For any patient who comes into my practice in Memphis, Tennessee, I try to put myself in their shoes for 30 seconds. If it were me, I’d always prefer to get care from the doctor I know and trust, in the office I know well, rather than taking a number at an ER waiting room.

This “put yourself in their shoes” philosophy has helped us at Cresthaven Internal Medicine achieve lower-than-average ER utilization rates, according to Wellvana’s analytics. And keeping down avoidable ER visits is a key driver to make value-based care work for both patients and for our practice.

In my view, we haven’t done anything extraordinary beyond committing to the following basics.

A Call-First Culture

It’s not like we’re passing out cards to every patient reminding them to call us before going to the ER. I simply find myself consoling patients when I do their post discharge follow-up.

“Sorry to hear about your ER experience. Next time, call us first and we can probably handle that,” since somewhere between 10% and 20% of emergency department visits are deemed avoidable. For a few patients, I even give out my cellphone number, and they’re respectful about when to use it. 

Advanced Imaging

In the last eight years, our practice decided to invest in a CT scanner. It’s worked out pretty well.

Figures published in 2021 show that 36% of ER visits result in a CT, and there are all sorts of nuanced reasons for this, as explored in studies like this one published by the Journal of the American College of Radiology. Dr. Eric Bricker, famous for his LinkedIn explainers, has a great whiteboard episode on this.

There’s certainly some overutilization in the ER. So having our own imaging allows us to say, “Come right in!” to more patients weighing an ER visit. It means we can handle diverticulitis and even a lot of kidney stone cases.

Having the equipment in-house puts the CT decision more in our hands. And if imaging is necessary, that revenue sticks with us instead of the ER — plus, it’s more affordable for the patient.

Same-Day Slots

Same-day appointments are a challenge. I don’t know if there’s much secret other than having an attitude of “we’ll fit you in.”

I’ve been doing this for 40 years. Back in the day, we hardly even scheduled patients. They just came in as needed. I still get a small thrill out of squeezing patient visits into my day. Some of my nurse practitioners also have slack in their schedules and can help me out.

It means I skip lunch more often than I’d like, but it’s also just good patient care. 

Foundational Care™

When you layer Wellvana’s Foundational Care on top of what my practice does internally, the benefits really start to stack up. Wellvana’s Registered Nurses connecting with our patients between in-office appointments — even just once a month — is powerful. Plus, they can get support from Licensed Clinical Social Workers when the needs veer into social determinants of health.

In 2024, Foundational Care as a whole drove is driving down hospital admissions by 17%, saving roughly $3,900 per patient, according to Wellvana’s latest actuarial analysis.

One of the most helpful insights our Wellvana partnership has provided is gaining a better sense of how frequently our patients are showing up in the ER. While it can be discouraging to look at those figures, it provides plenty of inspiration on those days when I’m squeezing in a patient instead of stopping to eat a sandwich.