Decline in use of emergency rooms slows; costs continue to rise

Although the rate of decline in emergency room (ER) use has slowed while the costs keep climbing, UnitedHealthcare and its clients have a variety of promising efforts underway to help reduce inappropriate ER use and control ER costs.

ER use was down 1.4 percent in 2017, which is not as sharp as the declines in 2015 and 2016, according to a new analysis of ER data for UnitedHealthcare National Accounts. A robust decline in ER use earlier in the year was offset by an upward spike in ER use during the last quarter, likely due to the unusually intense flu season.

ER use and trends have been a key focus area for UnitedHealthcare and despite the slowdown, ER use continues to decline among our members in large part due to efforts to help clients communicate with the employees about choosing an appropriate site of care.

UnitedHealthcare clients have found that targeted communications to encourage members to shift from the ER to more appropriate facilities are an effective tactic in helping reduce inappropriate ER visits. Here are 3 examples:

  • A retailer looking to reduce ER usage among members who took their children to the ER every other month or more sent mailings to them with a map to the nearest urgent care to home. Following the mailing, ER use fell by 50 percent while urgent care use increased by 67 percent for the population receiving the mailer, while during the same period there was a 14 percent increase in ER visits among those who didn’t get the mailer.
  • A heavy equipment manufacturer found high use of the ER was a becoming a cost concern, so it send mailings that showed appropriate care settings to the homes of members with 2 or more visits to the ER in the past year. As a result, ER visits were down 59 percent those who got the mailing.
  • A pharmaceutical company saw a spike in ER claims was coming from repeated use by the same people, so 2 mailers were sent: one to households with one ER visit in the past year; another for those with 2 or more visits. Following the mailings, there was a 63 percent drop in ER visits as well as a 3 percent increase in primary care visits and a 69 percent increase in convenience care clinic visits.

Overall, consumer awareness activities to reduce ER visits are up from 1.9 million in Jan. 2018 to 2.8 million in April 2018, as more National Accounts groups have opted into receiving the monthly awareness emails. In addition, communications strategies, such as campaigns like Check-Choose-Go, have reduced ER visits by helping members to make informed choices. In 2017, there were 179 custom ER Care setting projects launched among 62 National Account clients resulting in some significant reductions in ER use; the average savings of each redirected ER visit was $1,479.

Meanwhile, costs per ER visit were up 5.9 percent in 2017, likely due to the increased coding resulting in more Level 4 and 5 ER visits – codes used for patients with complex, resource-intensive conditions. Our data showed several examples in which essentially the same condition was treated the same way, yet the visit was upcoded one or two levels, resulting in about $1,000 in higher chargers per visit. A 50 percent rise in use of Level 4 and 5 codes from 2007 to 2016 has added more than $1.5 billion to the country’s overall health care costs, costing members from hundreds to several thousand dollars per visit.

UnitedHealthcare has a number of efforts underway to help keep costs down by ensuring accurate coding among providers:

  • Rolled out nationwide in March a new policy in which it will review and adjust facility claims for the most severe and costly ED visits if they didn't justify a high-level code. The program uses the Optum Emergency Department Claim (EDC) Analyzer tool, which bases appropriate E/M coding the patient’s presenting problem, what diagnostic services were performed and associated patient co-morbidities. 
  • Introduced an out-of-network shared savings program enhanced (SSPE) to help reduce costs for certain services provided by non-contracted providers while helping reduce member financial impacts of non-discretionary non-contracted use.
  • Supported state legislation in Texas and Colorado to ensure consumers are more aware of the costs that could face them from freestanding emergency rooms. The bills require the facilities to provide consumers with a list of fees and the costs of treating common conditions.

In the long-run, these efforts to encourage appropriate ER use and accurate coding will help us make more effective use our health care resources while also helping our members receive the right care at the right time and in the right place.

Other findings from the ER data analysis include:

  • Geography: Florida markets have higher ER utilization and a high proportion of avoidable use, while California, New York and New Jersey have lower ER usage and stronger indicators of appropriateness.
  • Income: ER use declines as income level increases up to $150,000, when potentially avoidable use increases.
  • Age: ER use was highest among 18- to 25-year-olds, likely due to the flu. Potentially avoidable use is highest among children age 12 and younger.
  • Virtual visits: There were nearly 90,000 total Amwell + Doctor on Demand visits in the first quarter of 2018, about 2.6 times higher than the 34,000 visits in the same quarter in 2017.

For more information, please contact your UnitedHealthcare representative.

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Disclaimer: Results shown may vary based on customer specifics and are not a guarantee of future results.