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Truven Health Analytics Study Finds Most Emergency Room Visits Made by Privately-Insured Patients Are Avoidable

Just 29 percent of ER patients required emergency attention

Ann Arbor, MI, Apr. 25, 2013 — It's not just the uninsured who use the emergency room for non-urgent healthcare. According to a new study from Truven Health Analytics™, formerly the Healthcare business of Thomson Reuters, 71 percent of emergency room visits made by patients with employer-sponsored insurance coverage are for causes that do not require immediate attention in the emergency room, or are preventable with proper outpatient care.

The study, Avoidable Emergency Department Usage Analysis, examined insurance claims data for over 6.5 million emergency room visits made by commercially insured individuals, under age 65, in calendar year 2010. It found that just 29 percent of patients required immediate attention in the emergency room.

Twenty-four percent did not require immediate attention, 41 percent received care that could have safely been provided in a primary care setting, and 6 percent received care that would have been preventable or avoidable with proper primary care. The analysis surmises that diverting just 10 percent of these unnecessary visits to an office setting would result in a net savings of $18.68 in total allowed costs per health plan member, per year. Based on the 24 million enrollees represented in the Truven Health MarketScan® databases, this represents a total potential savings of $461 million each year.

“Inappropriate use of emergency department services has become a major source of healthcare system aste, ” said John Azzolini, MPH, MBA, director of practice leadership at Truven Health Analytics. “Conventional wisdom has previously suggested that this issue was confined to the Medicaid, Medicare and uninsured populations, but our new research shows that the privately-insured population’s use of the ER is avoidable approximately three quarters of the time. This is important data to consider as we start to evaluate the effective use of healthcare resources under the ACA.”

The study also broke down findings by patient demographics, region, and clinical condition. Women were found to be 17 percent more likely to visit the emergency room than males, and have a higher number of non-emergency visits. Infants younger than 12-months old were found to have the highest percentage of non-emergency visits (82 percent), while patients between 60-64 years old had the lowest (67 percent). The top three non-emergent diagnoses were joint disorders, atopic dermatitis, and other soft tissue diseases.

“Hospital administrators have faced enormous challenges managing the use of their emergency departments because, historically, it has been very difficult to identify and categorize these visits, ” said Mike Boswood, president and CEO of Truven Health Analytics. “Thanks to the robust, detailed claims data in our MarketScan® databases, our team was able to fully categorize these visits, delivering more than just a wakeup call about the full scope of inappropriate ER use, but also a blueprint for how to measure the problem and start the process of correcting it.”

The Truven Health MarketScan Research Databases, which contain de-identified healthcare claims data reflecting the real-world medical care of over 170 million unique patients across the U.S. since 1995, were used to conduct this analysis. The methodology used to determine emergent and non-emergent care was based on an algorithm originally developed in 2000 by researchers from the NYU Center for Health and Public Services Research and the United Hospital Fund of New York. The algorithm was then updated by Truven Health Analytics in 2012 to reflect changes in diagnosis coding.

To read the complete study, follow this link: http://interest.truvenhealth.com/forms/EMP-201209-AvoidableERUsageAnalysisRB

About Truven Health Analytics, part of the IBM Watson Health Business

Truven Health Analytics®, part of the IBM Watson Health™ business, provides market-leading performance improvement solutions built on data integrity, advanced analytics and domain expertise. For more than 40 years, our insights and solutions have been providing hospitals and clinicians, employers and health plans, state and federal government agencies, life sciences companies and policymakers, the facts they need to make confident decisions that directly affect the health and well-being of people and organizations in the US and around the world. The company was acquired by IBM in 2016 to help form a new business, Watson Health. Watson Health aspires to improve lives and give hope by delivering innovation to address the world’s most pressing health challenges through data and cognitive insights.

Truven Health Analytics owns some of the most trusted brands in healthcare, such as MarketScan®, 100 Top Hospitals®, Advantage Suite®, Micromedex®, Simpler® and ActionOI®. Truven Health has its principal offices in Ann Arbor, MI, Chicago, IL, and Denver, CO.


Brian Erni
For Truven Health Analytics
J. Roderick, Inc. Public Relations