Lab Soft News: Possible Way to Avoid Some Unnecessary Visits to Emergency Departments

I recently encountered an article that quantifies the resources expended by unnecessary patient visits to emergency departments (EDs) (see: Diverting avoidable emergency department visits could save healthcare $32 billion annually). Many such visits could have achieved the same results and less expensively in a physician's office. Below is an excerpt from the article:

Diverting avoidable emergency department visits could save healthcare $32 billion annually. Primary care services rendered by hospital EDs come with substantially higher price tags than in primary care settings. Avoidable visits to emergency departments are among the major factors contributing to rising healthcare costs. Of the roughly 27 million annual ED visits by privately insured patients, about two thirds are avoidable....Part of the problem is that primary care services rendered by hospital EDs come with substantially higher price tags than in primary care settings. In fact, the average cost of treating 10 common treatable conditions at a hospital ED is $2,032, which is more than $1,800 higher than in primary care situations. The ED cost is 12 times higher than at a physician's office ($167) and 10 times higher than at an urgent care center ($193). The 10 treatable conditions examined in the brief were bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection....

Higher costs at hospital EDs are partially driven by a couple of different factors. For one, there are hospital facility fees (see: CMS Requires Hospitals to Post Prices for Medicare Patients; Useful Step?), which increase the cost of an average ED visit by $1,069. Then there are lab, pathology and radiology services, which average $335 at an ED. That's about 10 times more costly than at a physician office, where the same services average about $31. The money adds up. Of the 27 million annual hospital ED visits by privately insured patients in the U.S., 18 million were deemed avoidable, meaning those patients can be treated safely and effectively in high-quality, low-cost primary care settings. When those 18 million avoidable ED visits are multiplied by an estimated $1,800 cost reduction per visit, that translates to a $32 billion annual savings opportunity if care is diverted to a primary care setting.

Looking at the ten treatable conditions cited in the article above that drive ED visits (bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection), most are relatively non-specific. I was wondering whether it would be possible for CMS, or perhaps even a large health insurance company, to make freely available on the web a clinical decision support (CDS) program that could assist consumers in evaluating the criticality of their symptoms and avoid unnecessary ED visits. Such software would, of course, be developed with consumers in mind as the end users and would display an appropriate warning statement that it was not providing medical advice.

As one example of a condition that results in ED visits, headaches are rarely caused by a brain tumor. However, headache as a chief complaint in an ED might result in an expensive workup (see: Headache: Could It Be a Brain Tumor?). A CDS program oriented to healthcare consumers might be designed to guide a person with a persistent headache through the following "neurologic read flags" listed below that would suggest that a headache might actually be the result of a more serious condition. Absent any of them, the individual could take an aspirin and call it a day.