About 3 percent of ED visits are "avoidable"—and a significant number of those avoidable visits involve health issues that the ED "is not fully equipped to treat," according to study published in the International Journal for Quality in Health Care.
According to Axios, the study comes as some states and health insurers, including some Medicaid programs, charge patients higher out-of-pocket costs—or refuse to cover claims—for ED visits retroactively deemed unnecessary. These policies aim to save money and direct patients to more appropriate, lower cost care settings, Axios reports.
However, there's no consensus on what's considered avoidable, the researchers said, and patients might not know their visit was avoidable until after they've seen a doctor. "Defining what is 'non-urgent,' 'unnecessary,' or 'inappropriate' is perhaps the first problem, as these terms are often conflated due to the lack of a consensus for a standard definition of a non-urgent visit and the complex nature of its categorization," the researchers wrote.
According to the study, previous estimates of how many ED visits qualify as avoidable have varied from between 5 percent and 90 percent.
For the study, researchers defined avoidable visits "as discharged ED visits not requiring any diagnostic tests, procedures, or medications." The researchers excluded patients who were admitted for observation, hospitalized, transferred, died in the ED, or who were dead on arrival. The researchers said they "sought to present a characterization of a very restrictive definition of 'avoidable' ED visits, creating a baseline for which many practitioners would agree potentially would not warrant an ED visit."
The authors used data from the National Hospital Ambulatory Medical Care Survey (NHAMC) to assess 424 million ED visits made between 2005 through 2011. The authors said they only assessed data on patients ages 18 to 64 because that age range represents "the population affected by the current and potential Medicaid cost-sharing increases" for ED visits considered unnecessary.
Of patients included in the study:
- 33 percent had private insurance;
- 28 percent were uninsured;
- 22 percent had Medicaid; and
- 8 percent had Medicare.
Overall, the researchers assessed 424 million ED visits and found 115,081—or 3.3 percent—were deemed avoidable.
The researchers found that the most common reasons for avoidable visits were toothache, back pain, headaches, mental health concerns, and throat soreness.
Meanwhile, the five most-common diagnoses—based on ICD-9 codes used at discharge—for avoidable visits were alcohol misuse, dental disorder, depressive disorder, acute upper respiratory infections, and acute pharyngitis. However, the researchers found that 10.4 percent of alcohol-related visits, 16.9 percent of mood disorder-related visits, and 4.9 percent of dental related visits were avoidable—meaning patients who arrive at the ED with these health issues should not be dismissed out of hand.
According to the researchers, the "most striking finding is that a significant number of avoidable visits are for conditions the ED is not equipped to treat." They continued, "Emergency physicians are trained to treat life- and limb-threatening emergencies, making it inefficient for patients with mental health, substance abuse, or dental disorders to be treated in this setting."
The researchers said the findings suggest a need for "increased access to mental health and dental care," which "have traditionally been treated as separate categories of health care." They concluded, "Our findings serve as a start to addressing gaps in the U.S. health care system, rather than penalizing patients for lack of access, and may be a better step to decreasing 'avoidable' ED visits" (Hsia/Niedzwiecki, International Journal for Quality in Health Care, 8/31; Herman, Axios, 9/7; Bresnick, HealthITAnalytics, 9/5; Brooks, Medscape, 9/1; Haefner, Becker's Hospital Review, 9/7).
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