Short Takes On News & Events

Avoid The Rush! Some ERs Are Taking Appointments

By Anna Gorman

July 14th, 2014, 2:37 PM

This KHN story also ran on Southern California Public Radio. It can be republished for free. (details)

Three times within a week, 34-year-old Michael Granillo went to Northridge Hospital Medical Center because of intense back pain. Each time, Granillo, who didn’t have insurance, stayed for less than an hour before leaving without being seen by a doctor.

“I was in so much pain I wanted to be taken care of now,” said Granillo, who lives in Reseda and runs a hot dog cart business. “I didn’t want to sit and wait.”

On a recent Wednesday morning, he woke up feeling even worse. This time, Granillo’s wife, Sonya, tried something different: Using a new service offered by the hospital, she was able to make an ER appointment online, using her mobile phone.

When they arrived at the hospital, he was seen almost immediately.

Michael Granillo speaks to a doctor at Northridge Hospital Medical Center (Photo by Anna Gorman/KHN).

“That was my last resort and it worked,” she said. “He would have probably been at home in pain if not for the service.”

In an era of increased competition driven by the nation’s health law, hospitals in California and around the country are hoping online ER appointments will help attract patients anxious to avoid long waits in a crowded and often chaotic environment.

“It makes for a happier camper,” said Susan Dubuque, a national expert in hospital marketing. “When it comes to health care, consumers want more control over everything.”

The system, adopted by Northridge and other hospitals in the Dignity Health chain about a year ago, is intended only for patients who don’t have life-threatening or debilitating emergencies. To check in online, patients must explain the reason for their visit and check a box that they can wait for treatment.

Patients having chest pain or trouble breathing, for instance, are instructed to call 911 or go directly to an ER. Those with an ankle sprain or a fever, for instance, might be able to make an appointment.

When patients get to the hospital, they still may be bumped by more seriously ill patients.

The approach makes business sense for hospitals because it lets medical staff know who may be coming through the door and it makes patients more comfortable, hospital executives say.

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-based 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.

Some critics say the online check-in system may be convenient but is not necessarily cost-effective. 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.

“Emergency rooms are there to take care of people who have emergencies,” said Morris, medical director of the Stanislaus County Health Services Agency.

The Dignity chain says roughly 12,000 patients have scheduled visits for emergency rooms at hospitals in California, Arizona and Nevada. Recently, Dignity stepped up marketing, with billboards, print advertisements and online and radio spots. One features a woman sitting in a hospital waiting room chair – and then cuts to her on a living room couch with a dog, as the words on the screen read, “Wait for the ER from home.”

On the day of his appointment at Northridge Hospital Medical Center, Granillo winced and shifted uncomfortably in the ER exam room.

“How are you feeling?” asked his doctor, Stephen Jones. “Do you need more pain medicine?”

Granillo nodded and told him that his back and stomach both hurt.

After a CT-scan, doctors told the couple that Granillo, as it turned out, had a very serious condition– lymphoma, a type of cancer.

Jones, the medical director for the emergency room, said some patients who come in through the appointment service probably should be seen by a primary care doctor but either don’t have one or can’t get a timely appointment. Others, like Granillo, shouldn’t wait for care, he said.

Dignity Health, which is also offering the online reservations at urgent care centers and doctors’ offices, hopes that the new service will minimize wait times and boost patient satisfaction scores, said Page West, chief nursing officer. Under the Affordable Care Act, Medicare reimbursements for hospitals are tied to results on the patient surveys.

Others say hospitals need to do more to fix the emergency room process in which people show up and wait for hours, said Bridget Duffy, chief medical officer at Vocera Communications in San Jose and an expert in the patient experience. Besides offering online appointments, Duffy said hospitals need to assess patients more quickly, improve communication with them and better manage their pain.

As it stands, she said, “It’s ridiculous … it’s like herding cattle.”

Also from KHN: The Latest In Medical Convenience: ER Appointments

4 Responses to “Avoid The Rush! Some ERs Are Taking Appointments”

  1. Stanley says:

    “Others say hospitals need to do more to fix the emergency room process in which people show up and wait for hours, said Bridget Duffy, chief medical officer at Vocera Communications in San Jose and an expert in the patient experience. Besides offering online appointments, Duffy said hospitals need to assess patients more quickly, improve communication with them and better manage their pain.”

    Only a moron doesn’t know that most hospital emergency rooms are unsustainable in states that have Republican Governors and Republican Legislatures. Why? Because many of the people using the emergency room in those regressive states are too poor to pay. Emergency room relief was promised through the Affordable Care Act in the form of Medicaid Expansion. Medicaid Expansion promised that more poor people would be insured and could access healthcare without needing to use the emergency room. The Affordable Care Act initially promised to expand Medicaid for all 50 states in the union. However, a few Neanderthal dummies on the U.S. Supreme Court nixed that promise and gave the states the choice of whether or not to expand Medicaid. The result? Regressive Republican Governors and regressive Republican Legislatures in about 24 states chose to not expand Medicaid resulting in their hospitals seeing more and more uninsured people and making sure that those hospitals would not get the emergency room relief that they were promised for treating those uninsured people. So, as a result, those hospitals are going broke. Pennsylvania is the poster child for being the most regressive state in the union in this regard. When it comes to providing healthcare access for poor people, Pennsylvania is the Mississippi of the north.

  2. kevin says:

    Hey Stanley,

    Sadly, today’s Republican Party has its morons. The GOP is not the party that I joined years ago. I’m ashamed of my party! Somehow, a few crazies have taken over. Especially in the House of Representatives. In Speaker John Boehner’s House, the Republican tail is wagging the Republican dog. John Boehner’s legacy is, and will forever be, a legacy of capitulation to a very small minority of tea party members that constantly refuse to work with the rest of the Republican caucus. I fully expect Boehner to bend under the pressure from these tea party wackos and shut down the government “once again” before the end of 2014. Boehner has got to make a decision. Boehner has got to choose whether he’s going to grow up and be a man or whether he’s going to continue to be a mouse. First and foremost, he’s got to stop with the weeping! Either he takes charge of his caucus, or he needs to step aside and allow someone with the courage to take charge and stand up to the tea party minority. There’s no unity in the GOP today. The GOP is fragmented. The GOP message is not a defined message. The GOP is a confused mess. The GOP is an embarrassment to its members. All because the GOP leadership allowed a few crazies to have too much sway. Boehner needs to change things…soon!

  3. margie says:

    If you like your emergency room (ER), you can keep it? Not in Pennsylvania! In Pennsylvania, and in many other regressive states that are run by Republicans, that won’t be the case for too long. Since Governor Tom Corbett refuses to expand Medicaid, hospitals in Pennsylvania are going broke trying to fund their ERs. They simply can’t afford to treat uninsured poor people any longer. Medicaid expansion, under the Affordable Care Act (ACA), promised that hospital ERs would see more “insured” patients coming through the door. As it stands, ERs are seeing an increasing number of people that fall into the “Medicaid Gap”. Those people have no insurance because they earn too much to qualify for current Medicaid but not enough to afford to by insurance on the health exchange. So, when they get sick or injured, they seek free care at the ER. Apparently, Tom Corbett likes things that way. So, the ER that’s within a short distance from your home? It may be shutting down very soon. You may have to drive to another ER that’s further away. If you like that your ER may close its doors soon, then keep voting for Republicans. Republicans are fighting the ACA by shutting down hospitals ERs. That’s how they make their idealogical point. They will gladly throw the baby out with the bathwater. As someone stated above, we have some real morons in the Republican Party!

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