Two thirds of annual hospital ED visits are avoidable. ED costs are ten times higher than at physician offices or urgent care centers.

Emergency Care in the USA

• Number of visits: 130.0 million
• Number of injury-related visits: 35.0 million
• Number of visits per 100 persons: 40.4
• Number of emergency department visits resulting in hospital admission: 16.2 million 
• Number of emergency department visits resulting in admission to critical care unit: 2.3 million
• Number of visits resulting in ICU admission: 2.2 million
• Percent of visits with patients seen in fewer than 15 minutes: 43.5%
• Percent of visits resulting in transfer to a different (psychiatric or other) hospital: 2.3%

Healthcare experts estimate that Healthcare spending in the United States will grow from $3.5 trillion in 2017 to $6 trillion by 2027. (Centers for Medicare & Medicaid Services.) As a result, they also expect that healthcare share of GDP will reach 20 percent of the country’s Gross Domestic Product)

What’s driving the dramatic increase in spending? Price variation, which leads to overspending by many consumers.

However, UnitedHealth Group has conducted extensive research on the cost of care and has identified four areas where savings are achievable: 

• Avoidable hospital emergency department (ED) visits
• Hospital prices
• Specialty Rx
• Promoting High-value physicians and high value practices

The article below focuses on avoidable hospital ED visits.

18 Million Avoidable Hospital Emergency Department Visits

According to UnitedHealth Group research, two-thirds of hospital ED visits annually by privately insured individuals in the United States – 18 million out of 27 million – are avoidable.

An avoidable hospital ED visit is a trip to the emergency room for a primary care treatable condition—not an actual emergency. Ten common primary care treatable conditions frequently treated at hospital EDs are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat, and upper respiratory infection.

According to UnitedHealth Group, the average cost of treating everyday primary care treatable conditions at a hospital ED is $2,032. That number is 12 times higher than visiting a physician’s office ($167) and ten times more than traveling to an urgent care center ($193) to treat those conditions. In other words, visiting a physician’s office or an urgent care facility instead of a hospital would save an average of more than $1,800 per visit – creating a $32 billion annual savings opportunity systemwide.

What is driving the higher costs at hospital EDs? Higher costs are driven in part by hospital facility fees, which increase the cost of an average hospital ED visit by $1,069, and lab, pathology, and radiology services, which average $335 at a hospital ED – 10 times more costly than at a physician office ($31).

The following conditions would require an ER visit in most cases:

• Broken bones
• Chest pain
• Head or neck injury
• Serious burns
• Stroke symptoms 
• Uncontrolled bleeding
• vomiting blood

Emergency Care Experts estimate that a significant portion of emergency department visits are preventable. These are health conditions that primary healthcare providers could effectively handle in a non-emergency setting. This understanding empowers individuals to make informed healthcare choices and avoid unnecessary emergency room visits.

Among factors affecting the rate of preventable emergency room (ER) visits:

• Income.
• Education.
• Employment.
• Health insurance coverage.
• Transportation access.
• Internet access.

To avoid an ER visit, a patient or patient’s family should plan ahead by locating Urgent Care Clinics and Community outpatient clinics. Some ERs in the country even triage a patient to an Urgent care clinic in close proximity to the ER department, where care is delivered less intensely and less aggressively.

Urgent care

An urgent care visit costs less than a trip to the emergency room. The average cost for treating a non-emergency condition at a walk-in or urgent care clinic is $185. If you have insurance, it will likely be less, possibly a reduced co-pay amount. 

Urgent care can be a good option if you’re not experiencing a true emergency that needs the E.R. However, you must call your regular healthcare provider on Monday morning. Clinics are typically open after hours and on the weekends and can treat non-life-threatening issues like: 

• Bladder infections
• Body aches
• Ear infections
• Excessive vomiting or diarrhea
• Migraines
• Minor burns
• Severe sore throat

Some other nonprofits that can help with medical bills including ER visit bills— many for specific conditions and circumstances — include:

• CancerCare, which offers copayment assistance for people with insurance 
• Leukemia & Lymphoma Society, which offers financial assistance for people with certain conditions
• Patient Access Network (P.A.N.) Foundation, which helps underinsured people with life-threatening, chronic, and rare conditions
• Patient Advocate Foundation is a good starting point to find grant programs for which you are eligible that can help you cover medical expenses
• UnitedHealthcare Children’s Foundation, which offers grants of up to $5,000 for specific medical costs
• Upsolve a free online community that helps people with debt, including legal help

Practice Management News

Avoidable Hospital E.D Visits Cost the Healthcare System $32B Annually.

Unnecessary emergency room visits caused by low health system literacy cost at least $47 billion annually, according to a new report from experts at Accenture, a consulting and I.T. firm. 

Accenture analyzed the total number of annual “excess” visits to E.R’s by patients with low health system literacy for the report. Accenture defined low health system literacy as those needing help understanding the difference between in-network and out-of-network care, finding in-network physicians, or prior authorizations. 

Accenture found that those with low health system literacy and a chronic condition were twice as likely to have received care at an E.R in the last year than those more familiar with the healthcare system. Additionally, generally, healthy people with low healthcare system literacy were nearly three times more likely to have visited the E.R. than those more familiar with the healthcare system.

“The complexity of the healthcare system is driving people to choose the E.R. for acute care needs rather than in less expensive care settings,” the Accenture report reads.

Premier published in Modern Healthcare.

Premier said the six chronic conditions used in the analysis are asthma, chronic obstructive pulmonary disease, diabetes, heart failure, hypertension, and behavioral health conditions, such as mental health or substance abuse issues. They were selected because they are often cited in the academic literature as the most common and costly conditions in the healthcare system.

According to Premier, the data from the 24 million E.D. visits at 747 hospitals comes from Premier’s database, which has information on 45% of U.S patient discharges. To get the results, Premier identified hospitals with the lowest quartile visit rate or those with the lowest E.D admission rates by condition and calculated how many visits at the remaining hospitals could be prevented if all hospitals achieved those rates for the six chronic conditions.

To arrive at the $8.3 billion in costs, Premier used the average cost for an E.D. visit estimated by the Health Care Cost Institute, which is $1,917.