Hospital admissions account for most emergency care–directed costs

CHICAGO – About 11% of national health expenditures are related to emergency department–directed health care, with 7% of all expenditures from ED admissions and 4% of all expenditures from outpatient ED visits, Dr. Jessica Galarraga reported at the annual meeting of the American College of Emergency Physicians.

Based on volume, hospital admissions from the ED were about 11% of all emergency visits; however, they accounted for more than $182 billion or 62% of the costs of ED-directed care, said Dr. Galarraga of the George Washington University in Washington.

[RW] Proportional costs of ED-directed care and national expenditures by visit type

Increasingly, the ED is the “front door” for hospital care, as noted in a RAND report published last year.

With ED-directed health care comprising more than 11% of national health expenditures (NHE), it is important for ED providers to work collaboratively with other parts of the health care system to safely reduce health care costs, Dr. Galarraga said.

Potentially avoidable ED-directed encounters, including nonemergent visits, emergent but preventable visits, and ambulatory care sensitive condition (ACSC) admissions, together accounted for 1.8% of NHE. “Given the relative importance of ED admissions over outpatient encounters, making use of the emergency physician’s role as a gatekeeper to admission may be the most effective way to reduce costs,” she said.

Dr. Galarraga and her colleagues examined the costs of ED care and ED-directed health care by visit categories to provide a better understanding of the potential magnitude of cost savings from interventions directed at ED encounters.

Dr. Jessica Galarraga

The 2010 data from the Medical Expenditure Panel Survey (MEPS) were used to determine mean per-visit payments and charges for ED outpatient and inpatient encounters by visit type. National Hospital Ambulatory Medical Care Survey (NHAMCS) and the Healthcare Cost and Utilization Project (HCUP) were used to estimate the aggregate expenditures and proportional costs of NHE by each visit category. Outpatient encounters were categorized based on the New York University (NYU) classification and inpatient encounters by ACSC versus non-ACSC.

Among all encounters involving ED-directed health care, the greatest mean per-visit expenditures were attributable to hospital admissions from the ED, with mean payments of $12,817 and $9,708 for non-ACSC and ACSC admissions, respectively. Nonurgent outpatient ED visits generated the lowest mean per-visit expenditure of $819, even compared with all other outpatient ED encounters.

Dr. Galarraga had no relevant financial disclosures.

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