Healthcare News & Insights

ER revisits: Major financial drain on healthcare system

 

emergency room entranceHospitals are always looking for ways to cut costs. One way to do this — reduce unnecessary revisits to your emergency room (ER). 

Don’t think your facility has a big problem with that?

You may want to check in with your neighboring facilities.

A new study, published in the Annals of Internal Medicine, suggests patients return to ERs for the same complaint more often than you think, and they frequently end up at a different ER on the second visit.

Study results

The study looked at how often patients return to an ER within the same state.

The researchers examined data from the Agency for Healthcare Research, and Quality’s Healthcare Cost and Utilization Project database from 2006 to 2010. The data included 58 million patients discharged from ERs in six states for which data was available on subsequent ER visits and admissions. The purpose was to analyze revisit rates, variation in revisit rates by diagnosis and state, and associated costs.

The researchers found:

  • 2.7% of patients returned to an ER within one day, and, of these, 37% were admitted
  • within three days of an initial ER visit, 8.2% of patients had a revisit, and of these revisits 32% took place at different facilities
  • 20% of patients returned to an ER within 30 days
  • revisit rates varied by diagnosis with the most common being skin and soft tissue infections (23% of which 3% were admitted), abdominal pain (10% with 3% admitted), and headache (9% with 1% admitted)
  • revisit rates also varied by state (Florida had the highest risk-adjusted revisit rates with 24.8% and Nebraska had the lowest with 10.6%), and
  • Medicaid patients had the highest revisit rates at 10.1%.

Reason’s for revisits vary from case to case, such as inadequate access to primary care, a planned revisit to see if an antibiotic is working, a patient’s nonadherence to ER recommendations or poor quality care at the initial ER visit.

Taking action

Some facilities are already taking steps to lower their ER readmission rates.

At Thomas Jefferson University in Philadelphia, Dr. Kristin Rising interviewed patients to find out why they returned to the ER. She discovered that fear played a big factor in their decisions, according to an ABC News report. They either couldn’t get an appointment with their primary care physician and were afraid to wait, or felt too sick to endure multiple visits for X-rays and lab work when the ER had it all right in one place.

Now, Dr. Rising is part of a hospital telemedicine program that uses video calls to address patient concerns after they are discharged from the ER.

And in another pilot program, Dr. Rising noted that contractors will call patients identified as “high risk of returning” to help them set up follow-up appointments.

Often patients’ primary care doctors won’t know they were in the ER, unless patients contact them to find out what the next step in their care should be.

Electronic health records have made great strides in gaining popularity, but the healthcare system still has a big disconnect when it comes to cross communication in many areas.

ER physicians should encourage their patients to make follow-up appoints with their primary care physicians and have staff check up on “at-risk” patients to make sure they’ve made their follow-up appointments.

Visit another ER

So why do patients go to a different ER for the same complaint?

Often it’s because they aren’t satisfied with the care they received at the first facility. The problem here is often tests and X-rays will be repeated because the ER physicians don’t have immediate access to the previous tests. This adds unnecessary costs, which are 100% preventable, to the healthcare system, .

In the study, only Florida had a near-complete cost analysis. Estimates were made using 2008 Medicare reimbursement rates, and the researchers found that in 19.8% of revisits within 30 days, the total costs exceeded the initial ER visit by 118%.

Previous studies have found that about 3% of patients make a revisit to the ER in the first three days. This study, however, shows revisit rates are actually much higher because people seek care at different hospitals than the ones where they were initially treated. So the cost factor and burden on the healthcare system is also much higher than originally thought.

While creating a system to share information between emergency departments or with primary care providers may seem like an incredibly investment, it would actually save money in the long run.

 

 

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