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‘Avoidable’ ER Visits Fuel Health Care Costs

Emergency Room
Two-thirds of 27 million emergency department visits by patients with private insurance each year are "avoidable," a new analysis finds.

THE STAGGERING AMOUNT of money the U.S. spends on health care each year – expected to reach about $6 trillion by 2027 – is being driven in part by patients who get treatment in hospital emergency departments with problems a primary care doctor likely could solve, according to a data analysis released Monday by UnitedHealth Group.

And while the poor and uninsured may be unable to afford or without access to a primary care doctor, the analysis by the health insurer of its own data and claims found that of 27 million emergency department visits annually by patients with private insurance, two-thirds are "avoidable" and "not an actual emergency." The average cost of such visits for common conditions that could have been remedied through primary care tops $2,000.

The problem: an inconvenient and perhaps outdated primary care delivery system that's not always open or accessible when people need immediate treatment.

"The high number of avoidable hospital ED visits is neither a surprise nor a new problem," says a statement from UnitedHealth Group, headquartered in Minnesota. "Uneven access to timely, consumer-friendly, and convenient primary care options is a longstanding problem, and there is a need to bolster and expand primary care capacity through urgent care centers, physician offices, and nurse practitioners."

According to the analysis of UHG data, privately insured patients show up 18 million times in hospital emergency departments each year in visits that aren't necessary, adding $32 billion a year to national health care costs. Noncritical conditions treated often in EDs include bronchitis, cough, flu, nausea, sore throat, strep throat and upper respiratory infection.

"The average cost of treating common primary care treatable conditions at a hospital ED is $2,032," the analysis says, which is "12 times higher than visiting a physician office ($167) and 10 times higher than traveling to an urgent care center ($193)" for help with those same issues.

The upcharge is partially due to "hospital facility fees, which increase the cost of an average hospital ED visit by $1,069, and lab, pathology, and radiology services, which average $335 at a hospital ED – 10 times more costly than at a physician office ($31)."

Unless the primary care delivery system changes – doctors' offices offer extended, nighttime or weekend hours, or more urgent care clinics open – the problem won't improve, UnitedHealth Group officials say. The nation also needs more medical school graduates to go into general practice, the officials say.

In the meantime, absent better options, health care "consumers will continue to visit EDs for primary-care treatable conditions," the UnitedHealth Group statement says.

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