There was a recent report pointing to increased Medicare costs when patients returned to traditional Medicare, of course assuming that…
Curbside Consult with Dr. Jayne 8/8/11
I had a long, lazy weekend, of which I spent a good part staying up too late catching up on the Netflix releases that have been mocking me from the top of my television. Kind of like those folks that tend to smoke only when they visit bars — when I stay up late, I have a bad habit of winding up at Taco Bell. As I sat in the drive-through lane pondering what it is that makes even the most health-conscious physician stray, I noticed a billboard for a local hospital advertising the ability to hold one’s place in line in the emergency department.
It was news to me that one of our competitor hospitals had partnered with InQuickER, whose slogan is “Skip the Waiting Room.” Essentially, for a $9.95 registration fee, patients can register for their emergency department visit and wait at home until their projected treatment times. Kind of like call-ahead seating at Red Lobster, although I assume you don’t get a cute crustacean-shaped beeper when you arrive.
As a technical person who also speaks fluent Administralian, it sounds good. It’s a relatively easy technical application – if restaurants can do it, there’s no reason it can’t be applied to other industries, including healthcare. As a physician leader, I can imagine that patients who aren’t frustrated from sitting for hours in a crowded waiting room are likely to give higher scores on patient satisfaction surveys and may be less likely to taunt the triage staff or harass caregivers.
On the other hand, as a clinician, it makes me cringe a bit. Although InQuickER admits it doesn’t actually schedule appointments but rather holds a patient’s place in line while they wait at home, it does offer a guarantee in which users who aren’t seen within 15 minutes of their projected treatment time are given their money back.
During the past decade, I’ve watched the physician/patient relationship slowly erode. There are a lot of factors impacting this both positive and negative.
Personally, I believe that educated patients are healthier patients. I believe in patient self-determination and that some physicians need to jettison the antiquated paternalistic tendencies they continue to carry. I want patients to be smart shoppers and to understand their healthcare choices. I don’t want them to necessarily do things because “the doctor told me to.”
On the other hand, I believe the overt consumerization of healthcare has some serious downfalls and minimizes the complexity and skill involved in caring for and treating patients.
Although InQuickER’s FAQ section clearly states that hospitals do use triage protocols and that its users do not receive preferential treatment, it’s easy for a patient who doesn’t read the fine print to make the logical leap that they’re going to receive special or quicker treatment. They advertise a 95% success rate for patients being seen within 15 minutes of their projected treatment time, and for physicians already under pressure to reduce cycle times and see greater numbers of patients more and more quickly, this is just going to add more stress to an already bubbling pressure cooker.
I cover the emergency department regularly and see a large proportion of patients who don’t need to be there, many with non-urgent conditions who haven’t tried any over-the-counter remedies or exercised a reasonable degree of Boy Scout-level first aid skill. In some cases, the thought of sitting in the waiting room with “all those sick people” is enough to keep them at home and out of the emergency department, and sometimes their issues spontaneously resolve without at $50 copay.
For a mere $9.99, the inconveniences of waiting are avoided, and I worry that this will bring more non-urgent cases into our already overcrowded system. On the other hand, for some cases, this could be heaven sent – for the migraine patient who has exhausted all home prescription medications and is bothered by light and sound, the ability to minimize time in the waiting room is solid gold.
As I crunched on my Volcano Taco, I surfed the hospital’s Web site. Injecting a bit of humor into the situation was this: the InQuickER site projected a 75-minute wait for me, while the hospital’s own handheld app advertised a 14-minute wait on their real-time waiting room ticker. With stats like that, of course, the odds that I’d be seen before or within 15 minutes of my projected treatment time were pretty good.
I can see both sides of this one, so for me, the jury’s still out. Nevertheless, I put the word out to colleagues at the hospital in question to ask how it’s really going, but I’d also like to hear from readers. Are any of your facilities using the system or that of a competitor? InQuickER is SaaS model — how are they to work with? How is support? Any issues? E-mail me.
That whole thing is just amazing to me, having worked directly across the hall from a busy ER I was witness to the number of people who treated the ER like a free clinic. Why schedule an appointment with your family MD for the sniffles or a sore throat when you can go to the ER instead. It’s no damn wonder our health system is such a mess!
Another reader made this point: And what happens when someone’s urgent condition turns critical while they’re waiting at home?
As one of those migraine patients, I have to say that I would love this app. I have 3 ERs within reach, but one of them won’t tell me current wait times EVER. Guess which one I never go to…
All sorts of service businesses / organizations are forced into using data about their operations to set reasonable expectations for their customers. This has been going on for a long time. Traditional craftpeople who were experienced beyond an apprentice level could give you a pretty good idea when the job would be done once they understood the job. Seems to me like the same thing here.
The issue of unintentionally drawing non-emergent patients to the ER with better service (more knowledge about wait times) is a different question. My local hospital built an urgent care clinic next to the ER years ago – it works pretty well as a diversion route for people who aren’t in need of the high-cost services of the ER. Why don’t all hospitals with ERs have urgent care clinics open from early to late, staffed with the right mix of primary care docs, nurse practitioners, and with a pharmacy attached?