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,
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."