United Healthcare, the largest insurer in the US, recently announced a new policy it said would help hold down health care costs: It would review claims for emergency department care, opening up the possibility that the company might deny coverage if a patient’s medical needs were not actually an emergency.
After outcry from doctors and patients, the insurer said it would delay implementation until the Covid-19 pandemic has passed — but it still plans to institute the policy eventually.
United Healthcare framed the maneuver as a way to contain costs, as the New York Times reported. But there are problems with that idea, according to the half dozen health policy experts I spoke to. It’s not clear emergency room misuse is actually a rampant problem. And even if some patients do unnecessarily visit the ER, United’s new policy risks discouraging people from seeking necessary care without any guarantee that it will actually bring down costs.
“Too blunt and the wrong problem” is how Tom Tsai, a health policy researcher at Harvard University and a surgeon at Brigham and Women’s Hospital, succinctly put it to me.
“We shouldn’t reduce emergency department visits because we expect to save money,” Laura Burke, a physician at Beth Israel Deaconess Medical Center in Boston who has studied emergency room use, told me. “Because there is no evidence that’ll actually happen.”
The problem is not that patients overuse or misuse the emergency room, said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. Emergency department visits have actually been stable for years and, after a drop during the Covid-19 pandemic, have not yet recovered to previous levels.
Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021
Outpatient Visits for COVID-19 and Associated Antibiotic Prescriptions Among Medicare Beneficiaries Aged 65 Years or Older, by Setting, US, April 2020 to April 2021. The volume of COVID-19 visits differed by setting: emergency department, 525 608 (45.8% of all visits); office, 295 983 (25.3%); telehealth, 260 261 (22.3%); and urgent care, 77 268 (6.6%).
Source: Journal of American Medical Association Network