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Your top 3 questions on reducing avoidable ED visits—answered

November 15, 2017

    We introduced 15 tactics to reduce avoidable ED use during a webconference, and were thrilled that so many Advisory Board members—representing a wide variety of roles across provider, payer, and industry organizations—joined the conversation.

    Here are the top three questions we received on reducing avoidable ED visits, along with their answers.

    1. For many hospitals, the ED has become a profit center. So why would providers invest in reducing avoidable ED use?

    The business case for many of the most resource-intensive strategies is strongly tied to an organization's portfolio of financial risk contracts. While there are certainly benefits under fee-for-service and value-based care, these initiatives are most advantageous for organizations pursuing the latter.

    Under fee-for-service: The goal of targeted ED diversion tactics is to reduce avoidable visits resulting in bad debt, particularly if your ED is at- or over-capacity. By increasing access to low-cost sites, providers can improve throughput diminished by overcrowding, reduce the time facilities spend on ED diversion status, improve patient experience, and keep patients loyal to the organization.

    Under risk-based contracts: The goal is to reduce the total cost of care for attributed populations. Shifting patients' utilization to more appropriate, lower cost sites or methods of care allows for more preventive and holistic care. Not only does this decrease these patients' costs, but several of the tactics we shared in the webconference also improve readmission risk for complex patients.

    2. How do providers calculate the number of avoided ED visits?

    If we were striving for the perfect methodology, providers could measure effectiveness through a randomized controlled trial. However, that's not a reasonable aspiration for most organizations. In general, we've seen organizations evaluate an intervention's impact on avoided visits in the following ways:

    • Pre- vs. post-intervention analysis of ED use: For interventions targeting high-utilizer patients, providers assess patients' ED utilization for six months prior to an intervention and six months following. Under the assumption that their ED use trend would have otherwise continued, organizations calculate that change as avoided visits.
    • Follow-up survey: Some organizations even survey patients and providers to determine the impact of an avoidable ED intervention. They ask where the patient intended to seek care and whether they changed their minds based on the ED strategy deployed. Then, they ask their care team if that was the appropriate site of care.

    3. What strategies are especially advantageous for small rural hospitals to right-size ED usage?

    Small, rural hospitals face even tighter margins and can't rely as easily on community partners to fill in key service gaps. This becomes particularly difficult when trying to manage high-risk patients post-discharge to reduce risk of readmission, as patients often don't even have access to a primary care physician.

    To combat this issue, we've seen some organizations focus their efforts towards building post-discharge or transitions clinics. These clinics offer chronic disease and care management support to patients who need additional monitoring or who aren't yet connected with a permanent primary care physician.

    For example, El Rio Community Center in Tucson, Arizona, designed a post-discharge clinic that provides telephonic and in-person transitional care management services. Their target population is high-risk, complex patients, who otherwise would be unable to visit a PCP within seven days post-discharge. El Rio has seen impressive results. In the first nine months of operation, they collected $51,000 in revenue.

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