Frequent Emergency Department Users Enrolled in New Hampshire Medicaid

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Frequent Emergency Department Users Enrolled in
New Hampshire Medicaid

• Presentation to the New Hampshire CHIS Users
  Group Meeting, December 9, 2008

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Frequent ED User Study Goals

• Prior NH CHIS Outpatient ED Study
• Medicaid 4.4 times higher than CHIS commercial
• Frequent Outpatient ED User Study
• NH Medicaid ED users with 4 or more outpatient ED
  visits during CY2006
• Age, gender, eligibility group, Health Analysis
  Area, household income (Federal Poverty Level)
• Evaluate diagnoses, NH CHIS selected diagnoses
• Outpatient ED, office-clinic, inpatient ED,
  payments
• Evaluate primary care access and preventive
  visits
• Time between visits

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NH Medicaid Outpatient ED Use
Trend not reported due to small numbers
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Frequent Outpatient ED Users, CY2006
Outpatient ED visits do not include ED visits
resulting in hospitalization. Total payments for
37,105 outpatient ED visits was 7.8 million,
average210 per outpatient ED visit. Payments
for 54,287 visits 12.1 million, average 222.
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Frequent Outpatient ED User Prevalence, CY2006
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Leading Causes of Frequent ED User Outpatient ED
Use
Total Outpatient ED Visits 37,105
Grouping of diagnoses based ICD-9-CM Clinical
Classification Software (CCS) from Agency for
Healthcare Research and Quality (AHRQ). The
Healthcare Cost and Utilization Project.
http//www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs
.jspdownload
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Frequent ED User Cohort Leading ICD-9, CY2006
Office-clinic visit codes used for this study do
not include dental visit codes. Office-clinic
visit codes do not include psychotherapy codes.
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Selected Non-Urgent/Primary Care Treatable
Diagnoses Age-standardized rates of utilization
per 1,000 members. NH Medicaid-only, CY2006
Selected conditions accounted for 10,826 (29) of
the 37,105 ED visits of frequent users
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Access to Primary Care Practitioner and
Preventive Visits Age-standardized rates. NH
Medicaid-only, CY2006
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Prevalence Rate of Frequent ED Users, CY2006
3,855 frequent ED users were female and 1,902
frequent ED users were male. When
pregnancy-related and other gender-specific
diagnoses Were removed rates for adult females
remained 10 percent higher than adult males.
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Frequent ED User Time to Second Visit, CY2006
Grouping of diagnoses based ICD-9-CM Clinical
Classification Software (CCS) from Agency for
Healthcare Research and Quality (AHRQ). The
Healthcare Cost and Utilization Project.
http//www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs
.jspdownload
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Association Between Poverty Level and the
Likelihood of Being a Frequent ED User, CY2006
Among 67,566 average members with less than 100
FPL, 4,624 (6.8) were frequent ED users. Among
38,502 average members with 100 of higher FPL,
1,133 (2.9) were frequent ED users.
Replacement of the access to primary care
measure with total office-clinic visits in the
model yielded similar results.
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(No Transcript)
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Frequent ED User Conclusions

• Frequent ED users were prevalent and contributed
  to a large proportion of NH Medicaid outpatient
  ED use
• Adults accounted for a higher prevalence than
  children
• Within Medicaid poverty level was associated with
  increased likelihood of being a frequent ED use
• A significant amount of use for frequent ED users
  is for conditions for which primary care office
  or clinic setting is more appropriate
• Frequent ED users were more likely to visit a
  primary care practitioner but often do not have
  preventive visits. Any preventive visit reduced
  the likelihood of being a frequent ED user
• Frequent ED users often return to the ED within a
  short period of time and often for the same
  diagnostic condition
• Incorporation of an illness risk grouper (e.g.
  CRGs) in future evaluations is recommended