Nearly one of every three Hilo emergency room patients isn’t actually experiencing a medical emergency.

In the past five years, 29 percent of patients treated at Hilo Medical Center’s emergency department were “nonemergency,” according to data obtained by the Hawaii Tribune-Herald.

That worries health administrators because they want to focus on those in greatest need. But they also don’t want to discourage people in true need who already are reticent to call 911. They’re already taking action to address the situation.

Stacy Wong, spokeswoman for the Healthcare Association of Hawaii, the nonprofit trade organization representing Hawaii hospitals, said the national average is 27 percent of patients going to the ER for “potentially preventable” visits.

A hospital doesn’t necessarily lose money when it treats patients at the ER instead of at a clinic, said Dan Brinkman, regional chief executive officer of the East Hawaii Region of Hawaii Health Systems Corp.

A health system gets reimbursed about $35 by insurance for treating an urgent care clinic patient and about $100 for treating an ER patient in Hilo, he said.

“In a lot of cases, we make a little money,” Brinkman said.

But, he said, “It’s not a responsible way to serve patients” when those patients feel their best nonemergency medical option is to visit the ER.

The National Center for Health Statistics reported that 12 percent of U.S. patients in 2014, the latest year with data available, said they went to the ER because their doctor’s office was not open.

That’s why Hilo Medical Center is taking steps to make urgent care services more accessible.

In Pahoa, for example, the hospital is partnering with Puna Community Medical Center to lease expansion space so PCMC can treat more patients closer to home, thereby decreasing the likelihood they’ll feel compelled travel to the ER in Hilo.

“We’re hoping that the Pahoa urgent care will help,” said Odetta Rapozo-Pung, Hilo Medical Center emergency services director.

Ralph Boyea, vice chairman of the PCMC board, said state dollars were used to fund a feasibility study for construction of a new Pahoa hospital with an emergency room.

“We’re looking that over in terms of what will work in Puna,” he said. It will need to be financially viable, he said. Exactly what type of services might be offered, and when, is still in the planning stage.

“We are looking at including emergency services,” Boyea said.

Patients make 49,000 visits to the Hilo Medical Center ER annually, according to spokeswoman Elena Cabatu. Some of those are repeat visits. Forty-one percent are made by patients from the Puna District, Cabatu said, and 14,000 are from Pahoa or nearby.

Among those 14,000, hospital officials estimate, 4,000 a year could be cared for at an expanded Puna Community Medical Center instead of at the Hilo ER.

From 2012-16, Hilo Medical Center’s ER treated 132,866 patients.

Of those patients, 29 percent — 38,648 patients — were not experiencing what would fit within the definition of a health emergency, such as minor scrapes, head colds or other symptoms that could easily be handled by a patient’s primary doctor.

But once a patient goes through the ER doors, Brinkman said, health providers must by necessity, and by law, treat the patient.

“We’re considered a safety-net hospital, so we try to serve everyone,” Rapozo-Pung said. “We can’t refuse service to anybody.”

Wong said, by law, all hospitals that accept Medicare and operate an ER “must render care to anyone who presents.”

The Hilo Medical Center ER team assumes each patient has a potentially life-threatening condition until determined otherwise.

As examples, Emergency Department Nurse Manager Charlene Akuna said “jaw pain, it could be dental — or it could be a heart attack.” A woman with diabetes with a stomach ache, she said, might have blood sugar issues or might be going into cardiac arrest.

The hospital must make sure those with true medical emergencies seek and get care, which is why health providers avoid discouraging anyone from using the ER.

Wong said the number of hospital ER visits statewide in Hawaii has grown 18.5 percent in four years, from 414,370 visits in 2010 to 490,830 visits in 2014. During that time, Hawaii County’s population grew by 5 percent and the state’s population by 4.4 percent, she said.

Why do some patients go to the ER instead of a clinic when their conditions aren’t life-threatening? For some, the hospital might be their only health provider because of lack of insurance, inability to make co-payments or a work schedule that makes getting to a clinic during the day difficult.

When a patient calls a clinic, it sometimes can take more than a month to get an appointment, Rapozo-Pung said.

An emergency is any situation that requires immediate help from police, firefighters or ambulance crews, said Hawaii Fire Department Battalion Chief Lance Uchida, citing information from the federal government.

Examples can include a fire; crimes, especially one in progress; a car crash, especially if someone is injured; or a medical emergency that requires immediate medical attention.

Uchida said if you’re not sure whether something qualifies as an emergency, call 911 and let the dispatcher decide.

In addition, he said, “we encourage people to be compliant with their daily medications, regularly see their personal doctors and to live a healthy lifestyle” to prevent the need for emergency medical care.

Rapozo-Pung said there’s also a worry about people who wait too long to call 911 and get to the ER. For example, if someone says, “this is the worst headache I’ve ever had,” 911 should be called immediately.

She remembers a man coming in when she was a staff nurse.

“He fell to the ground and I shocked him and he came back and I was like, ‘Oh, you got here right in time!’” she said.

What’s most difficult emotionally for health professionals, she said, are preventable childhood deaths of kids not observed when around water, or not buckled in seat belts or safety seats.

Brinkman said the Hilo Medical Center ER is expected to reach full capacity within about a decade.

An average increase of about 897 patients per year in the ER has taken place the past few years, from 24,855 patients in 2012 to 28,445 patients in 2016.

That’s about a 3.5 percent increase in ER patient census per year, which, according to Brinkman, could boost the ER to 65,000 patient visits annually by around 2027.

That’s why Hilo Medical Center is collaborating with PCMC in Pahoa, and other actions are underway, to stem the tide of patients who would be better served by visiting the doctor’s office.

“If those things pan out, our ER will last us a lot longer,” Brinkman said.

The hospital is making contingency plans as if it will be maxed out on space by 2026. Already, Brinkman said, the hospital as a whole stays about 80-85 percent full, on average.

Building new facilities is costly, Brinkman said — perhaps $100 million-$300 million for a new hospital.

“We want to keep this one renovated and a great place for care,” he said.

In the meantime, county firefighters visit 911 “high utilizers” to connect them with social and medical services that can offset the need for future calls.

The hospital emergency department’s “fast-track” tries to get nonemergency patients in and out fast.

“Someone stitches you up, and then you’re out the door,” Brinkman said. “We generally can get people in and out within about an hour and a half through that area.”

Brinkman said it will be important to develop services in Pahoa that match need. For example, it’s possible an “urgent care-plus” could be used to start out, with X-ray, lab capability and extended hours.

Patients in need of a higher level of care would get transferred to Hilo.

“To me, that’s a logical step that can be ‘sized’ to grow with the population,” Brinkman said.

“Significant growth in population” will be needed before a hospital can be built there, he said.

Akuna said ER workers care about their job, each other and the community.

“Because this could be any one of our family members coming in here.”

Email Jeff Hansel at jhansel@hawaiitribune-herald.com.

Nearly one of every three Hilo emergency room patients isn’t actually experiencing a medical emergency.

In the past five years, 29 percent of patients treated at Hilo Medical Center’s emergency department were “nonemergency,” according to data obtained by the Hawaii Tribune-Herald.

That worries health administrators because they want to focus on those in greatest need. But they also don’t want to discourage people in true need who already are reticent to call 911. They’re already taking action to address the situation.

Stacy Wong, spokeswoman for the Healthcare Association of Hawaii, the nonprofit trade organization representing Hawaii hospitals, said the national average is 27 percent of patients going to the ER for “potentially preventable” visits.

A hospital doesn’t necessarily lose money when it treats patients at the ER instead of at a clinic, said Dan Brinkman, regional chief executive officer of the East Hawaii Region of Hawaii Health Systems Corp.

A health system gets reimbursed about $35 by insurance for treating an urgent care clinic patient and about $100 for treating an ER patient in Hilo, he said.

“In a lot of cases, we make a little money,” Brinkman said.

But, he said, “It’s not a responsible way to serve patients” when those patients feel their best nonemergency medical option is to visit the ER.

The National Center for Health Statistics reported that 12 percent of U.S. patients in 2014, the latest year with data available, said they went to the ER because their doctor’s office was not open.

That’s why Hilo Medical Center is taking steps to make urgent care services more accessible.

In Pahoa, for example, the hospital is partnering with Puna Community Medical Center to lease expansion space so PCMC can treat more patients closer to home, thereby decreasing the likelihood they’ll feel compelled travel to the ER in Hilo.

“We’re hoping that the Pahoa urgent care will help,” said Odetta Rapozo-Pung, Hilo Medical Center emergency services director.

Ralph Boyea, vice chairman of the PCMC board, said state dollars were used to fund a feasibility study for construction of a new Pahoa hospital with an emergency room.

“We’re looking that over in terms of what will work in Puna,” he said. It will need to be financially viable, he said. Exactly what type of services might be offered, and when, is still in the planning stage.

“We are looking at including emergency services,” Boyea said.

Patients make 49,000 visits to the Hilo Medical Center ER annually, according to spokeswoman Elena Cabatu. Some of those are repeat visits. Forty-one percent are made by patients from the Puna District, Cabatu said, and 14,000 are from Pahoa or nearby.

Among those 14,000, hospital officials estimate, 4,000 a year could be cared for at an expanded Puna Community Medical Center instead of at the Hilo ER.

From 2012-16, Hilo Medical Center’s ER treated 132,866 patients.

Of those patients, 29 percent — 38,648 patients — were not experiencing what would fit within the definition of a health emergency, such as minor scrapes, head colds or other symptoms that could easily be handled by a patient’s primary doctor.

But once a patient goes through the ER doors, Brinkman said, health providers must by necessity, and by law, treat the patient.

“We’re considered a safety-net hospital, so we try to serve everyone,” Rapozo-Pung said. “We can’t refuse service to anybody.”

Wong said, by law, all hospitals that accept Medicare and operate an ER “must render care to anyone who presents.”

The Hilo Medical Center ER team assumes each patient has a potentially life-threatening condition until determined otherwise.

As examples, Emergency Department Nurse Manager Charlene Akuna said “jaw pain, it could be dental — or it could be a heart attack.” A woman with diabetes with a stomach ache, she said, might have blood sugar issues or might be going into cardiac arrest.

The hospital must make sure those with true medical emergencies seek and get care, which is why health providers avoid discouraging anyone from using the ER.

Wong said the number of hospital ER visits statewide in Hawaii has grown 18.5 percent in four years, from 414,370 visits in 2010 to 490,830 visits in 2014. During that time, Hawaii County’s population grew by 5 percent and the state’s population by 4.4 percent, she said.

Why do some patients go to the ER instead of a clinic when their conditions aren’t life-threatening? For some, the hospital might be their only health provider because of lack of insurance, inability to make co-payments or a work schedule that makes getting to a clinic during the day difficult.

When a patient calls a clinic, it sometimes can take more than a month to get an appointment, Rapozo-Pung said.

An emergency is any situation that requires immediate help from police, firefighters or ambulance crews, said Hawaii Fire Department Battalion Chief Lance Uchida, citing information from the federal government.

Examples can include a fire; crimes, especially one in progress; a car crash, especially if someone is injured; or a medical emergency that requires immediate medical attention.

Uchida said if you’re not sure whether something qualifies as an emergency, call 911 and let the dispatcher decide.

In addition, he said, “we encourage people to be compliant with their daily medications, regularly see their personal doctors and to live a healthy lifestyle” to prevent the need for emergency medical care.

Rapozo-Pung said there’s also a worry about people who wait too long to call 911 and get to the ER. For example, if someone says, “this is the worst headache I’ve ever had,” 911 should be called immediately.

She remembers a man coming in when she was a staff nurse.

“He fell to the ground and I shocked him and he came back and I was like, ‘Oh, you got here right in time!’” she said.

What’s most difficult emotionally for health professionals, she said, are preventable childhood deaths of kids not observed when around water, or not buckled in seat belts or safety seats.

Brinkman said the Hilo Medical Center ER is expected to reach full capacity within about a decade.

An average increase of about 897 patients per year in the ER has taken place the past few years, from 24,855 patients in 2012 to 28,445 patients in 2016.

That’s about a 3.5 percent increase in ER patient census per year, which, according to Brinkman, could boost the ER to 65,000 patient visits annually by around 2027.

That’s why Hilo Medical Center is collaborating with PCMC in Pahoa, and other actions are underway, to stem the tide of patients who would be better served by visiting the doctor’s office.

“If those things pan out, our ER will last us a lot longer,” Brinkman said.

The hospital is making contingency plans as if it will be maxed out on space by 2026. Already, Brinkman said, the hospital as a whole stays about 80-85 percent full, on average.

Building new facilities is costly, Brinkman said — perhaps $100 million-$300 million for a new hospital.

“We want to keep this one renovated and a great place for care,” he said.

In the meantime, county firefighters visit 911 “high utilizers” to connect them with social and medical services that can offset the need for future calls.

The hospital emergency department’s “fast-track” tries to get nonemergency patients in and out fast.

“Someone stitches you up, and then you’re out the door,” Brinkman said. “We generally can get people in and out within about an hour and a half through that area.”

Brinkman said it will be important to develop services in Pahoa that match need. For example, it’s possible an “urgent care-plus” could be used to start out, with X-ray, lab capability and extended hours.

Patients in need of a higher level of care would get transferred to Hilo.

“To me, that’s a logical step that can be ‘sized’ to grow with the population,” Brinkman said.

“Significant growth in population” will be needed before a hospital can be built there, he said.

Akuna said ER workers care about their job, each other and the community.

“Because this could be any one of our family members coming in here.”

Email Jeff Hansel at jhansel@hawaiitribune-herald.com.