This article from the American Medical Association news service caught my eye because it discusses an issue central to the challenge of providing quality health care at the lowest feasible cost, to individuals and the society: ED use drops when medical practices extend office hours – amednews.com.

With the recent US Presidential election following the passage of the Patient Protection and Affordable Care Act (PPACA) aka “Obamacare,” the issue of access to health care has been prominent.

Access, however, does not merely mean having health insurance, although that is certainly important.

Access also means that the health care provider needs to be open and available. Those of us beyond a certain age can remember when the family doctor made house calls, even in urban and suburban areas.

All of us know that those times are gone, except perhaps in some small, rural communities. Attempts to revive house calls in some areas have not always endured or proved worthwhile.

A study in Health Affairs, 31:12, December 2012 finds that emergency department usage declined 20 percent and unmet medical needs declined over 40 percent when physicians stayed open extended hours.

In the absence of such access, patients go to the nearest hospital emergency room for non-emergency care. The result is a burden on emergency facilities treating more urgent cases as well as an added, and unnecessary burden, on health care insurers. Those costs through higher premiums are passed to the consumer: businesses and individuals.

This study points to a very important lesson: we can improve health care AND lower costs. One important detail is that the practice staying open might mean the availability of a nurse practitioner rather than a physician.

Improving access to health care in a time of fiscal restraint is going to require more innovative use of health care providers, especially nurses, physician assistants, and urgent care facilities. Not only does this study make that clear, but as James King, MD, a family physician in Selmer, TN suggests that practices partner with urgent care facilities in the community that supply after-hours care if the doctors can’t offer these services themselves. “Your patients know to go there, and then the urgent care center knows to get information back to their primary care physician when they’re seen” by their regular office.