Emergency Room Trip Prevention

Visits to the emergency room can be exhausting, both physically and financially. Did you know that approximately 71% of emergency room visits made by insured patients aren’t for causes that require immediate attention? In truth, only 29% of patients require immediate care in an emergency room.

Those 71% of patients who don’t need immediate care could have prevented their ailments with proper outpatient care. Of all of those who visit emergency rooms, 24% didn’t require immediate medical care, 41% received care that easily could have been provided at an urgent care clinic, and 6% of visits could have been prevented with proper medical care.

If a mere 10% of these emergency room visits were diverted, it would result in a net savings of $18.68 in total allowed costs per health plan member per year. When the 24 million people represented in Truven Health Marketscan data were taken into consideration, they represented a total potential savings of almost $461 million annually.

Overall, women were found to be 17% more likely to visit the emergency room than men, and also to have a higher number of non-emergency room visits. Infants under 12 months old had the highest percentage of non-emergency medical visits, at 82%, and patients between the ages 60 and 64 had the lowest percentage of non-emergency visits, at 67%.

One of the biggest issues with the high number of emergency room visits was that patients weren’t aware of what constituted a non-emergency situation. The top three non-emergency diagnoses given by emergency room doctors were joint disorders, atopic dermatitis, and other soft tissue diseases.

A Milliman study found a nearly 10% increase in the allowed per member per month costs for ER visits between 2007 and 2011. The increase was substantially higher than the inflation rate during that same time period.

The best way to decrease emergency room spending is to invest in proper preventative care and to support urgent care locations.

emergency room prevention