Analysis: Most ER Visits from Privately Insured are Avoidable

A Truven Health Analytics study of more than 6.5 million emergency department visits of privately insured patients finds only 29 percent of them required immediate attention.


A Truven Health Analytics study of more than 6.5 million emergency department visits of privately insured patients finds only 29 percent of them required immediate attention.

Twenty-four percent did not require immediate attention, 41 percent came for care that could have been provided in a primary care setting, and 6 percent received care that would have been preventable or avoidable with proper primary care, according to the vendor.

Truven Health estimates that diverting 10 percent of the unnecessary visits to an office setting would bring a net savings to insurers of $18.68 in allowed costs per plan member per year.

Counting the 24 million plan enrollees in Truven’s databases, potential annual savings could have hit $461 million. Other findings from the analysis:

* Women are 17 percent more likely to visit the ER than males,

* Infants young than 12 months had the highest percentage of non-emergency visits (82 percent) with patients aged 60-64 having the lowest percentage (67), and

* The top non-emergency diagnoses were joint disorders, atopic dermatitis and other soft tissue diseases.

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