This is a case in which an ounce of prevention is worth $8.3 billion in cure. That’s how much unnecessary emergency department visits cost the American health care system annually.
Premier looked at 24 million ED visits at 747 hospitals in 2017. The health care improvement company’s report said that 60% of those visits involved behavioral health problems, hypertension, chronic obstructive pulmonary disease, heart failure, and asthma—all of them chronic conditions that could have most likely been treated at a less-expensive outpatient setting.
As health care providers take on more risk in a system turning toward value-based care, the waste the Premier report uncovers provides a cautionary tale.
“Although the value of primary care services is known, access to and the use of these services varies dramatically,” T. May Pini, MD, principal of population health consulting at Premier, said in a press release. Pini added that there needs to be a “coordinated care management model that is truly focused on the patient.”
She’s talking to you, ACOs, and the report will doubtless be used in sales pitches Premier makes to those organizations. But the financial bleeding at EDs has gone on for years, as well as the accompanying gnashing of teeth over it.
Just last October, the Commonwealth Fund released a study showing that patients with one or two chronic conditions and “highly fragmented care” were 13% more likely to visit the ED. They also were 14% more likely to be admitted.
“Many previous interventions to improve health care have focused on the sickest patients,” the Commonwealth Fund study stated. “This study’s results indicate that future interventions for patients who may be less sick but who have highly fragmented care could have a large impact on overall health care costs and inefficiency.”