Prescription for Change

Trying to reduce unnecessary ED utilization? Here's your first step.

by Taylor Hurst and Dylan Jennings

Editor's note: This story was updated on May 16, 2019.

Across the country, hospital leaders are looking for strategies to help address rising ED volumes. But one of the first steps to increase ED capacity happens outside of the ED altogether: reducing avoidable visits.

May 22 webconference: How to curb unnecessary ED visits

The bad—and good—news is that a significant proportion of the nation's ED patients don't need to be there. For instance, an estimated 60% of Medicare ED visits are considered avoidable. Nearly all physician executives agree that redirecting avoidable visits is a critical lever to improve efficiency and quality. The challenge is that few have visibility into what that opportunity looks like at their own organization. 

Defining avoidable ED visits

Our Avoidable ED Utilization Assessment can help you see what proportion of your organization's ED visits are avoidable. The tool applies the NYU ED Algorithm to your organization's Medicare Fee-for-Service inpatient and outpatient data to classify ED visits as either avoidable or unavoidable.

Avoidable visits are further categorized based on the presenting condition (e.g. urgency, complexity of care) and whether the visit could have been prevented by timely and effective ambulatory care.

Use your results to inform your ED strategy

When you open the tool, you'll see your facility's distribution of avoidable ED visits since 2015 and how they compare with the cohort average at the service line level.

With results in hand, you can prioritize strategies that align with your organization’s top opportunities to reduce unnecessary ED visits. Members have used their results to: 

  • Identify inpatient and outpatient service lines with the highest proportion of avoidable ED visits;
  • Assess whether past interventions lowered avoidable ED volumes given historical performance; and
  • Compare their performance against a national, state, or custom cohort of providers to evaluate their opportunity to right-size ED visits.

If your organization is investing in a behavioral health strategy, you'll also be able to separately analyze claims whose primary diagnosis code relates to substance use disorder or mental health conditions. With this data, you'll be able to allocate behavioral health support across service lines.

Minimize unnecessary emergency department visits with a PACER program

Learn how the Police, Ambulance, and Clinical Early Response (PACER) model can help you reduce ED demand, decrease length of stay, and provide patient-focused mental health care.

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