CALL AN AMBULANCE! OR DON'T

Facing huge ER costs, Houston replaces some ambulance rides with videochatting and cabs

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If you call 911 for a stubbed toe in most of the U.S., you could get an ambulance ride and an emergency room visit, costing the system thousands of dollars for something that’s hardly an emergency. But if you try to do the same thing in Houston, you might get told to hitch a cab.

A new medical program in the city has saved more than $1 million by having doctors triage emergency patients over videochat and preventing patients with non-urgent cases from taking an ambulance or going to the ER.

Under the program, known as ETHAN, emergency responders in ambulances carry tablets equipped with video cameras. If responders find a case that isn’t obviously urgent, a doctor videochats with the patient, asking them questions and observing them to try to determine how sick or injured they actually are. If they aren’t facing something drastic, the doctor will schedule them a clinic appointment in the next day, and a cab paid for by city the will take them there.

This addresses a major problem in the medical system: Almost 40 percent of visits to ER rooms in Houston’s Harris County were not urgent or could have been handled by a primary-care doctor instead, according to a 2013 study from the University of Texas. And 61.5 percent of ER patients in the county were poor or uninsured, the Houston Chronicle reported.

“The current way of doing things is not sustainable,” Dr. David Persse, the director of Houston’s Emergency Medical Services offices, told Fusion. “We’re getting calls for things which are clearly not emergencies—medical refills, rashes, stubbed toes… Why are we using the most expensive form of transport to the most expensive form of healthcare for non-urgent patients?”

An ambulance ride in Houston costs about $1,000, and when a patient goes to the ER it costs another $1,300, Persse said. With ETHAN, those costs for non-urgent cases are replaced with a $35 cab ride and a $110 clinic visits.

The program has been used to triage almost 1,500 patients since launching in mid-December, Persse said. It’s saved more than $1 million based on the reduced costs of transport and treatment since then, the Chronicle reported.

Ambulance costs around the U.S. vary widely, from just a couple hundred to several thousand dollars. They used to be free, manned by volunteers or paid for by taxpayers, but now they’re another example of skyrocketing health costs in the country.

While liability is a concern, given that the doctor making the decision over video link could make a mistake in their video evaluation (which often last only five minutes), it’s no different than any other medical interaction, Persse said: “We’re relying on the fact that these are competent physicians,” he said. “There is the possibility that that could happen… but these interactions are all recorded in the event something goes wrong.”

Currently the program is funded by a federal grant, but that runs out in September, and it’s not clear who would then foot the bill. In fact, the city EMS office is losing money on the program—spending money on the remote doctors and cabs—while insurance companies and hospitals are seeing the benefits by spending less on poor or uninsured patients who don’t need emergency treatment.

“This could absolutely be a national model,” Persse said. “The challenge going forward is to establish a method such that those entities that are saving money from this actually fund it.”

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