Emergency care is a big problem in the American healthcare system, and one that mHealth and telehealth have the potential to ameliorate.


While a hospital emergency room certainly is the ideal destination for many patients in legitimate emergencies, it is also used by many who do not fit that description. Emergency departments are overcrowded, using precious resources and driving up long wait times for all but the most critical patients; partially as a result, the financial cost of a visit is exorbitant.

The astronomical (and rising) costs of emergency rooms in the US have been well documented in recent years, if not productively addressed (for an in-depth look at emergency room billing and hospital costs generally, check out this New York Times article). The article discusses a bill for $3355.96 for a few stitches, which is not as unusual as one might expect. ER prices, and hospital prices generally, are set much higher than most payers actually pay; Medicare, Medicaid, and insurance companies have negotiated lower rates, a small percentage of patients are treated though they will be unable to pay anything, and hospitals will often reduce the bill for private payers if asked. However, the sticker price is demanded of some patients.

The CEO of California Pacific Medical Center, the greatest revenue-generating non-profit hospital in the state, defends the prices as necessary to support the high costs of running a fully-prepared ER. He gave the NYT the example that the hospital’s ER needs to have a neurosurgeon on call at all times for potential stroke patients.

This could offer a more reasonable, albeit hardly more satisfying, explanation of thousand-dollar stitches: patients aren’t paying for the service they need, they’re paying for the service the hospital is ready to provide, with high fixed costs that must be covered regardless of what they do for the patient. As a Bloomberg article explains it, non-critical emergency room patients are displacing those who really need to be there, and the hospital is recouping its opportunity cost for not treating those potential expensive patients. “It’s not as though the actual value of a single stitch is $500. Rather, that price reflects the opportunity cost to the hospital of treating you rather than someone with graver (and more expensive) medical needs… [which] could very well be thousands of dollars, even for just an hour of medical attention.”

Bloomberg cites research findings that somewhere between 13.7% and 27.1% of visits to the ER are unnecessary (could have been treated elsewhere). Walk-in clinics and urgent-care centers exist for just this purpose. But frequently, the patient (or parent) lacks the resources to know if they (or their child) need the emergency room, another type of urgent care, a visit to a regular doctor sometime in the coming days, or just a bowl of ice cream.

This massive hole in the system can be filled quite effectively with telehealth. Many insurance companies actually offer a nurse hotline for their customers (or anyone who has the number) for just this kind of thing, but it can be difficult for the nurse to diagnose an unknown patient over the phone with no visuals, and even more difficult for a concerned patient to trust the unknown voice on the other end of the line when health is at stake.

Instead, modern mHealth could allow patients to contact someone in their own doctor’s office through a video-call, explain the scenario, and get an opinion on the best treatment option and where to get it. This way, the resources of the emergency room can be saved for those who really need them, while patients with lesser concerns can receive effective, safe and timely care at a reasonable price.

Comments are closed.