Variation in admission rates from EDs raises eyebrows
"High-mortality/low-variation diagnoses like sepsis and MI provide little opportunity to realize meaningful spending reductions. Instead, the Big-5 high-variation/low-mortality conditions represent the greatest source of potential savings," Dr. Kocher said.
The ED could become "a workshop for developing innovative strategies for care coordination and alternatives to acute hospitalization, particularly around a select group of high-variation/low-mortality conditions" with the goal of reducing health costs, he said.
If EDs with high risk-standardized admission rates above the median reduced admissions for the five high-variation/low-mortality conditions to the median rate, it would save an estimated $16.9 billion in charges and $5.1 billion in costs per year.Another option might be to set incentives to induce EDs with high-risk–standardized admission rates in the top quartile to reduce admissions to the 75th percentile; the resulting saving would be $7 billion less in charges and $2.1 billion less in costs per year.
Incentivizing top quartile and bottom quartile EDs to meet the median rate would yield an estimated $2.8 billion reduction in charges and a $0.8 billion decrease in costs per year.
The in-hospital mortality implications of moving admission rates toward the median are not known, Dr. Kocher acknowledged. "We’re not implying that we know the optimal rate of admission. In fact, it probably varies from condition to condition."
Further, a formal economic analysis of net expenditures would need to incorporate the increased outpatient expenditures of shifting care to ambulatory settings, he said.
The study was supported by AHRQ. Dr. Kocher reported having no financial conflicts.
