Short Takes On News & Events

Docs Say Concerns About ER ‘Frequent Flyer’ Use Are Overblown

By Ankita Rao

October 10th, 2012, 8:59 AM

When Mitt Romney advised uninsured Americans to head to the emergency room for care, analysts were quick to point out the burden of high ER costs and the danger of abusing a safety net system.

But emergency departments only account for 2 percent of health care spending, according to research presented by the American College of Emergency Physicians, a proportion they say reflects good value for the acute care delivered to 50 percent of the patients at hospitals.

In a news conference on Tuesday, the organization sought to debunk the idea that “frequent flyers,” or patients who used the ER repeatedly, were taking advantage of a costly system. Instead, it advanced multiple research studies to show that the worries about staggering emergency rooms costs and patient dependency were overstated. The studies were conducted by different research teams and employed varying measures of how many visits constituted a frequent flyer.

“This is a group that’s often targeted for cost reduction in the health care system,” said Dr. Robert O’Connor, a study author, and chair of University Of Virginia’s Department Of Emergency Medicine.

The research indicated that most frequent users, defined here as people who visit the emergency department two or more times within six months, are poor, chronically ill and live near the hospital. O’Connor said their concerns were the same as the general ER-visiting population: heart problems, breathing difficulties and mental health issues.

Emergency room visits varied with location, according to the statewide studies included in the ACEP presentation. In Massachusetts, a state with high rates of Medicaid, Medicare and subsidized insurance coverage, frequent flyers  — defined as patients who visited the ER five or more times — represented 2.1 percent of ER patients and 11.5 percent of total ER visits.

Meanwhile, in Virginia, where government coverage is less expansive, frequent flyers, defined as patients who went to the ER two or more times over six months, comprised 19.7 of all patients and 39.7 of total visits.

Author Dr. Andy Sama, president of ACEP and an ER doctor in Manhasset, N.Y., said that while the perception of emergency care costs was distorted, the roots of chronic illness and health issues needed to be addressed. Mental health crises, including drug addiction, often drove repeated ER use, because other facilities like urgent care clinics did not have a qualified staff of psychiatrists and therapists to address those concerns.

“It’s hard to access a doctor’s office or clinic under Medicare and Medicaid,” he said. “I think the real issue is how quickly we can create better infrastructure.”

ACEP authors also pointed out that more patients were seeking out innovative ways to receive care for unexpected health concerns, often in retail clinics and urgent care centers.

Rand Corporation analyst and physician Ateev Mehrotra, who co-authored a separate study about retail clinics, said the health care system could save $4.4 billion if  health concerns were addressed at a clinic rather than a hospital ER when appropriate.

He said education and access were the keys to improving efficiency in acute care, and that few patients would intentionally endure the often expensive and time-consuming experience of emergency rooms when another option was available.

“I think it’s dangerous to attack patients for this problem,” he said. “Lack of alternatives are the key driver.”

3 Responses to “Docs Say Concerns About ER ‘Frequent Flyer’ Use Are Overblown”

  1. samson p. says:

    Here’s your typical hospital administrator…

    http://www.youtube.com/watch?v=NO04VXBIS0M

  2. The flaws in this report are concerning. The term “frequent flyer” was developed for a reason, and there is sufficient statistical analysis to show that it is these few patients who are responsible for, when combined, a high amount of ER expenses. The type and location of hospitals cited for this research is also material. As the referenced article on “hotspotting” by Atul Gawande’s indicates, there are serious patterns in urban areas that need to be addressed. Finally, the long length of ER wait times is one of the unintended consequence of such frequent use. ER overuse is a serious concern and better methods of triage and access are needed.

  3. sfchris says:

    the ED docs are not a “disinterested party” here – contract groups make their money from the # and type of pts seen so of course they do not view “frequent flyers” as a problem. Over use of EDs is a SERIOUS problem in the US and not just because of the cost of care ……
    - overcrowding is a safety issue; presents staffing problems; leads to care being given in hallways; creates ethical problems; pts/payors charged for “in-pt care” when what they are given is hallway care
    - ED pts create higher use of diagnostic tests including expensive imaging
    - ED staff is more expensive because of the certifications and mandatory education that must be provided [vs urgent care staff or primary care staff]
    - payors deny ED charges routinely after care has been delivered leaving the patient to deal with these very expensive services and co-pays can now be in the $100-500 range for a single ED visit
    finally….there is no professionally accepted definition of what # of ED visits per patient constitutes a “FF” – is is 2x the average ? 3 or more ? an ED I was associated with was stunned to discover that 75 individuals accounted for over 25% of our TOTAL emergency visits for the year we studied. And you would be shocked to learn how many charges this amounted to and how little was compensated by 3rd party or gov’t programs. So how does it get paid for ? The hospital tries to recover the $$ and when that fails as it usually does it is written off as “charity care” — and next year the charges are increased across the board to compensate for that!

    So why on earth would we encourage patients to use EDs for anything other that EMERGENCY care and urgent care when those centers are closed. The answer here of course is to vastly improve the primary care system in the US and work like crazy to ensure that our EDs are used appropriately.

    I bet Mitt never sat for 6 hours in an ED waiting for his laceration to be repaired because the ED was too crowed with non-ED patients to accommodate him.

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