By ANYA MARTIN

The time it takes to get treated at emergency rooms in the U.S. is on the rise, but hospitals are trying new methods to reduce the wait.

One tactic that’s working: Some hospitals are redirecting people with less-urgent conditions to other health-care providers. But that practice comes with its own problems, some doctors say.

About 14% to 27% of all emergency-room visits could take place at urgent-care centers or retail clinics, according to a study published last September in Health Affairs.

Of course, beyond the inconvenience of a long wait time, treatment delays can be deadly. Consider the highly publicized 2006 case of a woman who went to an ER in Waukegan, Ill., with chest pains. She went into cardiac arrest after waiting two hours.

In Milwaukee County, Wis., 48% of the 363,377 emergency-department visits last year were nonemergent, according to Paul Coogan, emergency-department medical director at Aurora Sinai Medical Center in Milwaukee.

“There’s a lot of nonurgent, nonemergent use of ERs because, let’s face it, we’re pretty quick, open 24/7, board-certified in emergency medicine and because of [federal] law, we have to see everybody who shows up,” he says.

Since starting a program in mid-2006 that matches nonurgent patients with alternate providers, Aurora Sinai has reduced its annual ER visits by about 23%, Dr. Coogan says. That percentage might have been higher if a nearby hospital had not closed, funneling more emergency patients into Aurora Sinai, he says.

To meet federal legal guidelines, all arriving patients at Aurora Sinai’s emergency department are seen and triaged by a physician, nurse practitioner or physician’s assistant, he says. If a patient is found to have a nonemergent issue, he is educated about the appropriate use of the emergency room to reduce unnecessary future visits and then is sent to a scheduler to make a follow-up appointment with a primary-care provider.

“We don’t just kick the patient out,” Dr. Coogan says. “We make sure they have an appointment with a primary-care doctor in hand, and that’s whether they have insurance or not.”

Efforts to redirect ER patients are often criticized as not being effective because people don’t show up at these follow-up appointments. But MyHealthDIRECT, the Web-based scheduling program that Aurora Sinai uses, was specifically developed to address reasons why people might miss appointments, says Jay Mason, chief executive and co-founder of the Milwaukee-based software developer.

“We’ve learned through the years what the important variables are,” he says. “So, for example, Jay lives in this neighborhood and needs to be seen tomorrow afternoon with a Spanish-speaking doctor who takes Medicaid.”

Taking nonurgent patients out of the ER only addresses one cause of the overcrowding that leads to longer wait times, says Jesse M. Pines, an emergency physician and director of George Washington University’s Center for Health Care Quality.

Other hospitals are addressing the wait-time issue by improving their processes — for example, having patients seen first by doctors rather than nurses, he says. “Then people with more minor conditions who don’t need tests can be discharged immediately, and people who need tests can get those ordered upfront and get through the system more quickly.”

Easing ER Wait Times
WSJ.COM: MONEY | MAY 7, 2011
http://online.wsj.com/article/SB10001424052748703859304576309853969914200.html

Health care business CEO wants to relocate headquarters if state provides incentive

Premium content from The Business Journal – by Corrinne Hess

Date: Friday, April 29, 2011, 5:00am CDT

Dan Maynard . . . “If Gov. Walker wants to bring business here, I want to give him the opportunity to do so.”

An Atlanta-based health care technology company is considering relocating its corporate headquarters to Wisconsin if Gov. Scott Walker will provide the right incentives.

Dan Maynard, president and chief executive officer of Connecture, a software developer for health insurers and brokers, plans on doubling the size of the company in terms of employees and revenue over the next two years and he wants to do it here. He could hire up to 200 new employees in the Milwaukee area.

“Gov. Walker’s employer-friendly attitude maybe hasn’t all come to closure, but it has gotten someone like myself to pay attention,” Maynard said. “If Gov. Walker wants to bring business here, I want to give him the opportunity to do so.”

Maynard, who already operates an office in Waukesha with about 110 employees, and lives here himself, said he could easily expand in Atlanta, where the infrastructure is already in place, but he would prefer to grow the business in Wisconsin.

Recent headlines detailing Walker’s financial assistance to other businesses, such as the April 20 announcement that Merge Healthcare Inc. would receive $500,000 in tax credits and a $500,000 loan from the Wisconsin Department of Commerce to consolidate operations at its Hartland facility, made him think about his own value to Wisconsin.

“I’m an entrepreneur and I’ve never requested anything from the state before,” Maynard said. “But there will be some costs associated with the move, and I would certainly like some incentives to bring more employees to the state.”

The state is especially interested in helping companies relocate headquarters to Wisconsin and there are several programs available to people who want to do so, said Department of Commerce spokesman Tony Hozeny.

Connecture expanded last year when it began offering insurance brokers an online “shopping platform,” where they could search insurance carriers and compare rates. The broker exchange is similar to the health insurance exchanges that states are being asked to create under federal health care reform.

States must demonstrate to the federal government by Jan. 1, 2013, that their exchange is viable for implementation by Jan. 1, 2014. Wisconsin is one of seven states to receive a $37.7 million “early innovator” grant to develop an exchange model that can be used in other states.

Maynard would like to be awarded the contract to develop the exchange.

He said he is one of the top three choices in at least six other states, although he wouldn’t say which states.

Wisconsin’s health insurance exchange was being developed rapidly under former Gov. Jim Doyle. However, the Walker administration appears to have slowed down the process. The exchange will be a massive undertaking driven by guidance from the federal government and right now, a lot of that guidance is not available, said Seth Boffeli, spokesman for the state Department of Health Services.

Maynard has been a Wisconsin business owner since 1993 when he founded a computer consulting company called Computing Concepts Inc., which was purchased in 1999 by Workscape, a Massachusetts benefits software company.

Workscape closed the Waukesha office in 2001; Maynard and some of his partners bought the assets and intellectual property and opened Riverwood Solutions. In 2004, Riverwood Solutions merged with its largest competitor, Connecture.

When Maynard took over Connecture in 2004, the company had 47 employees and annual revenue of $16 million. Today, there are close to 200 employees in three locations and annual revenue of $30 million.

Maynard said his investors question his desire to expand in Wisconsin instead of Atlanta, which is why Maynard is trying to get Walker’s attention.

He’ll also ask Georgia Gov. Nathan Deal what incentives that state would offer him to stay in Atlanta.