Fix Emergency Care Triage, STAT

The problem of Emergency Room overuse persists despite a bounty of would-be solutions, and despite the passage of the Affordable Care Act.

When it comes to emergency care triage, somebody needs to call an ambulance. But, that's the problem given the rising numbers of inappropriate ER visits and recidivism. Obamacare has not changed things much to the dismay of policy wonks.

Solutions abound. Some have tried technology. But, the problem persists. Why?

1. Patients and doctors are just beginning to understand ER alternatives like retail based clinics and urgent care centers.

2. The "system" often works against patients or some alternative locations are not available.

3. There is a mixed message. Have you passed the billboards advertising their ER wait times?

4. Getting seen is but the first act of the play. Getting appropriate follow up triage takes up most of the rest of the performance and strangely looks like Act 1 in many instances.

5. Patients and doctors still don't trust one facility over another.

6. Most doctors don't want to see patients on nights, after hours, and weekends in their offices. ERs are a de facto on call coverage service.

7. The culture of ER users find it hard to change.

8. Doctors fear law suits from referral liability

9. Payers don't reward continuity of care in most instances

10. Changing habits of ER frequent flyers is the last mile when it comes to realizing cost savings resulting from appropriate triage. Information and education usually does not change behavior. You also have to provide incentives and psychic gratification to get someone to change and avoid relapsing.

Patients have a lot of options when it comes to getting care for urgent problems. Add to the list telemedicine, Uber Urgent Care, and DIY medicine and things start to get really interesting.

Wrong site surgery is still with us. Wrong site care is an even bigger problem and we won't crack the nut until we address the triggers, actions, rewards and sustainability factors that make patients do what they do and get care where they get it.