Reducing non-urgent ER visits will yield little to no savings for health care system

Reducing non-urgent visits to emergency departments – a growing focus of both private and public insurance plans – will yield little to no savings for the health care system, according to a paper published online yesterday in Annals of Emergency Medicine ("A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department") http://bit.ly/LSncb9.

"The focus on non-urgent ER visits distracts from the potential savings that do exist in the area of hospital admissions," said lead study author Peter Smulowitz, MD, FACEP, of Beth Israel Deaconess Medical Center in Boston, Mass.  "Emergency department patients are responsible for about half of all hospital admissions, and those admissions account for about 15 percent of all health care expenses. Many patients are admitted to the hospital from the ER either because the gaps in the rest of the health care system leave patients without other good care options, or because a fragmented system has failed to care for their complex chronic disease."

Dividing emergency department visits into three categories – emergencies, intermediate/complex conditions and minor injuries/illnesses – researchers assessed the potential cost savings for each. 

For minor injuries and illnesses, the potential cost savings were between 0.25 percent and 0.8 percent of health care costs, part of which would be offset by the additional cost of establishing new urgent care centers or adding after-hours or weekend primary care availability.

For emergencies, there were no available cost savings as they require care using the expensive resources available in the emergency department. 

However, for intermediate/complex conditions, the potential savings amounted to a maximum of 2.5 percent of all health care spending, which Dr. Smulowitz attributed mostly to reduced hospital admissions. The expanded use of observation units in emergency departments offers one opportunity to reduce costs by reducing hospital admissions.  Collaboration between emergency physicians, case managers and community based services could also allow for patients to be cared for at home or in short-term facilities rather than being hospitalized because of a lack of safe alternative options.

"In an atmosphere of cost-cutting, policymakers still need to re-think how we pay for emergency care," said Dr. Smulowitz.  "The current system doesn't support the standby costs mandated by federal law for 24-hour-a-day readiness to handle car crashes, heart attacks and pandemics.  True payment reform would be most effective if allowed for reimbrsement adequate to fund the emergency medical care system so it is ready for anything at any time, which is surely for the public good."