Unnecessary ED Visits from Chronically Ill Costs $8.3 Billion Annually

October 8, 2019

Medicare will cut payments to 2,583 hospitals by anywhere from 0.01 percent to the maximum of 3 percent for excessive readmissions.

Orb Health

About 30% of emergency department visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional costs for the industry, according to a new analysis.

The report, released Thursday, found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017; out of that 60%, about a third of those visits—or 4.3 million—were likely preventable and could be treated in a less expensive outpatient setting.

You can read the whole story here.

This is why a highly effective and Medicare reimbursed Chronic Care Management program is critical and Collaborative Virtual Care is a great way to extend care capacity as virtual service to meet the growing demand of the chronically ill.  By increasing care capacity and extending care between office visits without requiring additional staff, office space, or out of pocket expenses, emergency utilization dramatically drops (54% reduction in one ACO at a Florida FQHC) as seen in this 2019 Orb health study.  Since approximately 23% of ED visits result in a hospital admission, a dramatic drop in admissions is seen with the reduction in ED utilization as a result.  A scalable CCM program will dramatically reduce the waste that is seen in this space and help with value-based incentives from CMS in the process.