Most “Avoidable” ER Visits Really Aren’t, Say the Docs

There’s a common belief that “avoidable” emergency room visits are a major driver of high health care costs. Some new research sheds light on this phenomenon.
The American College of Emergency Physicians says that only 3.3% of all visits to emergency departments are classified as “avoidable,” according to a study published in the International Journal for Quality in Health Care.

“We found that many of the common conditions of ‘avoidable’ emergency department visits involved mental health and dental problems, which ERs are generally ill-equipped to treat,” said lead study author Renee Hsia, MD, MSc, of the Department of Emergency Medicine at the University of California, San Francisco.

“This suggests a lack of access to health care rather than intentional inappropriate use is driving many of these ‘avoidable’ visits. These patients come to the ER because they need help and literally have no place else to go.”

The study analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for years 2005 to 2011, examining ‘avoidable’ emergency department visits, defined as visits where patients did not require any diagnostic or screening services, procedures, or medications, and were discharged home.

Findings showed that among ‘avoidable’ ER visits, patients were most commonly discharged with alcohol-, mood-, or dental-related conditions.

The study results indicated that 10.4% of visits by patients diagnosed with alcohol-related disorders, 16.9% for mood-related disorders and 4.9% for dental-related conditions were ‘avoidable.’

These findings showed that while alcohol-, mood-, and dental-related conditions were the most common ‘avoidable’ ER visit discharge diagnoses, the majority of patients with these conditions still required some form of diagnostic or treatment service.

“Despite a relentless campaign by the insurance industry to mislead policymakers and the public into believing that many ER visits are avoidable, the facts say otherwise,” said Becky Parker, MD, FACEP, the president of the American College of Emergency Physicians. “Most patients who are in the emergency department belong there and insurers should cover those visits. The myths about ‘unnecessary’ ER visits are just that myths.”

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education.

We can draw two immediate conclusions from these findings:

The first is that the American College of Emergency Physicians is likely to believe that most ER visits are necessary, and should be covered by insurance. They are somewhat biased in this regard. Fair enough.

But the bigger, more troubling conclusion one draws from this report is that “avoidable” ER visits become unavoidable in a country where such things as mental health and drug addiction get so little coverage to begin with.

This is one more example of why our health care systems need fixing.

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