Report says 6 percent of patients account for $148M in ER spending

About 6,600 people in the state accounted for $148 million in hospital emergency department spending in 2016, or about 6 percent of total patients that year.

This group, called superutilizers, visited hospital emergency rooms numerous times in 2016, according to a report from the Alaska Department of Health and Social Services Division of Public Health. Among all patients, 1,216 visited 10 or more times each, and 6,651 visited five or more times. Eight patients visited emergency departments 50 times or more in a single year, and 95 of them had 25 or more visits, according to the report.

That includes both private insurance companies and patients on public insurance such as Medicare or Medicaid. The statistics are based on the total charges reported by the hospitals to the state through the Health Facilities Data Reporting program.

Emergency room visits are notoriously expensive and vary widely based on the condition treated. In total, hospitals charged approximately $621.6 million for 204,880 visits in 2016, coming out to an average charge of $3,033.85 per visit. However, the vast majority of those charges went to less than 10 percent of the users.

“Individuals who use the ED frequently contribute disproportionately to total charges,” the report states.

The state only has two years of data, for 2015 and 2016, as 2015 was the first mandatory year for reporting, so it’s hard to track long-term trends so far, said DHSS spokesman Clinton Bennett in an email. The state didn’t have any specific goals in compiling the data, he said.

“This analysis was produced for general informational purposes, to better understand who most uses Emergency Department services and why,” he said. “Any interested entity could then possibly make informed changes in their process.”

The most frequent diagnoses for the top 1.1 percent of emergency department visitors were alcohol-related disorders, abdominal and pelvic pain, pain in the throat and chest, back pain, unclassified pain, joint disorders, nausea and vomiting and anxiety disorders, according to the report. Medicaid was by far the most dominant type of insurance among the most common users, with about 53.9 percent of the top 1.1 percent of users on Medicaid. Medicare was the next highest at 18.4 percent, according to the report.

Anchorage is the most frequent location for both general emergency visits and for superutilizers, correlated to Anchorage being the population center for the state as well as the largest hospitals. However, a data error may have led to a slight undercounting, according to the report.

“Because one major facility in the Mat-Su region did not report a unique patient identifier, repeat visits cannot be identified and superutilizers from this region are likely undercounted,” the report states.

The trend of superutilization has received attention nationally after the term was coined in the early 2010s to refer to patients to utilize significantly more health care dollars than the average. In 2012, about 5 percent of patients accounted for 50 percent of Medicaid spending nationally, according to a 2015 report from the U.S. Government Accountability Office. Multiple other states have instituted programs to try to coordinate emergency department data to reduce usage and improve treatment, such as the University of Florida Health, which saw a 25 percent reduction in superutilizer hospitalizations after instituting a specialized clinic to treat them.

Alaska’s hospitals are starting to link together and coordinate information to do the same. The Alaska State Hospital and Nursing Home Association launched a collaborate project with the Alaska chapter of the American College of Emergency Physicians in 2017 to coordinate care better both to reduce overutilization and to help track prescriptions amid the ongoing opioid crisis in the state.

Most of the hospitals on the railbelt are already signed onto the system, which connects emergency department data between hospitals to keep both primary care physcians and emergency room physicians better informed about a patient’s background, said Becky Hultberg, the executive director of the Alaska State Hospital and Nursing Home Association. All the hospitals on the Kenai Peninsula are online with the project, she said.

“Emergency room physicians feel very strongly about the need for this project because it is improves quality of care — it gives them better information,” she said. “The goal is really better patient care.”

Emergency room physicians can feel like they are treating patients in a vacuum — when people come in, the physicians may not have any idea what medications they are taking at home or what their medical histories may be. It’s often the case with patients who live off the road system and come into Fairbanks or Anchorage to use hospitals, Hultberg said. The idea is to connect primary care physicians and emergency department doctors so they have more complete pictures of patients to improve care, she said.

“The states of Washington and Oregon are also live on this system and it is really becoming a regional if not a national network,” she said.

One of the challenges to quantifying how successful the project is, though, is in isolating its effect from other projects going on. The coordinators haven’t established any clear success metrics yet, Hultberg said.

“It’s a little bit difficult to identify the data,” she said. “There are also a number of other projects that are using the reducing of utilization of ED as their metric.”

Reach Elizabeth Earl at elizabeth.earl@peninsulaclarion.com.

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