Study shows parallels among emergency care facility options

Press Release (Baylor School of Medicine):

In the search for acute care, there are three options available to patients: freestanding emergency departments (EDs), hospital-based emergency departments and urgent care centers. A recent study conducted by researchers affiliated with Baylor College of Medicine examines the utilization, price per visit and types of care delivered by each of these options. The study appears in the Annals of Emergency Medicine.

Analyzing Blue Cross Blue Shield of Texas insurance claims from 2012-2015, the research team, including Drs. Cedric Dark and George Shelton of Baylor College of Medicine, looked at patient visits to freestanding EDs, hospital-based EDs and urgent care centers in 16 metropolitan areas in Texas, making up 84.1% of the state’s population. From these data, the team calculated the aggregate number of visits, average price per visit, percentage of cost attributable to facility and physician services and the percentage of the cost billed to Blue Cross Blue Shield of Texas as well as out of pocket costs for patients. The top 20 diagnoses and procedures by facility type are compared in the study.

“These findings are significant for both patients who find themselves in need of immediate care, as well as for the overall health care system,” said research co-author Vivian Ho, professor of health services research at Baylor, chair in health economics at Rice’s Baker Institute for Public Policy, and director of the institute’s Center for Health and Biosciences. “Many patients mistakenly think that freestanding emergency departments and urgent care clinics are similar, because they are often conveniently located in neighborhood shopping centers with modest storefronts.”

“While many Texans choose hospital-based EDs or urgent care centers, we have seen an increase in patient visits to freestanding EDs. So what economic, accessibility and quality factors are patients considering when making this decision?” said Dark, an assistant professor of emergency medicine at Baylor.

Making comparisons

A freestanding ED is structurally separate and distinct from a hospital. The study found that use of freestanding EDs increased 236 percent from 2012 to 2015, and its costs of services gradually increased to be comparable to those seen in hospital-based EDs.

“The appeal of freestanding EDs lies in the wait time – patients are seen relatively quickly compared to a hospital-based ED, and they are receiving a comparable quality of care and range of services a hospital ED is capable of, for roughly the same cost,” said Dark.

The highest costs per visit were seen at emergency departments, which Dark says is largely attributed to the facility fees incurred by both hospital-based and freestanding EDs in order to stay open 24 hours a day, to see every patient that walks through its doors, and to provide access to emergency trained physicians and nurses.

“EDs have to be prepared for any possible scenario, and their physicians are trained in emergency medicine specifically, providing highly specialized care,” Dark said. “The symptoms a patient presents with, such as general abdominal pain, may not be indicative of the final diagnosis. An ER doctor can consider those symptoms together, have access to various pieces of equipment to do the necessary workup, and can make those complicated diagnoses.”

The study shows urgent care centers have the lowest costs per visit. Compared to an average visit price of $168 at an urgent care center, the cost for care at a freestanding emergency room was $2,199 and $2,259 at a hospital-based ER. “The lower costs at urgent care centers is appealing to patients, but the range of diagnostic solutions is far more limited. Additionally, these are often staffed by physicians assistants, nurse practitioners or primary care physicians as opposed to emergency medicine doctors, which changes the type of care the patient is receiving,” Dark said.

“Hospital-based emergency departments must, and typically do, care for trauma patients, uninsured patients, and in some cases, patients who are generally sicker. The cost of this care is factored into the payments negotiated to allow these hospitals to remain fiscally sound and continue to provide the legally mandated emergency care for all patients regardless of ability-to-pay,” said Shelton, assistant professor at Baylor.

Overall, the study found that Texans are visiting freestanding EDs more frequently, even though the costs are comparable to those in hospital-based EDs for the same workup and services. Urgent care centers might be able to offload minor emergencies and indicate the need to increase the efficiency of emergency facility use.

Geospatial analysis of emergency department visits for targeting community-based responses to the opioid epidemic

From PLoS:

The opioid epidemic in the United States carries significant morbidity and mortality and requires a coordinated response among emergency providers, outpatient providers, public health departments, and communities. Anecdotally, providers across the spectrum of care at Massachusetts General Hospital (MGH) in Boston, MA have noticed that Charlestown, a community in northeast Boston, has been particularly impacted by the opioid epidemic and needs both emergency and longer-term resources. We hypothesized that geospatial analysis of the home addresses of patients presenting to the MGH emergency department (ED) with opioid-related emergencies might identify “hot spots” of opioid-related healthcare needs within Charlestown that could then be targeted for further investigation and resource deployment. Here, we present a geospatial analysis at the United States census tract level of the home addresses of all patients who presented to the MGH ED for opioid-related emergency visits between 7/1/2012 and 6/30/2015, including 191 visits from 100 addresses in Charlestown, MA. Among the six census tracts that comprise Charlestown, we find a 9.5-fold difference in opioid-related ED visits, with 45% of all opioid-related visits from Charlestown originating in tract 040401. The signal from this census tract remains strong after adjusting for population differences between census tracts, and while this tract is one of the higher utilizing census tracts in Charlestown of the MGH ED for all cause visits, it also has a 2.9-fold higher rate of opioid-related visits than the remainder of Charlestown. Identifying this hot spot of opioid-related emergency needs within Charlestown may help re-distribute existing resources efficiently, empower community and ED-based physicians to advocate for their patients, and serve as a catalyst for partnerships between MGH and local community groups. More broadly, this analysis demonstrates that EDs can use geospatial analysis to address the emergency and longer-term health needs of the communities they are designed to serve.

Dangerous Drug Carfentanil Blamed in 5 Minnesota Overdoses

From US News:

Minnesota authorities said Thursday that the dangerous drug carfentanil is to blame for five recent overdose deaths in the state, and could be a factor in up to five additional cases where confirmation is pending.

The confirmed overdoses represent the first known carfentanil deaths in Minnesota, said Andrew Baker, chief Hennepin County Medical Examiner. The five overdoses happened from Jan. 30 through Feb. 17 in Minneapolis, Apple Valley and Faribault, and the victims ranged in age from 23 years old to 43 years old.

Walgreens works to help curb opioid epidemic

From Reuters:

The drugstore chain Walgreens is taking a three-pronged approach to combat the public health crisis stemming from prescription opioids, according to a team of pharmacists and other clinicians from the company.

In the Journal of the American Pharmacists Association, they report that Walgreens pharmacies have expanded access to naloxone, a drug that can block the effects of opioid painkillers such as hydrocodone and oxycodone and thereby prevent overdose deaths from respiratory failure.

In addition, the chain installed medication-disposal kiosks in 500 of its 8,200 U.S. stores to make it easier for Americans to empty their medicine cabinets of unused pharmaceuticals that might otherwise fall into the hands of substance abusers.

Walgreens also has employed pharmacists and students to educate and counsel patients and caregivers about opioid overdoses and naloxone.