Is 911 a Necessary Call?
HMO Wants Members to Call Another Number for Non-Emergencies HMOs such
as Kaiser Permanente want patients to check with them before calling
for an ambulance.
by J. Jennings Moss, ABCNEWS.com
Aug. 24, 1999
One of the nation’s largest health maintenance organizations, Kaiser
Permanente, is trying to get its 8.6 million members to think of
a number other than 911 when they have a medical problem that’s not
an emergency.
Kaiser and a growing number of other HMOs around the country are developing
partnerships with private ambulance companies as a way to manage
care and prioritize medical emergency cases. But critics say this
trend is putting patients at risk.
Kaiser’s arrangement is a five-year, $600-million contract with American
Medical Response of Aurora, Colo., in which AMR provides all non-emergency
medical transport and claims processing. AMR calls its program Pathways.
Bob Eisenman, Kaiser’s director of strategy communications and external
relations, says the primary goal is to simplify the process of getting
a patient to a health facility when a doctor asks for it.
"We’re trying to organize how we do that better," Eisenman
says, "trying to make sure we have really good response times and
high-quality service."
800 Number or 911?
This is the way Kaiser wants the system to work: A member who is having
a health problem should call an 800 number that puts him or her in
touch with an AMR case worker, who then analyzes the situation and
suggests a course of action.
AMR could arrange for transport or, if the problem is judged to be an
emergency, would tell the member to hang up and call 911.
The goal is to sort out true emergencies from non-emergencies. Kaiser
hopes that the system will both save costs and focus attention on
valid emergency cases.
Eisenman says Kaiser is not trying to stop its members from dialing 911
in a time of crisis. "We tell our members to call 911 in serious
medical emergencies."
But critics fear that people won’t get that message and instead will
be fearful of an HMO rejecting a bill for ambulance services.
"They’re placing the public in jeopardy," says George Burke,
spokesman for the International Association of Firefighters. "People
who are in need of emergency care are not always capable of remembering
an 11-digit phone number. They can always remember 911."
Burke’s point is echoed by Dr. Mohammad Akhter, executive director of
the American Public Health Association.
"What’s the cost in human terms?" Akhter asks. "Someone’s
going to die, someone’s going to lose an arm or a leg in the process
because you are complicating things. In an emergency, the simpler the
better."
Intent to Save Money, Improve Services
Proponents of the partnerships between HMOs and ambulance services contend
public safety is their top priority. By separating true emergency
calls like a heart attack or a stroke from non-emergency situations,
like a rash or a coughing fit, they argue they can ensure the most
serious cases get the quickest care and attention.
"Fundamentally, we are improving the level of services by providing
access to someone who can get 911 to patients faster than has been done
in the past," Robert Watson, president of AMR's Pathway program,
told USA Today.
The partnership AMR has with Kaiser may be the biggest in the country
but it’s not the only one. AMR has contracts with Blue Cross in Connecticut
and Foundation Health in Miami as well as a pilot project with Humana
in Florida, according to the company’s Web site.
Dr. Ronald Roth, an associate professor of emergency medicine at the
University of Pittsburgh and the medical director for Pittsburgh's
911 system, described these arrangements as "the wave of the
future." "There are some 911 centers where if you call
and you meet certain criteria, they won’t send an ambulance," Roth
says. "They might send you to a non-emergency number, a nurse
online or get you referred to a clinic."