Sunday Q and A


Dr. Anna S. asks


How do I keep my patients out of the emergency room?


Make sure they have your home phone number.

“The government pays me to be your personal clinician. Use me. Contact me before you consider any medical care outside this office.”



Fortunately most ERs are paid by Medicare Advantage Organizations on a bundled basis—one payment for everything (though the payments are tiered somewhat based on the severity of the chief complaint).

Find out how the ER is paid under your contract. If it is strict fee-for-service (YIKES!), you may want to try out some of the bonus tactics below.

And try to renegotiate your contract at the same time.



Bonus tactic.


Find out which ER your patients most commonly patronize. Send each ER unit clerk there a token gift, with a note of thanks for doing such a good job caring for your patients.

Meet with them individually. Tell them it would really help the care of your patients if you were notified directly by them if one of your patients was seen. Tell them the formal channels are fine (even if they’re not) but hearing directly from them would be even more valuable. Any HIPPA-compliant way will do.

When you get the notification, have your nurse call the patient directly and make sure that they get in to see you to both address their health issue and to create a teachable moment to decrease the chances of an ER visit happening again.


Bonus, Bonus tactic

If you’re comfortable doing so, engage with the ER front staff in the same way. If a patient of yours comes in and the problem is non-emergent, have them call you first to see if you can deflect the patient before checking in.

This won’t work everywhere, but in my little town with my single hospital it was incredibly effective.


In the suffocating world of healthcare, a little innovation goes a long, long way