The number of international students who have visited an Emergency Room (ER) for non-urgent health care has more than doubled in the last six months, according to the July, 2010 LewerMark Emergency Room Admissions Report, which summarized trends over a six month period.

Conditions for which students sought treatment included acne and upper respiratory infections. One claim for the treatment of nausea resulted in a $1,359 bill. Another claim for acne treatment, a condition now treated by CVS and Walgreen’s walk-in clinics, cost $221. Treatment of acne using a topical cream and an antibiotic costs an average of $60 at a retail walk-in clinic, not including the price of the prescriptions.

Though a larger number of claims were paid out by the end of the six-month reporting period, ending June 2010, this doesn’t necessarily indicate a trend, according to LewerMark director Jeff Crawford.

“We are insuring more students coming from countries with socialized medicine. These students are more likely to visit the ER for non-urgent care because it is standard procedure in their home countries," said Jeff. "An increase in these enrollments has Lewer focused on addressing this cultural misunderstanding with these students as soon as they arrive in the United States."

In its effort to curb the practice among students of going to the ER for non-emergency medical care, Lewer is providing client schools with handouts, posters, and assistance during orientations.

"We are communicating that there are other options available, including our 24/7 Nurse Help Line and retail walk-in clinics," said Jeff. "With some of our larger schools, it is sometimes a challenge to connect with all students. We are working closely with these schools, making sure everyone knows there are other, excellent options.

"It is interesting to note that non-emergency ER claims are highest in areas where retail walk-in clinics are not as conveniently located as they are in other areas," says Jeff. "We expect to further reduce the number of ER visits for non-urgent care as Lewer continues to expand its retail walk-in clinic networks across the country."

Although heading to the ER when one becomes sick, instead of making an appointment to see a physician, is often a cultural decision, one wonders if once a student experiences care in a U.S. Emergency Room, if they will return next time they get the flu or a toothache. In addition to significant cost, ER visits require an investment of time. Visitors typically wait an average of four hours before receiving treatment. Wait times at retail walk-in clinics average 5 to 15 minutes.

According to a recent article published in the Kansas City Business Journal, which cited the most recent annual report from Press Ganey Associates, Inc., Emergency Room patients in Kansas had to wait an average of five hours and 43 minutes until they were seen by a physician. That’s 21 minutes longer than last year and almost two hours longer than across the state line in Missouri. “That wait makes Kansas the second-worst in the nation, ahead of Utah’s average wait time of eight hours and 17 minutes,” according to analysts. Nationwide, the average wait time was four hours and seven minutes in 2009, up four minutes from 2008.

With Emergency Rooms currently over-taxed because of the sluggish economy, students not only have to wait longer, they also take the chance of receiving rushed, sub-par care. Emergency Room physicians are busy dealing with an influx of unemployed patients with non-urgent conditions, including depression and anxiety.

In a study, funded by the Kaiser Family Foundation’s Commission in August, 2010, it was reported that “Emergency Room capacity is strained and almost all emergency departments reported rising volume. Nearly every emergency department represented in the study reported operating at or over capacity. Several were described as "overwhelmed" or "close to the breaking point."

The results of the study also revealed that the recession was widely viewed as a source of rising volume. Emergency departments are seeking to deal with volume increases by adding shifts for physicians, increasing physician staff, and increasing the number of patients ER physicians see per hour. It was stated that there is an “increased pressure on physicians and laboratory and imaging technicians to do more in less time inevitably increasing the risk of errors.”

A recent report from the U.S. Government Accountability Office labeled a whopping 43 percent of ER care “inappropriate.” These are all cases of a non-emergency or even non-urgent nature that could have been redirected to physicians’ offices, clinics, or other lower-tech sites.

The misunderstanding among international students as to which health conditions require a visit to the Emergency Room not only results in wasted time in the ER waiting room, and money, it reduces the chances of receiving quality care. In addition, it has been reported that ER patients who are advised to seek follow-up care, never return for a follow-up visit.

“When students visit the ER for non-urgent care, it can affect loss ratios for LewerMark schools and, in turn, impact premium rates," says Jeff. "Some of our schools most impacted by the threat of premium increases are just as eager as we are to address what is a cultural mindset of students conditioned to head straight to the ER for any kind of ailment." 

Though Lewer has made recent attempts to curb the unnecessary use of ER services by students, through the promotion of retail clinics, the 24/7 Nurse Line, and attendance at orientations, much work remains to be done. “Educating schools and students about choices is a priority,” says Jeff. “The key is continuous communication.”

The Lewer Agency offers client schools aids to help communicate when and when not to use the Emergency Room. Contact Jeff Crawford at jcrawford@lewer.com to receive a poster or request assistance during your school’s next orientation program.