Emergency department visits rose, but misuse fell in 2016
Emergency department visits increased by nearly 10 million patients in 2016 compared to the previous year, according to new data from the Centers for Disease Control and Prevention. The total of 145.6 million visits is the highest number in recent memory.
While the total number of visits increased, those who used EDs for regular care decreased. The percentage of emergency patients with nonurgent medical symptoms dropped from 5.5% in 2015 to 4.3% in 2016. Wait times also fell. Nearly 40% of ED patients had wait times of less than 15 minutes and 72% waited less than an hour.
The CDC found that illness is a more common ED visit than injury. Stomach aches (8.6% of visits) were the most common condition. Heart disease was the leading reason for hospitalization from the ED.
Culling the use of the pricey emergency rooms for nonurgent care has been a longstanding goal of hospitals.
Progress on that front helps wait times, lets emergency physicians focus on the urgent patients and reduces overall healthcare costs as patients receive care in the most appropriate locations. That's a positive for health systems, providers, patients and payers.
The American College of Emergency Physicians celebrated the report's numbers. EDs play a critical role in healthcare, as nearly two-thirds of emergency visits happen after doctors' offices are closed, Vidor Friedman, president of the organization, said in a statement.
"Emergency care is growing more complex and some of the larger trends that will impact emergency department planning and resource discussions include the rising number of elderly patients, preventing and treating opioid abuse and the role of the emergency department in treating and managing patients with mental illness," Friedman said.
Payers have increasingly tried to nudge patients away from EDs except for emergency care. Instead, they want patients to get care from primary care physicians, urgent care centers or retail clinics. Those locations have less overhead, which means lower costs.
One payer aggressive with such efforts is Anthem, which implemented policies to push patients away from hospital EDs and imaging centers. Instead, Anthem wants patients to use other less-expensive care locations, such as imaging centers, urgent care centers and physicians' offices. It's not only hospital EDs that have higher costs. A UnitedHealth Group study earlier this year found that freestanding EDs are far more expensive than a doctors' office or urgent care center.
Anthem's ED policies could result in patients getting surprise bills if the payer decides the symptoms didn't warrant an emergency visit. Hospitalizations that start in the ED can lead to a surprise bill if the emergency physicians aren't in the hospital's network.
The Health Care Cost Institute recently found that 12% of in-network admission claims include an out-of-network professional claim that can result in a surprise bill. Another recent analysis by USC-Brookings Schaeffer Initiative for Health Policy showed that about one in five ED visits included an out-of-network provider.
Policymakers in Washington are working on the issue. CMS recently said it will require Affordable Care Act plans to report denial reasons, including out-of-network, referral or prior authorization needed and services not covered. There's also bipartisan backing in Congress to cap out-of-network charges to 125% of the average amount payers pay in the surrounding geographic area. During a hearing on the subject last week, lawmakers from both parties said they want to ban surprise billing and put more consumer protections in place.
Hospitals and providers, however, have pushed back strongly against any fixed rates or payment bundling.