America’s hospital emergency rooms are overcrowded with patients who may be better served in doctors’ offices or other clinic settings, according to a national study of insured emergency patients conducted by the
Blue Cross and Blue Shield Foundation on Health Care and the Schneider Institute for Health Policy at
Brandeis University.
The study, which examined PPO claims data over a three-year period from 2.2 million Americans insured under a single large national account in all 50 states, found that patients with selected ambulatory care sensitive conditions (ACSC) had significantly higher emergency department (ED) utilization – as much as 2 to 3 times higher -- including repeat visits and consequent higher overall healthcare costs. ACSCs were defined in the study as high volume conditions such as congestive heart failure, pneumonia, chronic obstructive pulmonary disease, asthma, hypertension and diabetes that have a demonstrated relationship to avoidable hospitalizations.
The study is the first of its kind to look at claims data for ED services. Previous studies have been based on hospital surveys that focused on such factors as the availability of physicians and nurses and the number of beds. “Because the privately insured account for more than half of the recent growth in emergency department utilization, there may be ways to address the problem upstream and not just focus on the supply side,” said Blue Cross and Blue Shield Association Chief Medical Officer Allan Korn, M.D. “This new study provides a balance in understanding supply and demand issues and also sheds an important light on potential areas where insurers and physicians can work together to provide better patient care in more appropriate and less costly settings.”
Other key findings of the study: