Primary and specialty care physicians make it a practice to provide coverage after office hours and on weekends. In fact, it is a requirement for all network providers to maintain this coverage. However, are your patients aware of this service, or are they simply going to the emergency room/department (ER) for care?

Recent findings

According to the 2014 Accessibility of Services Report, over the last three years the number of members enrolled in AmeriHealth New Jersey HMO plans who called their physician after office hours remained essentially unchanged. (Comparison data is unavailable for members enrolled in AmeriHealth New Jersey PPO plans or AmeriHealth Pennsylvania plans due to changes in data collection for 2014 reporting purposes.)

Another recent study of a targeted member population showed that members were utilizing the ER for urgent medical care, including otitis media, upper respiratory infection, and acute pharyngitis. Thirty four percent of these ER visits occurred on the weekend, when most primary care practices are closed. Although some providers have voicemail or answering services that answer calls after hours, this may not prevent an ER visit if:

• the patient does not call;
• there is a delay in physician response;
• the member/caregiver does not understand the difference between an emergency and urgent medical care need.

Visits to the ER can interrupt continuity of care and may affect quality of care as well — especially if the patient?s physician is unaware of the ER visit and needed follow-up care is absent.

Educate your patients

AmeriHealth encourages all physicians to discuss after-hours and weekend coverage, as well as the availability of urgent care centers and retail health clinics with their patients. Physicians can communicate this message by:

• placing a notification in the office that explains how to contact you when the office is closed;
• providing a listing of the nearest urgent care centers and retail health clinics;
• discussing coverage individually with patients.

Remind patients to contact their primary physician or specialist after a visit to the ER, urgent care center, or retail health clinic for assessment of appropriate follow-up care. This is especially important for pediatric patients, elderly patients, and those patients with chronic conditions. Explain that calling will allow the physician office to coordinate services with the facility for the best patient outcome.

All patients want to receive the best possible care, so if they understand the rationale behind the request, they may be more apt to communicate more openly with your office to coordinate care after hours and after visits to the ER, urgent care center, or retail health clinic.