Reducing unnecessary emergency department (ED) visits should be a goal of all primary care and specialty practices. Vytalize considers “unnecessary” ED visits as those that could have been handled in a different setting as well as visits that could have been avoided through more appropriate preventive or chronic care.
At Vytalize, we use the New York University Emergency Department Algorithm (NYU EDA) to define unnecessary or avoidable ED visits. Unnecessary ED visits burden the healthcare system as they are costly and consume resources that other individuals with more acute needs may require. Among Medicare beneficiaries, unnecessary ED visits can also result in unnecessary hospitalizations.
Availability and Access to Primary Care
Ensure 24/7 access to your clinical staff. It is important to educate your Medicare patients to call you first when the issue is not an emergency. Reinforcing the importance of calling before going to the ED and making sure to follow up with you if they do go are important talking points and should be emphasized at every visit, as patients are unaware. Commonly, patients do not know what options are available to them after hours and during the weekend.
It is also important to ensure adequate access during regular hours. This means providing same-day or next-day access to a consistent provider or care team when needed for urgent care or transition management. Maintaining appointment slots for same-day urgent care and follow-up after either an ED or inpatient stay will help you be successful in transitions of care.
Proactive Steps to Prevent Unnecessary ED Visit
To proactively address the issue of unnecessary ED utilization, a practice can take steps to better understand its patient population, and anticipate and address reasons patients may go to the emergency room. For non-emergent issues, the most common reasons relate to access: lack of a strong relationship with a primary care provider or care team, lack of after-hours or timely access to a provider, or barriers to access, such as transportation.
For other ED visits deemed avoidable, the reasons may be more complex, including inadequate chronic care management or gaps in care coordination among multiple locations of care.
ED Frequent Utilizers
Identifying patients who are already, or potentially, high utilizers of the ED is a good place to start. This is often a small group, and understanding why they use the ED will have the biggest and most immediate impact on unnecessary utilization.
It is important to learn how best to assess risk factors, such as poorly controlled chronic medical or behavioral health issues, or social determinants such as unemployment, housing insecurity, or others.
Follow-Up after the ED: Reactive Care
Timely follow-up after an exacerbation is one of the claims-based quality measures for REACH ACOs. There is evidence that seeing patients in their primary care practice after an ED visit could reduce costs and impact mortality. A large study by Lin et al showed that ambulatory follow-up was associated with a higher risk of subsequent hospitalization, but a lower risk of 30-day mortality.
In our efforts to decrease the total cost of care, your attention to avoidable ED visits in 2024 will be critical. To be successful, you will need to educate your patients on when they should use the ED, ensure you and the care team are available 24/7, evaluate your list of patients who frequent the ED, and make a plan to engage them differently.
To learn more about reducing ED visits, contact Vytalize today!
