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Revived emergency room off to a busy start

Luis Fábregas
| Saturday, Feb. 18, 2012

If you're wondering why West Penn Hospital reopened its emergency department this week just a year after shutting it down, the reason is money.

An ER is a surefire way to draw sick patients who end up getting admitted to the hospital. West Penn needs lots of those patients. At last count, the Bloomfield hospital had lost more than 10,000 of its annual ER visits, which at one point exceeded 33,000 a year, before closing the ER in December 2010.

If the first few days are any indication, West Penn is achieving its goal. Patients jammed the newly redesigned ER, complaining of everything from chest pain to back pain, said Dr. Tom Campbell, chair of emergency medicine for West Penn Allegheny Health System.

Campbell is confident West Penn's ER can return to its glory days and isn't worried about the dozens of urgent care centers popping up around the area. The centers have turned into an attractive alternative for people with minor illnesses such as sore throats and bee stings.

UPMC has seven such facilities, including one across the street from UPMC Shadyside and less than a mile from West Penn's reopened ER.

What's interesting about the ER-vs.-urgent-care-center conundrum is that many people who show up in ERs could be treated at urgent care centers. A widely cited study by the RAND Corp. found that up to 27 percent of all ER visits could take place at an alternative site -- and save $4.4 billion a year.

As anyone with a high-deductible plan well knows, the care you get at the urgent center comes with a lower price tag. The U.S. Government Accountability Office last year reported that the average amount paid for a non-emergency visit to the ER was seven times more than that for a health center visit. Highmark Inc., the state's largest insurer, said treatment at an urgent care center can cost up to 75 percent less than the same treatment in an ER.

That's not to say there's no need for emergency rooms. Quite the opposite. If you have trouble breathing, chest pain or a gunshot wound, you belong in a full-scale ER. They have specialists and equipment you won't find at the corner MedExpress. UPMC says Presbyterian, Shadyside and Mercy hospitals this year could see more than 175,000 ER patients, compared with 128,000 three years ago.

"My only fear is that people may go to urgent care when they have more serious problems," Campbell said. "There are things that look very simple on the surface that might need some expertise to make sure it is minor."

Dr. Don Yealy, chair of emergency medicine at UPMC, said that if you think your life or a limb is in danger, that's when you go to the ER. Problem is, most people aren't as practical. They think the worst and head to the ER even when their situation doesn't call for it. That explains studies showing that so many people in ERs could be treated elsewhere, he said.

"How would you be able to tell that your severe headache wasn't due to a stroke?" Yealy said.

In other words, better safe than sorry. Which means there should be room in the health care system for both ERs and urgent care centers.

That's why controlling spiraling health care costs is not an easy problem to cure. Even if you're an ER doctor.

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