Michigan PPO asks frequent ED users to phone plan first

The Blues plan says its nurse line can help prevent unnecessary emergency visits. But doctors say that's their call.

By Robert Kazel, AMNews staff. Jan. 12, 2004.

Blue Cross Blue Shield of Michigan recently sent postcards to 40,000 of its PPO members. The note on the cards read:

"Where you receive medical treatment can sometimes be just as important as the treatment itself. The simple truth is, not all medical 'emergencies' require a visit to a hospital emergency room." The card then asked patients to call BlueHealthConnection, the disease-management program of which the nurse line is a part. The line is staffed around-the-clock by registered nurses trained to give out a variety of information.

The plan's idea is to reduce so-called unnecessary emergency department visits. Many of the 40,000 members who received the cards were identified by the plan as frequent ED users, defined as having visited "three or four times," said Tom Simmer, MD, vice president and medical director of the Michigan Blues. PPO members don't have to call the plan before going to the emergency department, and the plan cannot bar them from going. "This is a voluntary program and is not a prior-authorization program," Dr. Simmer said.

However, some Michigan physicians wonder how pure the Blues plan's motives are. Some doctors say call lines interfere with the physician-patient relationship and run the risk of giving patients faulty advice. They wonder if Blues-employed nurses could make an objective decision, knowing that sending a patient to the ED could increase plan expenses.

"There may be a conflict of interest," said Hassan Amirikia, MD, an ob-gyn in Detroit and president of the Michigan State Medical Society. "If they direct the patient to the ER, who gets the bill?"