Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease

In this new health care environment, there is a lot of discussion about frequent Emergency Department (ED) visits and reducing hospital readmissions. A recent study published in Health Affairs presents some findings that are counter-intuitive.  Though the findings are drawn from only one state’s Medicaid system, it is important to consider these results alongside studies in other states and the nation.

Frequent ED users are often assumed to be persons with co-occurring behavioral health conditions such as mental illness and substance abuse. And that may still be true in many cases. However, a recent Health Affairs article, Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease, finds that these “behavioral health conditions are responsible for a small share of ED visits by frequent ED users, and that ED use accounts for a small portion of these patientstotal Medicaid costs.”

Based on the multi-year New York City Medicaid data used in the study, frequent ED users are responsible for a fairly large share of all ED visits by Medicaid recipients. However, ED use accounts for a small share these patients’ total Medicaid costs. This would suggest that the frequent ED users are utilizing other health care services.  In fact, the study found that the frequent ED users did have fairly strong linkages to primary and specialty care outside the hospital.

Not surprisingly, the study finds that frequent ED users are quite sick and have a high prevalence of chronic disease.  The repeat ED users examined in this study did have a high prevalence of substance use and mental illness.  However, these users visited the ED for reasons other than substance use and mental illness; in fact visits due to these conditions represented a fairly small portion of their ED visits overall.

Based on these findings of high chronic disease prevalence and linkages to primary care, there is an opportunity to improve treatment of these patients in the primary care setting. The study authors suggest interventions that focus on increased care management and coordination may result in better health outcomes and reduced costs.

This study is important for behavioral health and primary care providers, particularly those who take Medicaid and also treat patients with chronic disease. Community behavioral health providers and primary care providers should consider whether these results also exist with their patient population.  If so, these results will be important tools to use in when working with policy makers, stakeholders, community partners, and funders.

To read the Health Affairs article, click here.

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