Strategies to Reduce Nonurgent Emergency Department Use Experience of a Northern Virginia Employer Group
*HealthCore Inc., Wilmington, DE †WellPoint Inc., Indianapolis, IN. Medical care
(Impact Factor: 3.23).
12/2012; 51(3). DOI: 10.1097/MLR.0b013e3182726b83
This administrative claims analysis evaluated the impact of a health plan-sponsored Emergency Room Utilization Management Initiative (ERUMI), which combined increased patient copays for ED visits with educational outreach to reduce inappropriate ED use and encourage use of retail health clinics (RHCs) and other alternative treatment sites among a commercially insured population.
Emergency department (ED) utilization rates for select acute but nonurgent conditions that could be treated appropriately in an RHC were compared for members of an employer group with (intervention group) and without (comparators) ERUMI. Utilization was compared for baseline period (January-June 2009) and ERUMI implementation period (January-June 2010).
A total of 56,896 members (14,224 intervention, 42,672 matched comparators) were included. ED utilization for conditions that could be treated appropriately by RHCs decreased by 10.39 visits/1000 members in the intervention group versus 6.29 visits in comparators. RHC visits rose for both the groups, with a greater increase in the intervention group (22.61 visits/1000 members, P<0.001) versus comparison (1.64/1000, P=0.064). After ERUMI implementation, intervention group members were nearly 5 times more likely than comparators to choose RHCs over ED for nonurgent care.
The health plan-sponsored ERUMI program, consisting of both financial and educational components, decreased nonurgent ED utilization while increasing the use of alternative treatment sites.
Available from: peerj.com
- "Numerous investigators have evaluated the effect of cost sharing on the medical system as well as specifically with regard to patient utilization of the emergency department (DeVries,Li & Oza, 2013;Hsu et al., 2006;Newhouse et al., 1981;O'Grady et al., 1985;Reed et al., 2005;Selby, Fireman & Swain, 1996;Shapiro et al., 1989;Shapiro, Ware & Sherbourne, 1986;Wharam et al., 2007;Wharam et al., 2013;Wong et al., 2001;Tzeel & Brown, 0000). In most cases, reports have shown evidence of reduced ED visits when co-payments are required for a wide range of respective cohorts (Hsu et al., 2006;Keeler & Rolph, 1983;O'Grady et al., 1985;Reed et al., 2005;Selby, Fireman & Swain, 1996;Shapiro, Ware & Sherbourne, 1986;Tzeel & Brown, 0000). "
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ABSTRACT: Many proponents for healthcare reform suggest increased cost-sharing by patients as a method to reduce overall expenditures. Prior studies on the effects of co-payments for ED visits have generally not been directed toward understanding patient attitudes/behavior at point of care.
We conducted a survey at point of care to test our hypothesis that a significant number of patients with urgent chief complaints might have avoided the ED if asked to provide a co-payment.
Cross-sectional study design. Stable, oriented, consenting patients at an inner-city, academic ED were consecutively enrolled at hours in which trained research associates were available to assist with data collection. Enrolled patients completed a written survey providing demographic/chief complaint information, and then were asked whether 13 interval amounts of co-payment ranging from 0 to >500 would have impacted their decision to visit the ED. Categorical data are presented as frequency of occurrence and analyzed by chi-square; continuous data presented as means ± standard deviation, analyzed by
-tests. ORs and 95% confidence intervals provided. Primary outcome parameter was the % of patients who would have avoided the ED if asked to pay any co-payment for several urgent chief complaints: chest pain, SOB, and abdominal pain.
A total of 581 patients were enrolled; 63.1% female, mean age 42.4 ± 15.1 years, 65% Hispanic, 71.2% income less than 20,000, 28.6% less than high school graduate, 81.3% had primary care physician, 57.6% had 2 or more ED visits/past year. Overall, 30.2% of patients chose 0 as the maximum they would have been willing to pay if it was required to be seen in the ED. 16/58 (28%; 95% CI [18–40%]) of chest pain patients, 9/43 (20.9%; 95% CI [11–35%]) of SOB patients, and 24/127 (26.8%; 95% CI [13–27%]) of abdominal pain patients would have been unwilling to pay a co-pay. Patients with income >20,000 were more willing to pay a co-payment (OR = 2.55; 95% CI [1.59–4.10]). No significant relationship was identified between willingness to pay for: gender, race, education, established primary care provider, and frequency of ED visits.
Overall, 30.2% of our patients would not have accepted a co-pay in order to be seen, including more than 20% of the patients with chest pain, shortness of breath, and abdominal pain respectively.
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ABSTRACT: The objective was to explore variation by insurance status in patient-reported barriers to accessing primary care. The authors fielded a brief, anonymous, voluntary survey of nonurgent emergency department (ED) visits at a large academic medical center and conducted descriptive analysis and thematic coding of 349 open-ended survey responses. The privately insured predominantly reported primary care infrastructure barriers-wait time in clinic and for an appointment, constraints related to conventional business hours, and difficulty finding a primary care provider (because of geography or lack of new patient openings). Half of those insured by Medicaid and/or Medicare also reported these infrastructure barriers. In contrast, the uninsured predominantly reported insurance, income, and transportation barriers. Given that insured nonurgent ED users frequently report infrastructure barriers, these should be the focus of patient-level interventions to reduce nonurgent ED use and of health system-level policies to enhance the capacity of the US primary care infrastructure.
Available from: Olivier Hugli
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ABSTRACT: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years.
Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP).
We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p = 0.128). Of these patients, 54.0% vs 57.0% were male (p = 0.329), 55.5% vs 58.7% were Swiss (p = 0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p <0.001); 57.7% vs., 58.3% consulted during out-of- hours (p = 0.821). Trauma-related visits decreased from 34.2% to 23.7% (p <0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p <0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p <0.001).
The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.
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