Food Trucks As a Model to Reduce Non-Emergent ER Care Use

Bill Gardner has a nice post on the use of Emergency Rooms (ER) for non-emergent care. Such use clogs the ER and is an expensive way to deliver basic care. However, many poor persons have no viable alternative. This is an old problem, and providing everyone with health insurance will not fix it. We need a care delivery innovation of some sort.

I have been considering investing in a food truck in Durham; the many food truck options in and around Durham, NC make me think that I have already missed the investment wave. However, my analysis has lead me to wonder if the food truck concept could be a useful way to address the use of ERs for non emergent care.

The best food trucks I have visited provide good quality food at a relatively low cost, typically by consistently providing a narrow range of fare, and showing up where the customers are when they want to eat.

In the same way, if Duke University Health System had an “ER on wheels” (or several) they could provide basic care at a lower cost than they do at the Duke ER, and could go to where the patients were. In fact, one set up just outside of the entrance to the ER might be the first place to start. After that, you could imagine a twitter driven service in which The Duke ER trucks broadcast their locations; potential patients could tweet or facebook them and say “can you come near the intersection of X and Y street” I think my 10 month old may have an ear infection and I need to figure out if I have to call out sick from work tomorrow”. Patterns of use would emerge. Even if you assumed everyone using such an ER truck was uninsured (they wouldn’t be if competent care could be delivered quicker and cheaper than that at the ER), then it would be advantageous to Duke to undertake something like this so long as the cost was less than their cost of providing care to the uninsured in the ER.* And what patient wouldn’t want to avoid an hours-long wait in the ER?

You can definitely deliver health care via a truck or bus as Hangoverhaven is demonstrating in Las Vegas.

Our facility is open seven days a week from 8 am to 4pm. We have a shuttle that can come pick you up and drop you back off. We have a special WSOP package that is one bag of IV fluids, IV vitamins, and IV glutathione. Glutathione is an antioxidant that also supports mental function. I have been using it the last few weeks with clients and have noticed a significant difference. The WSOP package is priced at $99.

Now, no matter what you think of this service (they take reservations!), it is a case of taking the care to where the people are and addressing their felt needs. And Dr. Jason Burke, the doc/entrepeneur who started this business is a Board Certified Anesthesiologist who trained at Duke. Maybe we need to get him back here for a consult, and see if a mobile ER might not provide quality care while both reducing costs and improving patient satisfaction.

I am being totally serious. When you see the same problem over and over (use of the ER for non emergent care), you need an innovation of some sort.

*I had a surprisingly hard time finding the value of uncompensated care that Duke University Health System says it provides via its Emergency Room, meaning I can’t find I number whose source I understand; I will update when I can dig it up.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

6 Responses to Food Trucks As a Model to Reduce Non-Emergent ER Care Use

  1. remo says:

    This won’t work. People using the ER for non-emergent care are doing so because inability to pay does not impede care. These care trucks are gonna want payment for rolling out to a housing project, not to mention police protection for their own safety in bad neighborhoods. Finally, the idea that a struggling household is gonna check Twitter for a care truck location is beyond clueless.

    Ask yourself this question: if I was going to attempt this in Haiti, how would I do it? If you got a good answer, it’ll scale to a first-world nation. Otherwise, you’re disconnected to reality.

    • Don Taylor says:

      twitter is a small part of what I wrote; just a way to communicate. Show up at the same place several nights in a row is just another way to communicate; EVERY kid in my kids public high school has a cell phone; email, text, twitter, etc is just an extension of yelling out the window…
      The key part of the story is that Duke now spends lots in uncompensated care, and as you note, that is not going away due to legal and cultural stipulations. The counterfactual is the default payment for uncompensated care, not providing no uncompensated care. The question is whether something like this could provide such care cheaper, with higher satisfaction, and more convenience? It might not be so hard to do a little better on the cost side. I know nothing about Haiti.

      • remo says:

        Leave aside Haiti for now.

        There exists many non-ER medical centers where I live (Newark NJ metro). All are walk-in, some extended hours (11p close), and meet your definition of non-ER walk-in medical service. So, is price the component you wish to optimize? If so, these places are definitely competitive. Is presence the component? If so, then ice cream truck medicine might have a play. However, I still see the need to be co-located to ERs or hospitals.

        Here’s the scenario: you drop in on a mobile care station. It’s more than they can handle. What next? In a co-located facility, they get admitted. You’re mixing mobility with low-cost or low-urgency care

  2. Don Taylor says:

    The mixing mobility with low(er) cost & low urgency is a useful distinction. I am mostly thinking from standpoint of an ER that seems to have low urgent cases, either due to cost and/or convenience. How to deliver this care better in terms of cost and quality and convenience to patients.

    • remo says:

      I understand the problem from the ER perspective but I still think you are not following the mobility piece to its logical conclusion. The ER docs are seeing cases as low-urgency; the patients and guardians are *not*. Moreover, you aren’t considering the “muffin bottom” perception that these mobile low-urgent trucks are for poor people only. I would guess backlash at 100% probability in three months from the fake Reverend Sharpton.

      If you are really trying to reduce a (real or perceived) burden on ERs, then I think you start with a larger ER: one with more low-urgency / quick-turnaround functions to divert cases from critcare staff. A bandaid squad, so to speak. I know you think the mobile function is compelling — “they come to *you*” — but there is no proper handoff to critcare ER when you are at a housing project 4mi from the hospital. You just wasted someone’s time that could’ve been spent at a real hospital. Show me a handoff solution with this.

      • Don Taylor says:

        What you say is reasonable….and it seems odd hospitals haven’t innovated this direction. Basically a 24/7 screening clinic nearby. For teaching hospitals, residents could mostly run it.

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