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SNAP experiments with rides to urgent care instead of ER for less-serious conditions
This story was originally written by Rachel Alexander for the Spokesman-Review.
(Dan Pelle / The Spokesman-Review)
(Dan Pelle / The Spokesman-Review)

When she worked as a paramedic, Ginifer Wallace saw people call 911 for sore throats or mild cases of the flu.

In those situations, responders usually have two choices: do nothing or take someone to the emergency room in an ambulance, racking up huge bills for the patient and their insurance company.

“You need Mom’s chicken noodle soup and a back rub, not the emergency department,” Wallace said.

In Spokane, paramedics will soon have a third option. Wallace, who works for SNAP, is coordinating a pilot program where patients who call 911 with less serious medical issues can be given a ride to an urgent care center instead of the hospital.

“Patients are going to have the opportunity to get the right care at the right place at a more reasonable cost,” said Dr. Darin Neven, a physician in the Providence Sacred Heart Medical Center emergency room.

The vast majority of 911 calls handled by the Spokane Fire Department are medical, and more than half of them are for “low-acuity” conditions such as urinary tract infections and broken fingers that could be better handled at an urgent care facility. So far in 2016, the fire department has handled 3,735 low-acuity medical calls for issues including back pain, toothaches and fatigue.

Some people don’t realize urgent care is available, don’t have a way to get there or want reassurance from a paramedic that their condition is not life-threatening.

“We can’t stop people from calling 911,” Brian Schaeffer, assistant Spokane fire chief, said during a recent local health care conference. “But could we send a better resource?”

Starting in early 2017, patients will have the option to be taken to urgent care in a vehicle paid for by SNAP. The nonprofit has secured grant funding and contributions from some insurance companies and other private sources to fund a pilot program they’re calling Ride to Care. Wallace said the pilot should run for six months, though that will depend on how much money they can raise.

When someone calls 911, the response from the fire department will not change. Dispatchers will get information from the caller and choose a response based on the apparent severity of the medical problem: a single firetruck with no ambulance for the least serious calls, up to multiple trucks and ambulances for a serious cardiac problem.

The change will be in the transportation offered to the person. If someone has a less serious issue like an ankle sprain, they’ll be offered an option to get a ride to urgent care instead of the hospital, Neven said. Anyone who wants to go to the hospital in an ambulance will still be able to.

“The patient’s always going to be seen by a doctor with this program and it’s always going to be voluntary,” Neven said.

If a patient chooses the urgent care ride, a SNAP-contracted vehicle will be dispatched to come get them within a certain amount of time. That frees up an ambulance to respond to a more serious call instead of transporting someone to the emergency room for a minor problem.

The contracted vehicle can take the patient to a pharmacy, if needed, before returning them home after the visit. The option will only be available during the hours urgent care centers are open, usually 8 a.m. to 8 p.m.

A program like Ride to Care was among the recommendations of Mayor David Condon’s fire task force, which issued a final report in 2013. Neven said the mayor’s willingness to look at doing innovative things in emergency medicine helped spur the program’s creation.

“That’s been kind of the secret sauce,” he said.

Until last year, a program like Ride to Care would have been illegal in Washington because of laws that barred transport of patients to somewhere other than a hospital or detox facility.

Neven said he frequently sees patients in the emergency room who know they don’t need to be there, but don’t have transportation to get to an urgent care center.

“This is a way that we can maximize our strengths and make sure people get to the right place and they’re not coming to the ER just because of the ways the laws are written,” Neven said.

SNAP estimates the average patient will save $300 to $800 in health care costs by being taken to urgent care, rather than the emergency room. Because emergency rooms treat people in order of the severity of their medical issues, patients also will avoid hourslong waits as doctors deal with life-threatening conditions.

Because the idea is so new, there’s no medical code to bill insurance for a ride to an urgent care center. SNAP was asked to participate in the program to bridge that gap by using nonprofit funding to pay for vehicles. Wallace said the eventual hope is that rides to urgent care could be billed to insurance, reducing or eliminating the need for nonprofit funding.

Several insurance companies have signed on to provide funding for the pilot or are involved in the consortium guiding the project. Those include Amerigroup, which is one of the insurance providers for Washington’s Medicaid program, Premera Blue Cross and Group Health.

Premera spokeswoman Melanie Coon said the company made a $30,000 donation to the Inland Northwest Community Foundation to help fund the pilot.

“Emergency room treatment is very costly and is a driver of higher costs for everyone,” Coon said in an email. Data from the pilot will be tracked to see if taking people to urgent care reduces overall emergency room visits and to identify long-term funding strategies for a permanent program.

Unlike emergency rooms, urgent care centers aren’t required to treat people by law if they can’t afford care.

“One of the reasons people go to the emergency department is because they can’t be turned away,” Wallace said.

Neven said Providence urgent care centers have a policy not to turn people away even if they don’t have insurance. Community Health Association of Spokane has the same policy in place.

SNAP is still working to determine which urgent care centers will be included in the plan, and Wallace said any that are selected will have to meet certain criteria, including accepting Medicaid, private insurance and self-pay patients.



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