Few ER visits from insured patients are necessary News added by Benefits Pro on April 26, 2013

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By Amanda McGrory-Dixon

Even patients with employer-sponsored health insurance are apparently misusing the emergency room, as only 29 percent of these patients actually required immediate attention, according to a new study from Truven Health Analytics.

The study also found that immediate attention was not needed for 24 percent of respondents while 41 percent of respondents received care that would have been appropriate by a primary care physician. Another 6 percent of respondents could have avoided the trip altogether proper primary care.

If the health care system could avoid 10 percent of these unneeded visits, it would lead to a net savings of $18.68 in total allowed costs per health plan member each year, the study finds. This could total to a possible savings of $461 million annually.

“Inappropriate use of emergency department services has become a major source of health care system waste,” said John Azzolini, MPH, MBA, director of practice leadership at Truven Health Analytics.

“Conventional wisdom has previously suggested that this issue was confined to the Medicaid, Medicare and uninsured populations, but our new research shows that the privately insured population’s use of the ER is avoidable approximately three-quarters of the time.

"This is important data to consider as we start to evaluate the effective use of health care resources under the (Affordable Care Act).”

After analyzing patient demographics, regions and clinical conditions, the study found that female respondents are 17 percent more likely to make a trip to the ER than male respondents.

Female respondents also make nonemergency visits more frequently.

Among all demographics, infant respondents are most likely to visit the ER with no emergencies at 82 percent, and respondents between the ages of 60 and 64 are the least likely at 67 percent. Respondents most often visit the ER for nonemergency situations for joint disorders, atopic dermatitis and other soft tissue diseases.

Originally published on BenefitsPro.com
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