Advocates for Evidence-Based Health Policy Speakers
The Most Expensive Decision in Health Care
As one-third of United States’ healthcare costs are derived from hospital-based care, it is important to analyze the trends in emergency department (ED) visits and admission rates from the ED.
This retrospective study focused on ED visits and ED admission rates over an 8-year period, from 2006 to 2014. Data were collected from the National Emergency Department Survey. It excluded patients that were 18 years or younger, left without treatment, transferred to another facility, died on arrival, or were missing final disposition.
The authors of the study found that ED visits increased by 18.4% from 2006 to 2014 while ED admission rates fell by 9.8% over the same period. It is interesting to note that the largest reductions in ED admission rates occurred in three populations: (1) older patients, (2) patients with Medicare as their primary insurance and (3) patients with more comorbidities.
Various factors could be playing a role in decreasing admission rates. The authors pointed to improved access to outpatient follow-up from the ED, placing patients in diagnostic protocols (for common complaints such as low risk chest pain and syncope) to avoid unnecessary hospitalizations, and increased scrutiny of short hospitalizations by CMS.
The increase in ED visits across all insurance types, after passing of the Affordable Care Act, is well-documented in prior studies. Although the decrease in ED admission rates may help curb healthcare costs – as the decision to admit a patient is the most-expensive decision in medicine – we still do not know the impact of this finding on patient morbidity, mortality, readmissions, and ED bounce-backs. The latter two lead to increased ED visits which in turn increases healthcare costs.
The reduction in hospitalization rates from the ED was not attributed to lower acuity patients. As the major decision makers for most hospitalizations, emergency physicians have a large influence on healthcare costs. It would be prudent to implement programs that ensure rapid outpatient follow-up with primary care providers for patients of advanced age or with multiple comorbidities. Ultimately, this could improve long-term patient care while tackling costs associated with ED visits and hospital admissions.
This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Emergency Medicine Residents’ Association. It is written by Sushant Kapoor, DO, MS. He is a fourth year emergency medicine/ internal medicine resident at Christiana Care.
No abstract available.
PMID: 30326057
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