Resource utilization and health care charges associated with the most frequent ED users

doi:10.1016/j.ajem.2014.07.013

The American Journal of Emergency Medicine

Volume 32, Issue 10, October 2014, Pages 1215-1219

https://doi.org/10.1016/j.ajem.2014.07.013 Get rights and content

Abstract

Study objective

Emergency department (ED) visits have continued to rise, and frequent ED users account for up to 8% of all ED visits. Reducing visits by frequent ED users may be one way to help reduce health care costs. We hypothesize that frequent users have unique ED utilization patterns resulting in differences in health care charges.

Methods

We conducted a retrospective review of electronic medical records from an urban community teaching hospital for the year 2012 comparing the top 108 frequent ED users (> 12 visits/year) to a randomly selected group of 108 nonfrequent users (< 4 visits/year). We compared demographic characteristics, distance lived from the hospital, medical and psychiatric history, substance abuse history, diagnostic testing, disposition, and amount charged to the patient for each visit. We compared data using χ² for proportions and t test or Wilcoxon rank sum based on normality of the data.

Results

The top 108 frequent ED users accounted for 1922 visits (2.9%), whereas the 108 nonfrequent users accounted for 150 visits (0.2%), in 2012 (all ED visits n = 65,398). Frequent users were more often unemployed, have public insurance, have mental health conditions, use tobacco, have a greater number of allergies to medications, and live closer to the hospital (P < .01). Disposition and median charge per visit did not differ between frequent and nonfrequent users ($1220 vs $1280). The total charges of the frequent ED users’ visits were $10,465,216.07 versus $1,012,610.21 for nonfrequent users.

Conclusions

Frequent users have unique medical and social characteristics; however, disposition and visit charges did not differ from nonfrequent users.

Introduction

In recent years, utilization of emergency departments (EDs) in the United States has continued to increase. From 1991 to 2011, the number of visits to US EDs jumped from 88.5 million to 129.5 million—an increase of almost 46% [1]. As visits have risen, so has Emergency Medicine’s share of overall health care spending. In 2011, Americans spent approximately US $2.4 trillion on health care overall, with ED costs accounting for between 2% and 10% of the total expenditure—a range of US $47 to $240 billion [2].

Although roughly 20% of US adults visit an ED annually [3], there is a subgroup of patients deemed “frequent users” (> 4 ED visits/year) that account for up to 8% of all ED patients but contribute to 21% to 28% of all ED visits [4]. These users are suspected of costing hospitals millions of dollars while decreasing the efficiency of the ED [5]. A recent study in South Carolina concluded that frequent visitors to EDs account for 10% of the total costs [6]. Previous studies have helped to define frequent users, with many studies investigating the impact these users place on the resources of the facilities they visit [3], [4], [5], [7], [8]. However, there are few objective data comparing the resources utilized by frequent users and cost associated with their ED visits.

We sought to determine the demographic characteristics, ED utilization, and differences in charges between frequent ED users and nonfrequent users. We hypothesize that frequent users utilize unique ED resources resulting in differences in charges.

Section snippets

Setting and selection of participants

The ED at our urban, teaching hospital averages approximately 65,000 visits a year. We defined frequent users as those with at least 4 visits/year [7], [9]. We identified those patients that visited the ED most frequently during 2012 (frequent users) through visit numbers associated with patient medical record numbers. We identified all patients who had at least 4 ED visits to our facility in 2012. We then focused our efforts on those patients who had more than 12 ED visits per year, defined

Results

During calendar year 2012, there were 65,398 visits to our ED. We identified 2960 frequent visitors (> 4 visits/year), accounting for 17,216 total ED visits (26.3% of all ED visits). The top 108 frequent users (> 12 visits/year) included in this study accounted for 1922 visits (2.9% of all ED visits), whereas the 108 nonfrequent visitors accounted for 150 visits (0.2% of all ED visits).

Frequent and nonfrequent ED users did not differ by age, sex, race, or access to a PCP (Table 1). Frequent users

Limitations

Our study has several limitations. First, we only evaluated 1 hospital ED in an urban environment. Locally, we have 4 hospitals within a 2.5-mile radius. Frequent users may utilize multiple health care resources; and without access to medical records at these nearby facilities, it is difficult to obtain the total number of ED visits annually for any 1 individual. However, the characteristics of our studied frequent ED users are similar to previously published work with regards to age, sex, and

Discussion

Physicians, health care workers, and policy makers may have a preconceived notion of ED frequent visitors [5]. Previous work has detailed providers’ misconception including that they are more often uninsured minorities that utilize the ED for basic care or drug-seeking behavior [5], [9]. However, others have shown that frequent ED users more often are white, are female, have a mean age of 40 years, and are covered by insurance [5]. The uninsured represent less than 15% of frequent users and are

Conclusion

In this single-center study, frequent users have unique demographics and live closer to the hospital than nonfrequent users; however, their dispositions are similar. Although charges per visit did not differ between frequent and nonfrequent users, the sheer number of frequent user visits amounted to approximately 10 times the total amount. Interventions aimed at lowering frequent ED use must be tailored to certain demographics and needs but could significantly reduce health care costs.

Acknowledgments

The authors would like to thank Dr. Arvind Venkat for his assistance in proof-reading this manuscript.

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Original ContributionResource utilization and health care charges associated with the most frequent ED users

Abstract

Study objective

Methods

Results

Conclusions

Introduction

Section snippets

Setting and selection of participants

Results

Limitations

Discussion

Conclusion

Acknowledgments

Ann Emerg Med

J Emerg Nurs

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Am J Emerg Med

US Census Bureau: national and state population estimates for community hospitals

Original Contribution
Resource utilization and health care charges associated with the most frequent ED users