Emergency department (ED) visits for people with at least one of six prevalent chronic conditions varied greatly and contributed to nearly 60 percent of all annual visits at nearly 750 hospitals in 2017, according to a Premier analysis released today. More than 4.3 million of these visits were potentially preventable and equate to an estimated $8.3 billion in ED costs, suggesting these patients may need more effective primary care services.
On Feb. 7, Premier published the analysis in its latest data-driven report, “Ready, Risk, Reward: Improving Care for Patients with Chronic Conditions,” which highlights the major opportunity to offer more coordinated and preventative care services in ambulatory care settings to avoid unnecessary ED visits. Premier analyzed 2017 data on nearly 24 million ED visits among patients with asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart failure, hypertension and/or a behavioral health condition, such as mental health or substance abuse issues. The findings showed variation in the rate of ED visits by hospital, particularly for patients with behavioral health issues (0.8 – 64.4 percent), diabetes (0.1 – 22.2 percent) and hypertension (0.1 – 48.6 percent).
“It is widely known that people with chronic conditions contribute to high healthcare expenditures, making them a critical population for more strategic, preventative care,” said Joe Damore, Senior Vice President of Population Health Consulting at Premier. “While providers face the challenges of perverse incentives that have impeded coordinated, cost-effective care delivery, Premier members are actively taking steps to overcome this fragmentation and assume responsibility for the total health of these patient populations through alternative payment models. Alternative payment models create an incentive for providers to organize high-value networks, such as accountable care organizations (ACOs), which deliver coordinated care across the continuum.”
In its work with more than 120 ACOs, Premier has observed that approximately 30 percent of ED visits occurred for issues that could have been treated in primary or other ambulatory care settings. To further investigate, Premier’s analysis compared hospitals that achieved the lowest quartile (25 percent) of ED visit rates for patients with chronic conditions to those that did not to identify the 4.3 million potentially preventable visits and associated $8.3 billion in ED costs. These findings underscore the value of pinpointing evidence-based care delivery improvement opportunities, as well as building integrated high-value networks across the continuum of care.
For high-value networks, such as ACOs and clinically integrated networks (CINs), preventing ED visits and improving health outcomes for patients with chronic conditions can mean the difference between significant cost savings or financial losses. Additionally, hospitals and health systems receiving traditional fee-for-service reimbursement are at risk for these patient populations under the Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing and Readmissions Reduction Programs, as well as the Merit-based Incentive Payment System.
