News: Unnecessary ED visits from chronically ill patients cost $8.3 billion, study says

CDI Strategies - Volume 13, Issue 7

About 30% of ED visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional healthcare costs, according to a new report from Premier.

The report found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017, ModernHealthcare reported. About a third of those visits (roughly 4.3 million) were likely preventable and could be treated in the outpatient setting.

The six conditions Premier based their report should seem familiar to CDI professionals. Premier chose these six because they are often cited in the academic literature as the most common and costly conditions in the healthcare system, according to ModernHealthcare:

  • Asthma
  • Chronic obstructive pulmonary disease
  • Diabetes
  • Heart failure
  • Hypertension
  • Behavioral health conditions (such as mental health or substance abuse issues)

To reach their conclusions, Premier identified the hospitals with the lowest ED admission rates by condition, and calculated how many visits at the remaining hospitals could be prevented if all hospitals achieved those rates.

Then, to arrive at the $8.3 billion in costs, Premier used the average cost for an ED visit estimated by the Health Care Cost Institute, which is $1,917, ModernHealthcare reported.

The report’s findings are in line with other research on patients with chronic diseases. The evidence points to the fact that chronic disease patients are more likely to use the ED and get admitted to hospitals because they experience poor care coordination.

Editor’s note: To read ModernHealthcare’s coverage of this story, click here. To read the report from Premier, click here. To learn more about chronic condition documentation, click here, or join ACDIS for a webinar on the topic of hierarchical condition categories on April 4.

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Clinical & Coding, News, Outpatient CDI