Costs associated with frequent use of emergency medical services
In 2012, 59,629 visits were made to the Emergency Department (ED) at our institution by 38,213 patients. Included in these are 1,242 patients who visited the ED five or more times (Frequent Patients or FP’s). FPs comprised 3.25% of ED patients, but accounted for 17% of ED visits and 13.7% of total hospital costs. Comparing FPs and non-FPs, FPs had higher rates of chronic disease and substance abuse, reflected in a higher mean age-adjusted Charlson severity score (3.62 vs 1.62, p<0.0001), as well as higher 1-year mortality (9.0% vs 4.0%; p<0.001). Though sicker by chronic disease metrics, visit acuity did not differ significantly between FPs and non-FPs (p=0.4714); both groups were discharged from the ED approximately 70% of the time. Despite similar acuity and ED disposition, FPs arrived far more often via ambulance (68% of visits vs. 29% of visits; p<0.0001) and accounted for 18.1% of the 17,779 total transports. The expense of emergency services and transport is often not reflected in hospital cost estimates, a frequently measured endpoint. We estimated prehospital costs using 2012 Medicare Reimbursement Schedules to be $2.5-$3.2 million for the FP group. Hospital costs attributable to FPs were $29.1 million, including $5.4 million in ED costs, bringing the total emergency services associated cost to $31.6-32.3 million, or approximately $25,000 per patient. Programs that reduce frequent ED use can have a disproportionately favorable cost benefit to health systems and may potentially provide more appropriate care for the FP population.
Provision of health care to the public
Public health or related public policy
Public health or related research
Identify factors associated with frequent emergency department use.
Discuss overall cost associated with the population of patients designated as frequent patients.
Formulate a plan for utilization of health services by frequent patients.
Keyword(s): Health Care Delivery, Emergency Medical Services
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I am a Fourth year medical student at the University of Virginia and have been an active member of Albemarle County Fire/EMS for four years. I have Master's of Science in Biomedical Sciences from Virginia Tech and have co-authored several peer-reviewed articles while working at the University of Virginia in basic science research. My current research interests include health system design and management.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.