted to a maximum of 2.5 percent of all healthcare spending, which Dr. Smulowitz attributed mostly to reduced hospital admissions. The expanded use of observation units in emergency departments offers one opportunity to reduce costs by reducing hospital admissions.

    Collaboration between emergency physicians, case managers and community-based services could also allow for patients to be cared for at home or in short-term facilities rather than being hospitalized because of a lack of safe alternative options, he continues.

    Collaboration was key to the success of a statewide quality improvement project aimed at reducing avoidable emergency room visits among Medicaid patients in California, which created a unique partnership between L.A. Care Health Plan, the country’s largest Medicaid managed care plan, and Children’s Hospital Los Angeles. Many patients, particularly in the Medicaid population, do not completely understand the primary care process or know of options when faced with medical problems. Providing them with information and options is crucial towards redirecting them to the proper medical avenue, explained Laura Linebach, director of quality improvement at L.A. Care Health Plan, who gave a recent webinar at the Healthcare Intelligence Network, Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach. In addition to launching a state-wide public health campaign including brochures and educational packets, a nurse advice line was very successful:

    “The nurse advice line provides 24-hour, 7 day a week telephone access to a registered nurse. Nurses advise members in their preferred language about the setting to receive care: PCP, home, ER, or urgent care. Preferred language is addressed by use of a bilingual nurse or interpreter services. But getting our diverse population to trust and call the line is difficult. However, we found that those members with the pre-intent of going to the emergency room when they called the nurse advice line and who would triage with the nurse advice line with advice not to visit the ER, 80 percent of those complied and did not go to the ER. We studied any visit within 48 hours after the nurse advice line call.”

    There are conditions that can be treated outside of the ER, in particular, two diagnoses with the greatest potential to reduce ED use for both nonelderly people covered by Medicaid and private insurance if access to appropriate alternative care settings existed, researchers at HSC said. First, acute respiratory and other common infections in children, and second, injuries among all nonelderly people.

    Diagnoses of acute respiratory and other common infections in children and injuries accounted for more visits by privately insured children aged 0 to 12 (60 percent) than those children covered by Medicaid: (53 percent). Researchers suggest that while some infections and injuries will be too serious to treat elsewhere, lower-cost settings that can provide a moderate intensity of care and urgent response time likely could reduce emergency department use.

    The study goes on to state that

    “…primary care settings may not be a practical solution for all cases. Many primary care offices cannot see patients quickly enough to manage urgent problems or do not have the right equipment at the practice. Alternative care settings would need to provide prompt care for urgent cases and have appropriate services and equipment to diagnose and treat minor cases,” the study concludes.