To Lower Healthcare Costs, Lower ED Visits

July 30, 2019

New study shows that billions may be wasted on unnecessary ED visits.

Two-thirds of hospital emergency department (ED) visits annually by privately insured individuals in the U.S-18 out of 27 million-are avoidable, according to a new study.

The study, “The High Cost of Avoidable Hospital Emergency Department Visits,” from UnitedHealth Group, underscores the challenges that exist for patients in accessing healthcare services, lowering costs, improving quality, and simplifying the patient’s experience.

“This research underscores that the high price of emergency care makes health care more expensive for patients.  Patients need more convenient and practical access to primary care providers. This will help lower costs, improve outcomes and simplify the patient experience.”,” says L.D. Platt, vice president, external affairs communications.

According to the research, the hospital ED cost is:

  • 12 times higher than at a physician office ($167)

  • 10 times higher than at an urgent care center ($193)

The 18 million avoidable hospital ED visits add $32 billion in costs to the healthcare system each year, according to the report.

Currently, nearly one-in-five residents (62 million individuals) live in an area with a shortage of primary care providers. The U.S. is projected to experience a shortage of up to 120,000 physicians by 2030, which includes a shortfall of between 20,000 and 55,000 primary care physicians, according to the report.

According to the report, advanced care practitioners (ACPs), nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs), are providing effective primary care and demonstrating equal or better outcomes than physicians for certain clinical and patient experience measures.

According to UnitedHealth Group “Broader deployment of ACPs in primary care will improve patient outcomes and the care experience, and increase efficient use of health care resources.”.

Related: Top 10 States for Hospital Safety

Ten common primary-care-treatable conditions frequently treated at EDs include:

  • Bronchitis

  • Cough

  • Dizziness

  • Flu

  • Headache

  • Low-back pain

  • Nausea

  • Sore throat

  • Strep throat

  • Upper respiratory infection

The average cost of treating those 10 conditions at a hospital ED is $2,032, more than $1,800 higher than in primary care settings.  

“Increasing primary care capacity, and making primary care options more available and accessible to consumers beyond normal business hours, will help consumers avoid unnecessary and costly visits to hospital EDs,” Platt says.

Specifically, UnitedHealth Group points to solutions that would increase the primary care workforce size and in turn advance high-quality, affordable, and convenient healthcare, including:

  • Increasing ACP workforce capabilities
  • Eliminate scope of-practice barriers for NPs and enact uniform Nurse Practice Acts to expand the reach of NPs into primary care settings.

  • Revise State Medicaid regulations to recognize NPs as primary care providers in managed care networks.

  • Expand Medicare and Medicaid reimbursement for telehealth and recognize telehealth as a standard delivery modality for ACPs.

  • Incentivize increased utilization of urgent care centers and retail health clinics that leverage ACPs.

  • Enabling opportunities for ACP workforce development

  • Increase federal financial support for an additional 3,000 new ACP residency positions each year over the next five years.

  • Provide Federal education grants to increase nursing faculty in select geographies to address local workforce shortages.

  • Incentivize the creation of ACP “Ambulatory Care” clinical rotations to advance teaching in lower cost settings of care.

  • Provide Federal funding to ambulatory care facilities and Federally Qualified Health Centers (FQHCs) that create clinical rotation programs for ACPs in primary care and behavioral health.