The emergency room at Saint Francis Hospital was dead quiet at 2:30 p.m. on a Friday. The rows of chairs were vacant, the only people inside were two security guards.
On Thursday, the Kanawha County Commission voted to raise county employees' insurance deductible on emergency room visits from $50 to $100 in attempts to help keep it that way.
Last year, the county spent $949,941 on emergency room expenses for its employees. The commission is hoping that with a higher deductible, some people who are going to the emergency room for things they probably shouldn't be, like the flu, will be deterred and will opt for an urgent care or primary care physician instead, both of which are cheaper than an emergency room visit.
While the insurance hike and re-education policy won't save the county that much money, it could help emergency rooms decrease wait times for their patients.
"There's only so many resources in an emergency room," said Mark Stephens, a physician at Charleston Area Medical Center's urgent care. "Only so many doctors and mid-level practitioners and nurses and the more things that they have to deal with, the longer the wait times are."
According to Highmark West Virginia, the insurance company of Kanawha County Employees, 13.9 percent of a company's employees will usually go to the ER for injuries that are minor, or low to moderate. Those are typically the injuries that can be taken care of by urgent care or a primary care physician.
Sometimes, there's a reason for that. The hours of operation for primary care aren't always conducive to family life. If a boy breaks his bone jumping on the bed at a sleepover at midnight, his parents won't be able to take him to the primary care doctor or urgent care. If there's a late-night problem, most patients have only one option - the emergency room.
But not all visits happen at night.
"There are people who go to the ER for non-emergent things because that's pretty much all that they know," said Kala Withrow, a nurse practitioner at the Thomas Memorial Hospital in-house urgent care clinic.
Thomas Memorial Hospital started a new technique to solve the problem in February after facing a rise in minor cases following the expansion of Medicaid - an in-house clinic.
Now, when patients show up to the ER with the flu, they can be sent to the clinic where there's a shorter wait.
"People usually wander in over to us first and basically they'll say they don't know if they should come to us or to the ER," Withrow said.
Thomas has more resources than the average urgent care clinic. They're attached to a major hospital, so they can send people out for X-rays and have an in-house pharmacy attached.
"I know some doctors and some people are kind of leery about what we do here," Withrow said. "They feel like we're taking some of their patients away from them."
But the biggest advantage for patients going to urgent care is that it will cost less on their insurance.
"If you go to the ER and you're not in emergency, for example you just have a cold, the expense is a heck of a lot more for the insurance company," Stephens said. "Because not only do you get charged for the doctors' services and whatever things they do to you, the insurance company gets charged a facility fee."
Cathy McAlister, a Highmark spokeswoman for West Virginia, stressed the advantages of a primary care physician over going to the emergency room or urgent care.
Not only is there a continuity of care when a person goes to a primary care physician, McAlister said, but it can cost less too.
If a person goes to an urgent care facility they risk being marked as a first-time patient, even if they've been there before, according to McAlister. First-time patients are charged more based on insurance codes.
Despite the higher costs, people are gravitating toward emergency rooms and urgent care clinics, according to McAlister.
Urgent care clinics have seen tremendous growth over the past few years and there are now 6,900 urgent care centers in America, according to the Urgent Care Association of America, including at least four in Charleston.
Of course, if there is a real emergency, there's still only one place to go: the emergency room.
"If you have a life threatening emergency and you go to urgent care first, then they send you to the emergency room," Stephens said.
Reach Daniel Desrochers at dan.desrochers@wvgazettemail.com, 304-348-4886 or follow @drdesrochers on Twitter.