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

t the ER for urgent or more serious problems."

Policymakers often contend that nonemergency or preventable visits comprise a large proportion of emergency room visits, the authors say. To reduce ER use for non-serious conditions, policymakers have proposed denying payment if the patient's diagnosis upon discharge appears to reflect a nonemergency condition.

Legislation or regulations to deny or limit payment based on discharge diagnosis for nonemergency ER visits by Medicaid enrollees has been considered or enacted in Tennessee, Iowa, New Hampshire and Illinois. Other states, including Arizona, Oregon, Illinois, Iowa, Nebraska, North Carolina and New Mexico, recently have implemented or considered implementing some level of copayment required for nonemergency use of the ER. And Washington recently garnered attention for a proposal in which payment would be based only on discharge diagnosis and whether the patient is hospitalized instead of weighing other clinical information.

For this approach to be successful, "it would be necessary to predict discharge diagnosis based on information before the patient is seen in the emergency department," the authors write.

For patients who end up with diagnoses that are classified as non-serious, the authors sought to determine how often other patients with the same symptoms are diagnosed with serious conditions. Data were drawn from the 2009 National Hospital Ambulatory Medical Care Survey conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics.

For each visit with a discharge diagnosis classified as "primary care-treatable," the authors identified the patient's chief complaint upon arriving at the ER.

Of the nearly 35,000 ER visits in the study, an estimated 6 percent are primary care-treatable, yet the presenting complaints that represent those diagnoses the symptoms that these patients come in with comprise nearly 89 percen
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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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