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Despite efforts to teach patients when they really need to go to the emergency room vs the urgent care center or other settings, TennCare reports that its members have continued to head straight to the ED for relatively minor complaints—to the tune of $87.9 million in fiscal year 2017. That’s an increase of $3 million over the previous year. Claims data released by the state show too many use the less convenient, costlier ED for nonemergencies. TennCare’s chief medical officer, Victor Wu, MD, MPH says this is a long-term problem for all insurers, not just his agency. He says one answer, in addition to getting patients to understand they don’t need to sit in the waiting room to see an emergency physician for an earache, would be to convince them of the importance of preventive care and disease management so they don’t need immediate care as often in the first place—perhaps more rationale for expanding services in the urgent care center to include maintenance check-ups for patients with diabetes, hypertension, and other chronic conditions.

Nonemergent Trips to the ED Cost Tennessee Medicaid Nearly $88 Million This Year
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