To cut costs, focus on avoidable admissions: researchers

To maximize cost savings, hospitals and health systems should focus on reducing avoidable patient admissions to the hospital from the emergency department rather than on preventing nonurgent emergency department visits, a group of Massachusetts researchers says.

In a commentary posted on the Annals of Emergency Medicine website (PDF), researchers with Boston's Beth Israel Deaconess Medical Center and Harvard Medical School argue that more money can be saved by reducing the number of patients admitted to the hospital from the ED because there are no other good care options for them at the time or because a patient's complex chronic conditions were not treated properly. The researchers estimated that minor injuries and illnesses accounted for 12% to 40% of ED visits but only 0.4% to 1.6% of overall healthcare expenses, so even reducing these visits by 50% would result in savings of less than 1% of costs. On the other hand, patients with intermediate or complex conditions account for 31% to 57% of all ED visits.

Noting that ED referrals now account for 50% of hospital admissions, which then generate 15% of total healthcare expenses, the authors estimate that 10% of these expenses are the result of patients who visit the ED with intermediate or complex conditions. So, they argue, reducing these types of admissions by 10% to 25% could, in turn, reduce overall costs by 1% to 2.5%

"Visits of intermediate severity, including exacerbation of chronic disease and acute presentations of complex medical illness, have the most potential for substantial cost savings, mainly through reduced admissions yet also to a lesser degree from streamlined ED evaluations," the authors wrote in the commentary.

To accomplish this, the healthcare system should better manage patients who have chronic disease such as congestive heart failure; expand the use of ED observation units for patients with a defined diagnosis and expected short-time stays; have emergency physicians work with case managers and community-based services; and improve collaboration between the emergency and primary-care teams, according to the authors.

"Central to this are robust health information technology systems, vital to improving care coordination through facilitating communication and providing greater information by which emergency physicians can make crucial decisions about testing and disposition of complex patients," the authors wrote.

They add that payment reform also is needed, as the current system rewards the increase of low-acuity ED volume while not adequately reimbursing emergency medicine's role in maintaining capacity for disasters or pandemics.