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Charges for emergency room visits often based on incorrect assumptions
Date:3/20/2013

Visits to the ER are not always for true medical emergencies and some policymakers have been fighting the problem by denying or limiting payments if the patient's diagnosis upon discharge is for "nonemergency" conditions.

Now a new UC San Francisco study challenges that framework by showing that criteria used as a basis to determine the appropriateness of an emergency room visit and to deny payment is inherently flawed. The study analyzed nearly 35,000 visits to hospital emergency departments around the country.

The research is published online today in JAMA (Journal of the American Medical Association).

Overuse of the ER for nonemergency visits is often touted as a costly problem in the United States. The new study highlights the complexity of the issue by showing that using discharge diagnoses to determine the validity of an ER visit could have serious implications, including dissuading patients from using the ER when they really need it. While many patients are given a diagnosis upon discharge that their condition was treatable through primary care, other similar patients actually required immediate emergency care or to be admitted to the hospital, the researchers found.

The authors conclude that strategies aimed at narrowly reducing use of the emergency room are unlikely to improve a community's general health or to lower health system costs.

"This study highlights the flaws of a system that fails to distinguish between information available at arrival in the emergency department and information available at discharge," said lead author Maria C. Raven, MD, MPH, a UCSF assistant clinical professor of emergency medicine. "Attempting to discourage patients from using the ER based on the likelihood that they would have nonemergency diagnoses risks sending away patients who require emergency care. The majority of Medicaid patients, who stand to be disproportionately affected by such policies, visi
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Contact: Elizabeth Fernandez
elizabeth.fernandez@ucsf.edu
415-502-6397
University of California - San Francisco
Source:Eurekalert  

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Charges for emergency room visits often based on incorrect assumptions
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