NEW YORK (MainStreet) — For many Americans, a visit to the emergency room is a necessity when a particular ailment is a matter of life or death. Yet in instances when the health issue is not life-threatening, the decision of an ER doctor to admit a patient for an overnight stay can be a costly one. In fact, those overnight hospital stays can rack up costs in the tens of thousands of dollars per patient and may make people think twice about submitting to a sleepover after an ER visit.
That's all the more true, because the price tag is arbitrary. A new study released by the University of Michigan and published in a September issue of Health Affairs found that overnight admittance rates from ER visits can vary greatly by hospital. In particular, one hospital may be as be as much as six times as likely to admit an emergency patient with a common and non-fatal health condition than another hospital that is treating a patient with an identical diagnosis and symptoms.
The study concluded this variation in treatment can cost consumers, insurers and government agencies an extra $5 billion dollars a year.
"Our data reveal widely varying decision-making about hospitalization for patients who come to the emergency department with symptoms such as chest pain, asthma flare-ups, an infected wound or a urinary tract infection," Keith Kocher, M.D., MPH, senior author of the study and an assistant professor of emergency medicine at the University of Michigan Medical School, said in a press release. "This suggests tremendous opportunity for care improvement and cost reduction, and even the chance to turn [the emergency department] into a workshop for new forms of care coordination and alternatives to acute hospitalization for such patients."
Specifically, Kocher believes identifying ways to streamline the decision-making process in ER departments so that there is less variation in admittances could yield huge savings to the companies and government agencies that often have to pick up the tab for hospital stays. Considering hospital admittance decisions from ER visits are made an average of 350,000 times a day across the U.S., this would require a formally organized effort.
To come to their findings, Kocher and team analyzed national data on the 28.5 million emergency visits that occurred in 961 hospitals in 2010. The adults in these cases suffered from 15 different common conditions and had different insurance plans. Overall, patients were admitted for a hospital stay approximately 15% of the time – with an average cost of nearly $35,000 per admittance.
Meanwhile, patients who visited the ER with a life-threatening condition such as a heart attack or kidney failure tended to be admitted for hospital stays with little variation in rates. Yet, for those patients who presented chest pain but did not have a heart attack, their likelihood of being admitted varied widely. Patients with chest pain who visited the ER at hospitals with the highest rates of admissions were 6.55 times more likely to be hospitalized than patients treated at hospitals with lower overall admission rates.
Variation in admittance rates was smaller for patients with soft tissue infections or asthma attacks. But still, some hospitals were three times more likely to admit these cases than others. And for those patients seeking ER treatment for emphysema, chronic bronchitis or a urinary tract infection, the admittance rate was twice as likely in some hospitals as compared to others. All five of these conditions had very low in-hospital death rates when patients were admitted, with only a 0.05% death rate among chest pain patients.
The total spending for ER patients admitted for hospital says for all 15 conditions was found to likely exceed $266 billion a year, with hospitals probably paying close $80 billion once insurers such as Medicaid or Medicare covered their portion. However, around 18% of patients in the study were uninsured, leaving the bulk of pay to hospitals and government overhead.
"Finding ways to determine which patients with less-serious emergency symptoms have the highest risk of dying or serious complications, and therefore the most need for hospitalization, should be a priority as we seek to make the best decisions about emergency admissions and individualized care," says University of Washington faculty member Amber Sabbatini, M.D., MPH, who is also an emergency physician.
--Written by Laura Kiesel for MainStreet