Discharge Diagnoses Do Not Identify “Non-Emergency” ER Visits
WASHINGTON, March 19, 2013 /PRNewswire-USNewswire/ — The small number of emergency patients who are ultimately discharged with “primary care treatable” diagnoses come to the ER with the same symptoms as other patients who need immediate or emergency care, hospital admission or surgery, according to a study to be published tomorrow in the Journal of the American Medical Association (JAMA). The American College of Emergency Physicians (ACEP) has actively opposed the growing practice by insurance carriers – including Medicaid – of denying payment for so-called “non-emergency” visits is likely to discourage patients with true emergencies from seeking care in the emergency department.
“Two patients could come to the emergency department with the same symptoms: one could be diagnosed with a condition that is not that serious, while another could be diagnosed with a life-threatening condition,” said lead study author Maria Raven, MD, MPH, FACEP. “Currently, there is no possible way to determine the outcome of the visit in advance, and our study has shown that it’s not good policy to do so after the fact. Insurance companies should not treat these two patients differently. Patients should never be burdened with the task of diagnosing themselves out of fear that their potential emergency isn’t covered by insurance.”
Dr. Raven and her team applied the NYU Emergency Department Algorithm (“Billings algorithm”) which is commonly used to identify “non-emergency” ER visits, to nationally representative emergency department visit data from the Centers for Disease Control and Prevention (CDC) for the purpose of identifying all visits with “primary care treatable” diagnoses. Although only 6.3 percent of emergency department visits were determined to have “primary care treatable” discharge diagnoses based on the algorithm, the chief complaints reported for these visits were the same chief complaints as those reported for 88.7 percent of all other emergency visits, and a substantial portion of these visits required immediate emergency care or hospital admission. These findings suggest that these “primary care treatable” discharge diagnoses are unable to accurately identify non-emergency ER visits.
“If a triage nurse were to redirect patients away from the ER based on non-emergency complaints, 93 percent of the redirected ER visits would not have had primary care-treatable diagnoses,” said Dr. Raven. “The results call into question reimbursement policies that deny or limit payment based on discharge diagnosis. The majority of Medicaid patients, who stand to be disproportionately affected by such policies, visit the emergency department for urgent or more serious problems.”
The American College of Emergency Physicians (ACEP) is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
SOURCE American College of Emergency Physicians (ACEP)