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The Definitive Guide to Emergency Department Operational Improvement
Published in Jody Crane, Chuck Noon, The Definitive Guide to Emergency Department Operational Improvement, 2019
Unfortunately, the data published by the CDC in 2014 does not ring true with what we are seeing in the real world. Specifically, we are seeing lower and decreasing percentages of ESI 4 and 5 patients. The typical ED has between 20% and 35% ESI 4 and 5, with the range between 10% and 40%. With the evolution of alternative sites of care, namely urgent care centers, free-standing EDs (FSEDs) and retail clinics, and increasing ED visit co-pays and deductibles, we expect to see continued downward trends in the percentage of low-acuity patients seeking care in the emergency department. An admission rate of 21% implies that 79% of ED patients are discharged. There has been much debate recently in literature on the actual percent of ED visits that are avoidable, ranging from 3.3% in one study to 71% in another study6. While this topic is more political than operational, the reality is that, although many ED visits may be technically avoidable, lack of access and the layperson’s understanding of disease processes makes intervention unlikely without significant malpractice reform and substantive changes in primary care access and EMTALA. The recent trends in retrospective insurance denials are nothing more than financial penalties to patients that are ultimately passed on to providers and which ultimately jeopardize patient care due to the potential to deter patients with possibly life-threatening conditions from seeking emergency care (Figure 1.2).7
Longitudinal patterns of employee high-deductible health plan choices
Published in IISE Transactions on Healthcare Systems Engineering, 2019
Shan Xie, Qing Ye, Bhagyashree Katare, Denny Yu, Yuehwern Yih
We evaluated risk segmentation based on the employees’ health status as measured by Charlson comorbidity score and health spending. Total spending was calculated using the allowed amount, which includes payment made by both the individual and the employer. We grouped spending into four categories using place of service indicator from the claims data: (1) spending on outpatient services, including services received at physician office, independent clinic, independent laboratory or hospital outpatient department; (2) spending on urgent care, including services received at emergency department (ED), urgent care facility and ambulatory care setting; (3) spending related to inpatient admission; and (4) spending on pharmacy prescriptions. The difference in spending between employees enrolled in HDHPs and PPOs was estimated using linear regression, controlled for health status. We also compared prior-year spending with current-year spending for each employee to evaluate the impact of plan benefit change on health care utilization. The significance of the difference was estimated using the paired t-test. Spending was log transformed to adjust skewness.