Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014

Jiang J, Weiss A, Barnett M
Publication Year: 2017
Patient Need Addressed: Behavioral health, Chronic Conditions
Population Focus: Complex care, Vulnerable/disadvantaged
Demographic Group: Adult
Study Design: Other Study Design
Type of Literature: Grey
link: https://www.bettercareplaybook.org/resources/characteristics-emergency-department-visits-super-utilizers-payer-2014
Abstract

This resource analyzes nationwide 2014 ED data across 13 geographically dispersed US states. Findings include:
– For ED visits covered by Medicaid, high-need, high-cost patients were on average older than other patients.
– For patients under age 65 years, a greater share of ED visits among high-needs, high-cost patients were discharged against medical advice compared with ED visits among other patients.
– Mental health visits constituted a greater share of ED visits among high-need, high-cost patients than among other patients, regardless of payer.
– Nonspecific chest pain was the most common first-listed diagnosis for ED visits among Medicare high-need, high-cost patients aged 65 years and older.
– Urinary tract infection was the fourth most common first-listed diagnosis for ED visits among Medicare high-need, high-cost patients aged 65 years and older.

Insights Results

Overview of article

  • This article examine super-utilizer use of services in emergency department (ED) visits, specifically looking at patients who were treated in the ED and then released from the ED, transferred to another type of nonhospital health facility, or died in the ED across Medicaid, Medicare and private insurers

Methods of article

  • Results derive from an analysis of pooled 2014 ED data across 13 geographically dispersed states, representing about 28% of the US population

Results

  • For ED visits covered by Medicaid, super-utilizers were older than other patients (i.e., those on Medicare or private insurance), on average
  • Patients with 3 or more chronic conditions accounted for a greater share of all ED visits among super-utilizers than among other patients. For patients with private insurance and Medicaid, patients with 1 or 2 chronic conditions also had a higher share of ED visits among super-utilizers than among other patients
  • For patients under age 65, a greater share of ED visits among super-utilizers were discharged against medical advice compared with ED visits among other patients
  • Super-utilizers accounted for a disproportionate share of ED visits with an average of 4-5 times as many ED visits per year. Specifically, Medicaid insured super-utilizers had 9.5 ED visits per year on average
  • Although super-utilizers did not differ substantially from other patients on average total charges per ED visit, they did account for a disproportionate share of aggregate ED charges (i.e., only 3.7% of all Medicaid ED patients were super-utilizers but they accounted for more than 5 times as much aggregate ED charges)
  • Mental health visits constituted a greater share and injury visits constituted a smaller share of ED visits among super-utilizers than among other patients across all payers. Maternal and neonatal ED visits were more common among super-utilizers than among other patients for those with private insurance or Medicaid
  • Abdominal pain and back pain were leading diagnoses for ED visits among super-utilizers across payers; abdominal pain was the most common first-listed diagnosis for patients under age 65 years regardless of payer. Additionally, headache was a common first-listed diagnosis for ED visits among super-utilizers under age 65 years
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