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.