Assesses emergency department (ED) utilization among commercial (18 and older) and Medicare (18 and older) health plan members. Plans report observed rates of ED use and a predicted rate of ED use based on the health of the member population. The observed rate and expected rate is used to calculate a calibrated observed-to-expected ratio that assesses whether plans had more, the same or less emergency department visits than expected, while accounting for incremental improvements across all plans over time. The observed-to-expected ratio is multiplied by the emergency department visit rate across all health plans to produce a risk-standardized rate which allows for national comparison.
Why It Matters
ED visits are a high-intensity service and a cost burden on the health care system, as well as on patients. Some ED events may be attributed to preventable or treatable conditions. A high rate of ED utilization may indicate poor care management, inadequate access to care or poor patient choices, resulting in ED visits that could be prevented.1,2 Plans can ensure that members receive appropriate, coordinated primary care to address preventable ED visits.
Emergency Department Utilization Total Rate
|Year||Commerical HMO||Commercial PPO||Medicare HMO||Medicare PPO|
*Lower rates signify better performance.
- Dowd, B., M. Karmarker, T. Swenson, et al. 2014. “Emergency department utilization as a measure of physician performance.” American Journal of Medical Quality 29 (2), 135–43. http://ajm.sagepub.com/content/29/2/135.long
- Agency for Healthcare Research and Quality. 2015. Measures of Care Coordination: Preventable Emergency Department Visits. Accessed at https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/carecoordination/measure2.html