For example, a patient experiencing chest pain may rush to the ER thinking he is having a heart attack, but after being seen by a physician he's diagnosed with only indigestion.

"If a patient is having difficulty breathing, they don't know if it's due to sore throat or asthma," Tarantelli said. In some cases, it could be something much more serious.


According to NYU's Center for Health and Public Service Research, the algorithm takes into account initial complaint, presenting symptoms, vital signs, medical history, age, gender, diagnoses, procedures performed and resources used in the ER.

The data Excellus BCBS applied in the algorithm to local data from the Statewide Planning and Research Cooperative System (SPARCS), which looks at patient diagnoses.

The NYU algorithm defines non-urgent care as any patient who could wait at least 12 hours for treatment, but the Centers for Disease Control and Prevention defines non-urgent care as anyone who could wait 24 hours for treatment.

Excellus BCBS reported that one out of four ER visits in which the patient was treated and released the same day was for a medical issue that didn't need care within 12 hours, such as a back problem. And 18 percent of visits were for conditions that needed treatment soon but could have been treated in a primary care setting, such as an ear infection.

One of the main concerns, according to the report, is the increase in emergency care spending due to unnecessary visits. The analysis found that it's about $450 to $650 less expensive to seek primary care instead of ER care for non-emergent care, or care not needed within 12 hours. And it's $600 to $900 less expensive to go to a primary care doctor instead of the ER for emergent or primary care, which was needed within 12 hours but could be treated by a physician.

Surprising to Lustick, 45 percent of "unnecessary visits" occurred between 9 a.m. and 5 p.m. -- "typical working hours," according to the report.

"To me, the most surprising thing in numbers is when we looked at hour of the day and day of the week," Lustick said. "Half [of non-emergent visits] are during office hours. Before seeing the numbers, [we thought they were] weekends and nights, when the doctor's office is not open. But that's not the case."

Lustick, a pediatrician himself, pointed out that for some, the ER is the only option, but for others with a primary care physician, the ER should be avoided unless it truly is an emergency.

But now that the information is out there, Excellus BCBS hopes that people will start coming up with ways to deal with the problem.

"The goal is to get issues out in the open so everyone starts thinking and comes together to figure out some solutions," he said.

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