Chronic Conditions Account for $8.3B in Avoidable ED Visits

Emergency department (ED) visits for people with at least one chronic condition contributed to nearly 60 percent of all annual visits in 2017 and $8.3 billion in spending, says a report from Premier.

Of these visits, over 4.3 million were potentially preventable, suggesting that these patients need access to higher-quality primary care.  

Costly chronic conditions are only growing more prevalent as the US population ages, the report noted, and hospitals and health systems are increasingly facing financial pressures as the industry shifts to population health management approaches and value-based care.

"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, 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.”

To avoid preventable ED visits and subsequent hospital admissions, it is critical that patients with chronic conditions receive proactive primary care.

Premier analyzed nearly 24 million ED visits at 750 hospitals among patients with asthma, COPD, hypertension, heart failure, diabetes, and behavioral health issues. Researchers found that nearly 60 percent of all annual visits were for people with at least one of these conditions, of which more than 4.3 million were potentially avoidable.

Premier also found that ED visits varied greatly for each condition, particularly among behavioral health issues, hypertension, and diabetes patients.

Behavioral health issues accounted for approximately 24 percent of all ED visits in Premier’s analysis. This is mainly due to national shortages of mental health professionals and affordable psychiatric care, the report said.

“One of the primary reasons for ED visits associated with mental health conditions is lack of access,” the report said.

“Nearly 40 percent of adults with severe mental illness - such as schizophrenia or bipolar disorder - received no psychiatric treatment in the previous year, according to the 2012 National Survey on Drug Use and Health. Among adults with any mental illness, 60 percent were untreated.”

Hypertension accounted for 17 percent of all ED visits, due to a lack of lifestyle modification counseling, Premier said.

“Lifestyle modifications have been found to be effective in managing hypertension, yet only about 35 percent of patients with hypertension receive counseling for diet and 26 percent for exercise, and only 10 percent continue to follow advice concerning lifestyle modifications,” the report stated.

Medication non-adherence can also be a problem for hypertension patients, researchers said, noting that about half of patients stop drug treatment after one year.

Diabetes accounted for approximately 9 percent of all ED visits. These instances primarily occurred because patients were unable to fill insulin prescriptions, were not taking insulin as prescribed, and making poor lifestyle choices, including diet and exercise.

The results indicate that patients with chronic conditions may benefit from improved primary care services, which will involve significant changes in care delivery.  

"ED visits can be costly as they may lead to hospitalizations and other high-cost services. Although the value of primary care services is known, access to and the use of these services varies dramatically,” said T. May Pini, MD, MPH, Principal of Population Health Consulting at Premier.

“People with chronic conditions need more preventative and proactive care, including more reliable access to their primary care provider for urgent issues. However, the delivery of high-quality primary care requires significant transformation across acute, ambulatory and community providers to align around a coordinated care management model that is truly focused on the patient.”

Premier outlined several ways organizations can develop care management models that align with primary care providers and effectively coordinate care.

The report said that care teams should reach consensus on standardized processes, including risk assessment tools and algorithms, to identify patients who will most benefit from care management services.  

Additionally, the report recommended that organizations improve their multidisciplinary care coordination efforts. Staff should understand their various roles and responsibilities, and leaders should cultivate positive physician partnerships.

Technology and analytics will also play a major role in improving care management, Premier said. Tools that can customize care management assessments will help enable timely communication and efficient workflows. Moreover, health IT systems that integrate clinical and claims information can measure performance and identify opportunities for improvement.

The significant variation in ED visits for individuals with chronic conditions indicates that providers can improve their care management and coordination efforts.

“Premier’s analysis reveals that ED visits for patients with chronic conditions vary greatly, representing a major opportunity for healthcare providers to come together and focus on the total medical, behavioral and social needs of these patient populations,” the report concluded.

“Employing a comprehensive patient-centric, physician-aligned care management model is a key element of clinical integration that can reduce unnecessary ED visits and associated expenditures, as well as generate ROI for high-value networks.”